Page 4 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

Short-term Results of Laparoscopic TAPP Inguinal Hernioplasty
successful reconstruction of the inguinal floor. Then, Table 2: Comparative data of various studies
in the late 20th century, the tension-free repair, intro- Duration Return to
duced by Irving Lichtenstein, caused a dramatic drop in Study of surgery Complication work Recurrence
8,9
recurrence rates and became the procedure of choice. Hamaza et 77.4 min. 25.0% 14.87 days 4%
18
al
However, the introduction of a laparoscopic technique in Leibl et al 19 66.0 min.
the early 1990s started a new debate over the best method Felix et al 20 0.78% 16 days
of inguinal hernia repair. Master of 10.7% 2%
Recurrence is the most important indicator of the surgery
success of a hernia procedure, which may occur in 15% Swanstorm 92 min. 2%
21
of the cases or more. The frequency of hernia recur- et al 60.0 min. 0.00% 14.63 0%
Our study
rence depends on many factors including the type of
hernia repair, the comorbidities of the patient, and the
experience of operating surgeon itself. Cochrane Data-
base Systematic Review (2003) reported 86 recurrences the rate of recurrence of surgeons who had performed
among 3,138 patients who underwent laparoscopic fewer repairs.
repair and 109 among 3,504 patients who underwent Surgeons who have performed a high volume of
open repair. 10,11 A separate meta-analysis published in hernia operations appear to have better results in terms
the British Journal of Surgery in 2000 reported similar of recurrence and operation time. Cochrane Database
findings in that overall recurrences did not differ Systematic Review in 2003 demonstrated that the duration
12
between the laparoscopic and open groups. There is, of operation was longer in the laparoscopic groups with
however, some evidence in the literature demonstrating mean difference 14.81 minutes. An article published in the
increased recurrences with laparoscopic repair. Neu- British Journal of Surgery described a similar increase of
17
13
mayer et al, in a randomized controlled study, found 15.2 minutes with laparoscopic inguinal hernia repair.
that laparoscopic repair resulted in significantly more With regard to operation length, most evidence in the
recurrences at 2 years (10.1 vs 4.9%) and was associated literature points to a shorter operation duration with
with more complications (39 vs 33.4%) including life- open repair (Table 2) 18-21 .
threatening complications (1.1 vs 0.1%). Surgeons who Postoperative pain is an important consideration
have performed a high volume of hernia operations when choosing between laparoscopic and open repair of
13
appear to have better results. In an article published inguinal hernias. Laparoscopic repair has been associated
in the Lancet, all seven hernia recurrences occurred in with less postoperative pain than open repair. Cochrane
the laparoscopic group, while there were no recurrences Database Systematic Review (2003) demonstrated less
14
in the open repair group (1.9 vs 0.0%). The largest persisting pain (overall 290/2,101 vs 459/2,399), and
reviews of inguinal hernia repairs suggest no apparent incidences of numbness were less (overall 102/1,419 vs
217/1,624) in the laparoscopic groups. Similarly, another
difference in recurrence between laparoscopic and open meta-analysis study from the EU Hernia Trialists Col-
mesh methods of hernia repair. However, there are some laboration reported decreased postoperative pain with
evidences in the literature demonstrating increased the employment of laparoscopic methods. Bignell et al
22
23
recurrences with laparoscopic repair. In 2004, Neumayer reported a similar higher incidence in chronic groin pain
13
et al. found in a randomized, controlled study that in open vs laparoscopic inguinal hernia repair. However,
laparoscopic repair resulted in significantly more recur- the decrease in chronic groin pain with laparoscopic
rences at 2 years (10.1 vs 4.9%) and was associated with repair reported in this study did not translate into a
more complications (39 vs 33.4%) including more life- significant improvement in the quality of life.
threatening complications (1.1 vs 0.1%). In another study Another variable, i.e., used as a primary outcome in
published in the Lancet, all seven hernia recurrences numerous studies comparing laparoscopic and open
occurred in the laparoscopic group, while there were techniques is time to return to work. There is a consensus
no recurrences in the open repair group. When treating in the literature that patients who undergo laparoscopic
recurrent hernias laparoscopic repair of inguinal hernias inguinal hernia repair return to work and normal activi-
was found to have a similar recurrence to open repair ties earlier than those with open repair. An earlier return
(10.0 vs 14.1%). 15,16 The laparoscopic approach to inguinal to work and resumption of normal activity is associated
hernia repair is also associated with a steeper learning with an earlier discharge from the hospital and fewer
curve, probably due to the increased complexity and postoperative complications, both of which are associated
technical difficulty of the surgery. Surgeons who had with laparoscopic hernia repair. Liem et al reported that
performed more than 250 laparoscopic repairs had half patients following laparoscopic inguinal hernia repair
World Journal of Laparoscopic Surgery, September-December 2017;10(3):83-86 85