LAPAROSCOPIC TOTAL EXTRAPERITONEAL REPAIR OF INGUINAL HERNIA DIRECT: NONFIXATION OF THREE-DIMENSIONAL MESH

2016 ◽  
pp. 21-27
Author(s):  
Dinh Tuan Dung Phan ◽  
Anh Vu Pham ◽  
Manh Ha Le

Introduction: Laparoscopic inguinal hernia repair frequently is performed with mechanical fixation of a flat polypropylene mesh. Mechanical fixation is associated with pain syndromes and mesh migration may occur without fixation of flat protheses. An anatomically contoured mesh 3D-Max (3DMAX Mesh/Bard-Davol, France) using no fixation would avoid these problems. The objective of this study is to demonstrate the effectiveness and safeness of laparoscopic totally extraperitoneal (TEP) hernia repair with nonfixation of three-dimensional mesh. Materials and methods: A prospective analysis of patients, admitted for groin hernia type direct and operated by laparoscopic TEP hernia repair with nonfixation of 3D mesh (3DMAX Mesh), performed between June 2010 and June 2015. Data were collected regarding general characteristics, complication rates, length of hospital stay and the recurrence rate postoperative of this method. Results: 36 patients/42 hernias type direct underwent laparoscopic totally extraperitoneal (TEP) repair with nonfixation of 3D mesh. The results show with an average age of 59,5±13,2 years (range 36–85 years); peritoneal laceration was noticed during dissection in 7,1%, there was no injury of the inferior epigastric vessels during dissection. Unilateral hernia had an operative time of 54,5±18,1 minutes (range 30–115 minutes), bilateral hernia was 88,3±24,6 (range 65-120 minutes). All of these patients in the study were controlled with 2,4% had pain post-op at 3 months follow-up postoperative, but at 12 months and 24 months follow-up, there were no complication, no recurrences. Conclusions: The laparoscopic (TEP) repair of inguinal hernia with nonfixation of three-dimensional mesh is safe and effective. Keywords: groin hernia – TEP hernioplasty - laparoscopy

2012 ◽  
pp. 9-14
Author(s):  
Dinh Tuan Dung Phan ◽  
Nhu Hiep Pham ◽  
Loc Le

Objectives: Inguinal hernia is the most common hernia and inguinal hernia repair is the most frequently performed operation in gerenal surgery. Hernioplasty by laparoscopy was gradually the standard method for inguinal hernia repair all over the world. The objective of this study is to demonstrate the effectness and safeness of laparoscopic totally extraperitoneal (TEP) hernia repair. Materials and methods: A prospective analysis of patients, admitted for groin hernia and operated by laparoscopic TEP hernia repair, performed between June 2010 and December 2011. Data were collected regarding general characteristics, complication rates, length of hospital stay and the recurrence rate postoperative of this laparoscopic method. Results: 35 patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with an average age of 51.3±13.8 years (range 31 – 72 years); 5.7% of the inguinal hernias were operated bilaterally, peritoneal laceration was noticed during dissection in 14.3%, there was no injury of the inferior epigastric vessels during dissection. Unilateral hernia had an operative time of 66.52 ± 17.4 minutes (range 45 – 115 minutes) and bilateral hernia took 107.5 minutes (range 95 – 120 minutes). All of these patients in the study were controlled, 5.7% had seroma at the time 3 months postoperative, there were no recurrences during follow-up ranging from 3 – 18 months (average 9.6 months). Conclusions: The laparoscopic (TEP) repair of inguinal hernia is safe and effective. That laparoscopy method should be the gold standard technique in treatment for the repair of inguinal hernias. Keywords: groin hernia – TEP hernioplasty - laparoscopy


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Đình Tuấn Dũng Phan ◽  

Tóm tắt Đặt vấn đề: Đến nay, phẫu thuật nội soi trong điều trị bệnh lý thoát vị bẹn được thực hiện ngày càng nhiều trên lâm sàng, trong đó phẫu thuật nội soi hoàn toàn ngoài phúc mạc đã được sử dụng rộng rãi cùng một tấm lưới nhân tạo được cố định vào thành bụng trước. Tuy nhiên, sự cố định này là một trong những nguyên nhân chủ yếu gây ra tình trạng đau sau mổ và ngược lại sự di chuyển của tấm lưới nhân tạo phẳng chính là nguyên nhân gây ra tình trạng thoát vị tái phát. Việc sử dụng tấm lưới nhân tạo 3D (3DMAX Mesh/Bard-Davol) có thể tránh được những vấn đề này. Mục tiêu của đề tài nhằm đánh giá kết quả lâu dài của phương pháp phẫu thuật đặt tấm nhân tạo 3D ngoài phúc mạc qua ngã nội soi trong điều trị bệnh lý thoát vị bẹn trực tiếp. Phương pháp nghiên cứu: Phương pháp nghiên cứu mô tả tiến cứu được thực hiện trên các người bệnh được chẩn đoán thoát vị bẹn trực tiếp và được điều trị phẫu thuật nội soi hoàn toàn ngoài phúc mạc (TEP) đặt tấm nhân tạo 3D (3D-Max - Davol) từ tháng 6 năm 2010 đến tháng 12 năm 2018. Nghiên cứu đánh giá về các đặc điểm chung, đặc điểm phẫu thuật, biến chứng, thời gian nằm viện và đánh giá tái khám sau phẫu thuật sau 36 tháng. Kết quả: Có 62 người bệnh (tổng số 67 trường hợp thoát vị trực tiếp) đã được phẫu thuật bằng phương pháp đặt tấm nhân tạo 3D ngoài phúc mạc bằng nội soi. Độ tuổi trung bình 54,7 ± 13,1 tuổi (nhỏ nhất 41 tuổi, lớn nhất 81 tuổi). 91,9% là thoát vị bẹn một bên. Đặc điểm phẫu thuật: thủng phúc mạc trong quá trình phẫu thuật chiếm tỷ lệ 4,5%, không có trường hợp nào tổn thương các mạch máu lớn trong phẫu thuật. Thời gian phẫu thuật trung bình là 47,2±11,9 phút (35-95 phút) đối với thoát vị bẹn một bên và 81,4±18,9 phút (65-120 phút) đối với thoát vị bẹn hai bên. Tái khám sau mổ: 3/67 (4,5%) trường hợp còn cảm giác đau khi tái khám vào tháng thứ 3, không có trường hợp tụ dịch ở vết mổ, không có trường hợp tái phát nào được ghi nhận lúc tái khám vào ở vết mổ, không có trường hợp tái phát nào được ghi nhận lúc tái khám vào tháng thứ 36. Kết luận: Phẫu thuật nội soi hoàn toàn ngoài phúc mạc với tấm nhân tạo 3D trong điều trị thoát vị bẹn trực tiếp có tính an toàn và hiệu quả cao. Kỹ thuật này có thể được áp dụng rộng rãi và nên được xem như là tiêu chuẩn vàng trong điều trị bệnh lý thoát vị bẹn. Abstract Introduction: Laparoscopic inguinal hernia repair is frequently performed using the mechanical fixation of a flat polypropylene mesh. This procedure is associated with pain issue and mesh migration that may occur without fixation of flat prothesis. An anatomically contoured mesh 3D-Max (3DMAX Mesh/Bard-Davol, France) using no fixation would prevent these problems. The objective of this study is to evaluate the effectiveness and safety of laparoscopic totally extraperitoneal (TEP) for inguinal hernia repair with nonfixation of three-dimensional mesh. Material and Methods: A retrospective analysis of patients, admitted for direct inguinal hernia and operated by laparoscopic TEP with nonfixation of 3-D mesh, performed between June 2010 and December 2018. Data were collected regarding general characteristics, complications, length of hospital stay and the recurrence rates. Results: 62 patients with 67 direct hernias underwent laparoscopic (TEP) to repair hernia with an average age of 54.7±13,1 years (range 41 – 81 years); peritoneal injury was noticed during dissection in 4.5%, there was no injury of the inferior epigastric vessels during dissection. Average operative time of unilateral hernia was 47.2±11.9 minutes (range 35 – 95 minutes). All patients in this series were followed, pain in 4.5% at 3 months after operation. There were no recurrences at 36 months postoperative follow up. Conclusion: The laparoscopic (TEP) repair of inguinal hernia is safe and effective. It is considered as the gold standard technique in treatment of direct hernia. Keyword: Inguinal hernia – Laparoscopic TEP, hernioplasty – laparoscopy.


2018 ◽  
Vol 5 (3) ◽  
pp. 1016
Author(s):  
Iqbal Saleem Mir ◽  
Tajamul Rashid ◽  
Irfan Nazir Mir ◽  
Suhail Nazir ◽  
Imtiyaz Ali ◽  
...  

Background: Inguinal hernia repair by laparoscopy is gaining acceptance worldwide. A flat mesh used in laparoscopic inguinal hernia repair is associated with more complications especially early and late postoperative pain owing to the need of mechanical fixation of this mesh. A three-dimensional mesh in this context is an emerging alternative which needs no or minimal fixation.Methods: A retrospective study of 123 patients was carried out from July 2012 to August 2017. All patients who underwent TEP by a single surgical team using three-dimensional mesh were included in the study. Data collected was analysed retrospectively.Results: Out of a total of 123 patients, 114 patients had unilateral hernia and 9 had bilateral hernia. A total of 132 laparoscopic hernia repairs were done using three-dimensional mesh. All the patients were male aged 29 to 75 years with a mean age of 51.5 years. Indirect hernias were more common comprising of 87.7%. The mean operative time was 46.9 minutes. The average mesh fixation time was 12.6 minutes. No major intraoperative complications were noted in any of the patients. Three patients (2.45%) experienced severe postoperative pain. Most of the patients 117 (95.12%) were discharged within 24 hours of surgery. Mean hospital stay in our study was 1 day. The mean length of follow-up was 12 months. Mild persistent groin pain was found in four patients (3.25%). Seroma was noted in five patients (4.06%). Hematoma and wound infection was noted in none. One patient (0.81%) had recurrence after completion of follow up. We found use of 3D mesh costly.Conclusions: Laparoscopic inguinal mesh hernioplasty using 3D mesh is a viable alternative of hernioplasty with minimal post-operative pain and recurrence and using 3D mesh has a technical advantage of easy insertion in an anatomically correct position with minimal fixation.


2020 ◽  
Vol 23 (2) ◽  
pp. 54-58
Author(s):  
ABM Mahbubur Rahman ◽  
Tamjeed Alam ◽  
AHM Shamsul Alam ◽  
Fahim Ferdaus ◽  
Gazi Gias Uddin

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting. Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence. Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence. Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period. Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias. Journal of Surgical Sciences (2019) Vol. 23(2): 54-58


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem AbdelSalam Mohamed ◽  
Karim Fahmy ◽  
Mohammad Ahmad Abd-erRazik ◽  
Shaimaa Atef Ismaeil Awwad Elkomy

Abstract Background The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. Aim of the Work To assess intra-operative difficulties of laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative time. And early post-operative complications including post-operative seroma, early postoperative pain, chronic pain and limitation of function. Patients and Methods In our study 30 patients were recruited according to our preset inclusion and exclusion criteria. They were divided randomly into two groups, a group in which the 3D mesh was used and a group in which the polypropylene mesh was used. The study was conducted in Ain Shams University hospitals for 6 months, in which patients where followed up from 3 to 6 months and compared in terms of intraoperative time, post-operative pain after one week, restriction of physical activity, seroma formation and presence of chronic pain. Results In our study the mean application time (minutes) in 3D group was found to be 7.07 ± 2.66 while in PP group it was found to be 12.53±3.66 with highly statistically significant difference between them at p < 0.001. We believe that this difference in fixation time in our present study is attributed to easy insertion through the port, easy intraoperative handling, and easy unfolding of 3D mesh. Conclusion The use of three-dimensional mesh (3D mesh) for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, shorter hospital stays, early recovery with a better movement limitation score. Whereas chronic pain was found to be similar in both groups. Further, elimination of tacks for fixation and shorter hospital stay may reduce the cost of 3D mesh. Longer-term studies are recommended with a larger sample size and follow up duration for better assessment of chronic pain, also for following up on recurrence.


2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Đức Anh Lương ◽  

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi đi đường ngoài phúc mạc hoàn toàn đặt lưới để điều trị bệnh thoát vị bẹn (TVB) ở người lớn là một tiến bộ kỹ thuật đang được phát triển và áp dụng bổ sung cho các phương pháp khác, nhưng đây lại là phương pháp có nhiều thách thức về kỹ thuật nhất với các phẫu thuật viên. Tại Bệnh viện E từ tháng 5/2017 đến tháng 5/2019 có 35 ca được mổ theo phương pháp này. Mục tiêu nghiên cứu nhằm đánh giá kết quả sớm, một số kinh nghiệm về chỉ định và kỹ thuật mổ. Phương pháp nghiên cứu: Thiết kế nghiên cứu can thiệp, một nhóm, dạng quan sát mô tả tiến cứu, đánh giá kết quả trước và sau can thiệp. Kết quả: 35 bệnh nhân (BN) TVB gồm 2 nữ, 33 nam; tuổi TB 66,2±10,65 (41- 91); TVB 1 bên: 33 (94,3%), 2 bên: 2 (5,7%); TVB trực tiếp: 13 (37,1%), gián tiếp: 22 (62,9%); một ca có tiền sử mổ Bassini hai lần cùng bên và tái phát được mổ thành công. Hai ca thủng phúc mạc trong khi phẫu tích, khắc phục không phải chuyển TAPP. Thời gian mổ: 121,1±33,20 phút (90-190). Kết luận: Phương pháp khả thi an toàn thời gian nằm viện giảm, thẩm mỹ và ít đau, tuy nhiên có nhiều điểm cần lưu ý trong kỹ thuật cần nghiên cứu tiếp tục liên quan đến kết quả mổ như nhận định giải phẫu, phẫu tích, xử lý thủng khi thủng phúc mạc, cố định chắc chắn vật liệu vào khoang để che phủ lỗ thoát vị... Abstract Introduction: Laparoscopic totaly extraperitoneal inguinal hernia repair with placement of a mesh outside the peritoneum to repair inguinal hernia in adult patients is an advanced technique has been developing as alternative choice for surgeons. However, this method has is challenging in technical issues for surgeons. Over a 24-month period (May 2017 through May 2019), a total of 35 laparoscopic TEP inguinal hernia repairs were carried out. This paper aimed to evaluate the early results and discuss some important technical issues as well. Material and Methods: A prospective observational study, one group, evaluating results before and after intervention. Results: 35 patients including 2 females and 33 males with mean age of 66,2±10,65 years old (41- 91); unilateral inguinal hernia (IH): 33 patients (94,4%), bilateral IH: 2 patients (5,7%); direct IH: 13 patients (37,1%), indirect IH: 22 (62,9%); One patient underwent two times previously by Bassini procedure due to recurrence. Per-operative adverse events including: peritoneum laceration during dissection in 2 cases, overcome by repair peritoneum damaged without conversion into TAPP. Mean operative time: 121,1±33,20 min (90-190). Conclusion: Laparoscopic TEP IH repair with prolene mesh placement is a suitable treatment option for selected inguinal hernia patients. However, some technical issues should be considered such as accuracy recognization of endoscopic anatomy landmarks during dissecting inguinal canal elements and management of incident happened management for example peritoneum being lacerated, clearing the pre- peritoneal space for laying mesh, substantial fine fixation of mesh... may cause the outcomes. Keywords: Laparoscopy, Inguinal hernia, TEP repair.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Kryspin Mitura

Abstract Aim Chronic postherniorraphy pain occurs in 8-25% of patients undergoing groin hernioplasty with mesh insertion. The most common cause for inguinodynia is neuropathy resulting from nerve damage or entrapment during mesh fixation. With wide mesh insertion there is often a conflict between upper prosthesis margin and an iliohypogastric nerve. The aim of this study is to present a routine elective iliohypogastric neurectomy in Lichtenstein groin hernia repair for prevention of chronic inguinodynia. Material and Methods Between 2018 and 2020, 398 patients were admitted for open inguinal hernia repair. 218 patients underwent a Lichtenstein repair with transection of iliohypogastric nerve before implantation of 10x14 polypropylene mesh (IH group). In the control group of 180 patients all nerves were spared (C group). Follow-up was conducted on 1 POD,1 month, and 1 year after surgery. Results 1 month after a surgery a pain was reported in 24 (11%) patients in IH group (2.9% severe; 8.1% moderate; 89% no pain), and 48 (26.7%) patients in C group (3.9% severe; 22.8% moderate; 73.3% no pain). 1 year after a surgery a persistent pain was reported in 1 (0.4%) patient in IH group, and in 5 (2.8%) patients in C group. An incidence of inguinodynia was significantly lower after iliohypogastric neurectomy (0.5% vs. 2.8%; p < 0.001). Conclusions Routine neurectomy of iliohypogastric nerve appears to be an effective technique in chronic inguinodynia after open mech repair for inguinal hernias. Iliohypogastric nerve resection allows to place a flat synthetic mesh with wide coverage of myopectineal orifice with no need for additional mesh trimming.


2017 ◽  
Vol 5 (1) ◽  
pp. 248
Author(s):  
Yousef Hisham ◽  
Mannarakkal Ranjith ◽  
Thommil Padinjarenalakath Nabeel ◽  
Kummankandath Abbas Sidhic

Background: Laparoscopic inguinal hernia repair has become increasingly popular as an alternative to open surgery. Aim: To evaluate total extraperitoneal repair with direct telescopic dissection and mesh hernioplasty for inguinal hernias.Methods: This study was conducted at General Surgery department the period of 1 year on 30 patients having inguinal hernia.Results: This prospective study included 30 adult patients with primary unilateral inguinal hernia, all of them were males. Age of study patients ranged from 22 to 64 years old. Intraoperatively, 6 patients were presented to have direct inguinal hernia (20%) while 21 patients had indirect inguinal hernia (70%). In 3 patients, combined direct and indirect hernia defects were present (10%). Mean operative time was 99.30±25.13 min. Mean time for analgesia was 3.62±1.57 days. Hospital stay mean was 1.43±0.62 days. The mean time until return to work was 14.1±3.13 days, the mean time of follow up was 7.1±2.2 months. Intra operatively 5 (15%) and post operatively 8 (26.6%)complications were observed.Conclusions: Laparoscopic TEP repair is an excellent alternative to open preperitoneal repair of inguinal hernia. Complication rate was average with other studies while there was no hernia recurrence during the period of follow up.


Hernia ◽  
2020 ◽  
Vol 24 (5) ◽  
pp. 1033-1040
Author(s):  
W. J. Bakker ◽  
C. V. van Hessen ◽  
G. J. Clevers ◽  
E. J. M. M. Verleisdonk ◽  
J. P. J. Burgmans

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