Prospective study of laparoscopic totally extraperitoneal repair (TEP) & open mesh hernioplasty
Corresponding Author(s) : Tajamul Rashid
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 6 No. 1 (2018): 2018 Volume 6- Issue -1
Abstract
Background
Inguinal hernia repair by laparoscopy has gained much importance in the past decade as it has been shown to be associated with lesser incidence of morbidity and a faster postoperative recovery than open repair, however many laparoscopic surgeons are still reluctant to adopt this technique because of long learning curve.
Materials and Methods
This was a hospital based prospective study comparing the results of TEP & open hernia repair. The study was conducted in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, New Delhi. Data from all the patients was collected prospectively over a period of 2 years from June 2015 to June 2017. A total of 160 patients were enrolled in the study. Patients were divided into laparoscopic (Group A) and open hernia repair group (Group B) strictly based on patient preference and anaesthetic risks after meeting the inclusion criteria. Patients with uncomplicated, unilateral/bilateral inguinal hernia were included in the study. Polypropylene mesh was used in both procedures. Tacks were used in TEP for the fixation of mesh. Data collected was analysed and expressed as average, mean/median.
Results
All patients in our study were men in the age group of 20 to 60 years and above, with a mean age of 49 years in group A and 53 years in group B. All patients in our study had unilateral inguinal hernia. Postoperative pain was slightly more in group B (7.5%) than group A patients (2.5%). Postoperative urinary retention was found to be lower in group A (2.5%) compared to group B (7.5%). In our study 02 patients (2.5%) in group A developed postoperative seroma and same complication was found in 06 patients (7.5%) of group B. Our study found a superficial wound infection rate of 1.25% and 5% in groups A and B respectively. The average hospital stay in our study was 2.5 days in group A and 3 days in group B. The recurrence rate in group A and group B was 0% and 2.5% respectively. Laparoscopic repair was found to be slightly costlier than open hernia repair in our study.
Conclusion
Laparoscopic TEP repair is a safe option in expert hands for the repair of uncomplicated inguinal hernias. Although, slightly costly with marginally higher rate of recurrence, laparoscopic hernia repair has comparable results with open hernia repair with fewer general complications.
Keywords
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Malangoni M. A, Rosen M.J; Hernias. In: Townsend CM, Beauchamp RD, Evers BM. Mattox KL, eds. Sabiston Textbook of Surgery. Pa: Saunders Elsevier; 44( 1155), 2010, 1160-1161
[2]. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 362, 2003, 1561-71
[3]. Chow A, Purkayastha S, Athanasiou T, Tekkis P, Darzi A. Inguinal hernia. BMJ Clin Evid 4, 2007, 1-20.
[4]. Devlin HB. Trends in hernia surgery in the land of Astley Cooper. In: Soper NJ, ed. Problems in general surgery Philadelphia, PA: Lippincott-Raven, 12, 1995, 85-92
[5]. Gilbert AI, Young J, Graham MF, et al. Combined anterior and posterior inguinal hernia repair: intermediate recurrence rates with 3 groups of surgeons. Hernia. 8(3), 2004, 203-207
[6]. Ferzli G, Sayad P, Huie F, et al. Endoscopic Extraperitoneal Herniorraphy: A 5-year experience. Surgical Endoscopy. 12, 1998, 1311
[7]. Malik AM, Hussain Talpur KA, Soomro AG, Qureshi JN. A walk along the learning curve of totally extra-peritoneal (TEP) Repair of Inguinal Hernia. Surgery Curr Res. 2, 2012, 116. DOI:10.4172/2161-1076.1000116.
[8]. Stoker DL, Spiegelhalter DJ, Singh R, Wellwood JM. Laparoscopic versus open inguinal hernia repair: Randomised prospective trial. Lancet. 343, 1994, 1243–1245.
[9]. Collaboration EH. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. 87, 2000, 860–867.
[10]. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 235, 2002, 322–332.
[11]. Jain SK, Gupta A, Kumar S. Laparoscopic vs open inguinal hernia repair: A systemic review of literature. Asian Journal of Medical Sciences. 5(3), 2014.
[12]. Vidovic D, Kirac I, Glavan E, Filipovic?Cugura J, Ledinsky M and Bekavac?Beslin M. Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications. J Lap & Ad Surg Techniques.17, 2007, 585?590.
[13]. Shah AH, Rathod JB, Yagnik VD. A comparative study between Laparoscopic Hernia Repair and Open Lichtenstein Mesh Repair. British Journal of Medicine & Medical Research. 21(9), 2017, 1-8.
[14]. Chalkoo M, Mir MA, Makhdoomi H. Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience. Surgical Science. 7, 2016, 107-113.
[15]. Zeineldin, A. Transabdominal (TAPP) versus Total Extraperitoneal (TEP) Laparoscopic Inguinal Hernia Repair: A Prospective Comparative Study. Menoufiya Medical Journal, 21, 2008.
[16]. McCormack K, Scott NW, Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev.1, 2003, CD001785.
[17]. MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic Versus open repair of groin hernia: A randomized comparison. Lancet 354, 1999, 185-190.
[18]. Champault G, Rizk N, Catheline J, et al. Inguinal hernia repair, totally preperitoneal laparoscopic approach versus Stoppa operation. Randomized trial of 100 cases. Surg Laparosc Endosc 6, 1997, 445 -450.
[19]. Neumayer L, Giobbe-Hurder A, Johansson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Eng J Med 350, 2004, 1819-1827.
References
[2]. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 362, 2003, 1561-71
[3]. Chow A, Purkayastha S, Athanasiou T, Tekkis P, Darzi A. Inguinal hernia. BMJ Clin Evid 4, 2007, 1-20.
[4]. Devlin HB. Trends in hernia surgery in the land of Astley Cooper. In: Soper NJ, ed. Problems in general surgery Philadelphia, PA: Lippincott-Raven, 12, 1995, 85-92
[5]. Gilbert AI, Young J, Graham MF, et al. Combined anterior and posterior inguinal hernia repair: intermediate recurrence rates with 3 groups of surgeons. Hernia. 8(3), 2004, 203-207
[6]. Ferzli G, Sayad P, Huie F, et al. Endoscopic Extraperitoneal Herniorraphy: A 5-year experience. Surgical Endoscopy. 12, 1998, 1311
[7]. Malik AM, Hussain Talpur KA, Soomro AG, Qureshi JN. A walk along the learning curve of totally extra-peritoneal (TEP) Repair of Inguinal Hernia. Surgery Curr Res. 2, 2012, 116. DOI:10.4172/2161-1076.1000116.
[8]. Stoker DL, Spiegelhalter DJ, Singh R, Wellwood JM. Laparoscopic versus open inguinal hernia repair: Randomised prospective trial. Lancet. 343, 1994, 1243–1245.
[9]. Collaboration EH. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. 87, 2000, 860–867.
[10]. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 235, 2002, 322–332.
[11]. Jain SK, Gupta A, Kumar S. Laparoscopic vs open inguinal hernia repair: A systemic review of literature. Asian Journal of Medical Sciences. 5(3), 2014.
[12]. Vidovic D, Kirac I, Glavan E, Filipovic?Cugura J, Ledinsky M and Bekavac?Beslin M. Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications. J Lap & Ad Surg Techniques.17, 2007, 585?590.
[13]. Shah AH, Rathod JB, Yagnik VD. A comparative study between Laparoscopic Hernia Repair and Open Lichtenstein Mesh Repair. British Journal of Medicine & Medical Research. 21(9), 2017, 1-8.
[14]. Chalkoo M, Mir MA, Makhdoomi H. Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience. Surgical Science. 7, 2016, 107-113.
[15]. Zeineldin, A. Transabdominal (TAPP) versus Total Extraperitoneal (TEP) Laparoscopic Inguinal Hernia Repair: A Prospective Comparative Study. Menoufiya Medical Journal, 21, 2008.
[16]. McCormack K, Scott NW, Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev.1, 2003, CD001785.
[17]. MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic Versus open repair of groin hernia: A randomized comparison. Lancet 354, 1999, 185-190.
[18]. Champault G, Rizk N, Catheline J, et al. Inguinal hernia repair, totally preperitoneal laparoscopic approach versus Stoppa operation. Randomized trial of 100 cases. Surg Laparosc Endosc 6, 1997, 445 -450.
[19]. Neumayer L, Giobbe-Hurder A, Johansson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Eng J Med 350, 2004, 1819-1827.