Laparoscopic Totally Extraperitoneal Hernia Repairs: a Case Series Analysis

Abstract

Traditionally, inguinal hernias have been treated with open Lichtenstein hernioplasty. But in the last 2 decades, the trends have changed with the introduction of laparoscopic inguinal hernia repair techniques mainly by totally extraperitoneal herniorrhaphy. This was a case series analysis of 160 consecutive patients who underwent totally extraperitoneal repair and were included accrual between January 2015 and August 2018 in our single tertiary center. Patient demographics, details of the surgery, postoperative Visual Analogue Scale, return time to work, early and late postoperative complications, recurrence, and chronic pain were evaluated. A hundred seventy-eight repairs were performed in the study cohort (median age, 46.3 years; range, 22–84 years; men, 93%). The mean follow-up was 15 months (range = 12–30). Mean hospital stay time was 22.6 h (range 15–27). The mean surgery time was 55 min (range 35–110). Second day postoperative mean Visual Analogue Scale was 2.3 (range 1–5). The mean return time to their routine work was 8.3 days (range 5–17). Seroma (10%), scrotal pain (9%), scrotal paresthesia (6%), and hydrocele (6%) were the most commonly noted complications. Recurrence was detected in 4 (2.5%) patients. Recurrences were noted at 1st week and 6th month following surgery. Chronic groin pain was reported by 4 (2.5%) patients. Totally extraperitoneal hernia repair has become increasingly applicable among surgeons due to less postoperative pain, short return time to routine work, acceptably few complications, and recurrence rates compared with the other inguinal herniorrhaphy techniques.

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References

  1. 1.

    Patchayappan M, Narayanan SN, Duraisamy N (2015) Three stitch hernioplasty: a novel technique for beginners. Avicenna J Med 5(4):106–109

    Article  Google Scholar 

  2. 2.

    Scheuermann U, Niebisch S, Lyros O, Jansen-Winkeln B, Gockel I (2017) Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair - a systematic review and meta-analysis of randomized controlled trials. BMC Surg 17(1):55

    Article  Google Scholar 

  3. 3.

    McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7(1):26–28

    CAS  Article  Google Scholar 

  4. 4.

    Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27(7):2373–2382

    Article  Google Scholar 

  5. 5.

    Evans MD, Williams GL, Stephanson BM (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow up. Ann Surg 250(2):354–355

    Article  Google Scholar 

  6. 6.

    Messenger DE, Aroori S, Vipond MN (2010) Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients. Ann R Coll Surg Engl 92(3):201–205

    CAS  Article  Google Scholar 

  7. 7.

    Mihaleanu F, Chiorescu S, Grad O, Negrea V, Silaghi H, Mıronıuc A (2015) The surgical treatment of inguinal hernia using the laparoscopic totally extra-peritoneal (TEP) technique. Clujul Med 88(1):58–64

    Google Scholar 

  8. 8.

    Köckerling F, Bittner R, Jacob DA, Seidelmann L, Keller T, Adolf D, Kraft B, Kuthe A (2015) TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with primary unilateral inguinal hernia. Surg Endosc 29(12):3750–3760

    Article  Google Scholar 

  9. 9.

    Swadia ND (2011) Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience. Hernia. 15(3):273–279

    CAS  Article  Google Scholar 

  10. 10.

    Ferzli GS, Khoury GE (2006) Treating recurrence after a totally extraperitoneal approach. Hernia. 10(4):341–346

    CAS  Article  Google Scholar 

  11. 11.

    Edwards CC 2nd, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10(3):149–153

    Article  Google Scholar 

  12. 12.

    Bansal VK, Krishna A, Misra MC, Kumar S (2016) Learning curve in laparoscopic inguinal hernia repair: experience at a tertiary care centre. Indian J Surg 78(3):197–202

    Article  Google Scholar 

  13. 13.

    Lim JW, Lee JY, Lee SE, Moon JI, Ra YM, Choi IS, Choi WJ, Yoon DS, Min HS (2012) The learning curve for laparoscopic totally extraperitoneal herniorrhaphy by moving average. J Korean Surg Soc 83(2):92–96

    Article  Google Scholar 

  14. 14.

    Schouten N, Elshof JW, Simmermacher RK, Van Dalen T, De Meer SG, Clevers GJ, Davids PH, Verleisdonk EJ, Westers P, Burgmans JP (2013) Selecting patients during the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair. Hernia 17(6):737–743

    CAS  Article  Google Scholar 

  15. 15.

    Krishna A, Bansal VK, Misra MC, Prajapati O, Kumar S (2019) Totally extraperitoneal repair in inguinal hernia: more than a decade’s experience at a tertiary care hospital. Surg Laparosc Endosc Percutan Tech 29(4):247–251

    Article  Google Scholar 

  16. 16.

    Prakash P, Bansal VK, Misra MC, Babu D, Sagar R, Krishna A, Kumar S, Rewari V, Subramaniam R (2016) A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair. J Minim Access Surg 12(2):154–161

    Article  Google Scholar 

  17. 17.

    Reiner MA, Bresnahan ER (2016) Laparoscopic total extra-peritoneal hernia repair outcomes. JSLS. 20(3):e2016.00043

    Article  Google Scholar 

  18. 18.

    Sevinç B, Damburacı N, Güner M, Karahan Ö (2019) Comparison of early and long term outcomes of open Lichtenstein repair and totally extra-peritoneal herniorrhaphy for primary inguinal hernias. Turk J Med Sci 49(1):38–41

    Article  Google Scholar 

  19. 19.

    Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90(12):1479–1492

    CAS  Article  Google Scholar 

  20. 20.

    Köckerling F, Simons MP (2018) Current concepts of inguinal hernia repair. Visc Med 34(2):145–150

    Article  Google Scholar 

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Acknowledgments

We thank Dr. Mustafa Uygar Kalaycı for encouraging us to perform laparoscopic repairs.

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Authors

Contributions

Study conception and design: Yasin Kara and Hakan Bölükbasi

Acquisition of data: Yasin Kara

Analysis and interpretation of data: Yasin Kara

Drafting of manuscript: Yasin Kara and Hakan Bölükbasi

Critical revision: Yasin Kara and Hakan Bölükbasi.

Corresponding author

Correspondence to Hakan Bolukbasi.

Ethics declarations

Approval was given by the ethical committee of Ministry of Health, University of Health Science, Kanuni Sultan Süleyman Training and Research Hospital—no.: KAEK/2019.04.96. This study was carried out according to the principles of the Helsinki Declaration. All the patients were routinely informed and provided their written consent.

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The authors declare that they have no conflict of interest.

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Kara, Y., Bolukbasi, H. Laparoscopic Totally Extraperitoneal Hernia Repairs: a Case Series Analysis. Indian J Surg (2020). https://doi.org/10.1007/s12262-020-02416-3

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Keywords

  • Total extraperitoneal approach
  • Laparoscopic surgery
  • Complications
  • Recurrence
  • Return time to work