Experience and results of laparoscopic inguinal herniorrhaphy

Introducción. Con la invención de la cirugía poco invasiva, la herniorrafia inguinal por laparoscopia se ha convertido en un procedimiento de realización frecuente. En el presente artículo se publican los resultados de 92 herniorrafias inguinales por laparoscopia realizadas con técnica transabdominal preperitoneal (TAPP) entre agosto de 2001 y enero de 2014.Objetivo. Presentar resultados en cuanto a tasa de recurrencia, dolor post-operatorio y necesidad de conversión en las herniorrafias inguinales por laparoscopia analizadas.Materiales y métodos. Se analizaron de manera retrospectiva los resultados del procedimiento realizando técnica TAPP con seguimiento promedio de 8 años.Resultados. Se presentaron tres (3.2%) casos que requirieron conversión, tres (3.2%) de recurrencia y seis (6.4%) de dolor crónico.Conclusión. La herniorrafia por laparoscopia con técnica TAPP es un procedimiento seguro; esta tiene tasas similares de efectividad y complicaciones a la técnica abierta y totalmente extraperitoneal TEP.

Bladder Fill after Laparoscopic Inguinal Hernia Repair Reduces Time to Discharge

Laparoscopic inguinal herniorrhaphy (LIH) has a relatively high risk of urinary retention. Bladder dysfunction may delay discharge after LIH. We hypothesized that filling the bladder before Foley catheter removal decreases time to discharge (TTD) after LIH. A secondary aim was to determine incidence of postoperative urinary retention (POUR) after bladder fill (BF). We reviewed a consecutive series of total extraperitoneal and transabdominal preperitoneal LIH procedures performed by a single surgeon at our institution from 2010 to 2013. All patients were catheterized during LIH, and selected patients received a 200-mL saline BF before Foley catheter removal. Patients were required to void >250 mL before discharge. TTD and incidence of POUR were compared between the BF and no-BF groups. A total of 161 LIH cases were reviewed. BF was performed in 89/161 (55%) of cases. TTD was significantly shorter in the BF versus the no-BF group (222 vs 286 minutes, respectively; P < 0.01). Patient and operative characteristics were similar between the BF and no-BF groups (P > 0.05). Incidence of POUR in the BF and the no-BF group was 10.1 and 16.7 per cent, respectively; however, this difference was not significant (P = 0.22). No postoperative urinary tract infection occurred in either group. In conclusions, postoperative BF significantly reduces TTD after LIH. Further studies may help to determine whether shorter postanesthesia care unit time and lower POUR rates associated with BF can lower LIH procedural costs and increase patient satisfaction.