Totally extraperitoneal repair of inguinal hernia: Sir Ganga Ram Hospital technique (original) (raw)
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International Journal of Medical Science and Clinical invention, 2018
Background: The treatment of hernia has passed through an extensive evolution ever since Eduardo Bassini performed the first tissue repair of inguinal hernia in later half of nineteenth century. There is no single repair that can be considered as a standard repair for inguinal hernia and the process is still evolving. We performed a study to evaluate the outcome of laparoscopic totally extraperitoneal prosthesis repair of inguinal hernia. Method: The study is a prospective observational study conducted in a department of surgery, Govt medical college Srinagar from 2012 onwards. Patients having groin hernia presenting to the OPD of the SMHS hospital were randomly selected for this study. A total of 200 patients were considered for the study. After doing all base line investigations and proper pre anaesthetic check up patients were taken for TEP. Results and Observations: In our study minimum and maximum age was 20 and 80 years for TEP with mean age of 46.76±13.0 years; showing that no age is immune to inguinal hernia. In our study there were only male patients, a total of 200 patients were included in the study. Overall complications in our study were 12.5%. 7.5% cases were converted from TEP to other procedure. Seven patients had vascular injury (inferior epigastric artery) during the procedure. Hemostasis was achieved in 2 parients while as 5 patients were converted to open procedure and ligation of vessel was done. 5% of patients were converted to TAPP because of technical difficulties like loss of pre peritoneum, perforation of peritoneum. Conclusion: We concluded that TEP is a safe and effective procedure of repair for inguinal hernias with minimum morbidity in expert hands with a comparable complication rate to other procedures but has a long learning curve and with experience, the complication rate also reduces.
IOSR Journals , 2019
Objective- To compare Totally Extra Peritoneal (TEP) repair with Trans Abdominal Pre Peritoneal (TAPP) repair of inguinal hernia. To compare the operative time, technique, intraoperatve and postoperative complications of TEP and TAPP repair of uncomplicated inguinal hernia. Material And Methods: The study is prospective & randomized clinical trial in nature. A sample of size 60 was studied in the DEPARTMENT OF SURGERY, at the SUBHARTI MEDICAL COLLEGE ,MEERUT.The sample size was calculated by using the formula n=4σ2 /L2 . where σ 2 =variance of sample observations and L2 = least permissible error. In our study, the variance was maintained 1.36 & least permissible error was fixed at .02 (2%) . The Patients, who underwent LAPAROSCOPIC REPAIR OF GROIN HERNIA between 1st May, 2016 and 31st March, 2018 were randomized to either TEP or TAPP repairs. The two types of surgical methods were analyzed by making the frequency tables of 60 patients. The significant difference b/w TEP & TAPP surgeries was observed by un-paired/student’s “t” test at .01 level of significance.The p- value less than .01 was considered as significant .i.e.P<.01.Further, all the statistical analysis was done by using S.P.S.S. software 23.0 version. Result- In this study out of 60 patients ,37 patients were treated by TAPP surgery and 23 patients were treated by TEP. Out of which all patients are male and all are unilateral hernia.Out of 60 patients study shown, 23 patients was of TEP. study showed the duration of stay of hospital in both TEP and TAPP is 3 to 4 days.In our study the cost of TEP and TAPP was 10200 and 11050 respectiely. There was significantly mild pain following TEPP repair; however,the pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two group. In our study there is no vas deferens injury ,no blader injury ,no bleeding and no bowel Injury. Conclusion— The both type of surgeries are safe. However in TEP and TAPP surgeries , cost factor is less for TAPP and operative time increases for TEP surgery .The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. However,in many study TEP surgery was associated with significantly higher incidence of early post-operative pain having longer operative time and cord edema, whereas TAPP was associated with a significant higher incidence of SEROMA formation. But in this study no SEROMA formation and pain was not significant. The cost was comparable between the two types of surgeries.
Totally extraperitoneal endoscopic inguinal hernia repair (TEP)
Surgical Endoscopy, 2003
Background: This report reviews our experience with 5,203 totally extraperitoneal (TEP) endoscopic hernia repairs performed in 3,868 patients over the 7.5-year period between May 1994 and December 2001, 34.5% of whom had bilateral hernias and 13% recurrent hernias. Methods: We performed TEP as the method of choice in more than 92% of all the patients presenting with inguinal hernia, including those with incarcerated, strangulated, or inguinoscrotal hernias. After reduction of the hernial sac and appropriate dissection of the preperitoneal space, we placed a slit-free 10 • 15-cm polypropylene mesh without the use of staple fixation. Results: Altogether, 29 recurrent hernias (0.6%) were observed, more than 50% of which occurred during the first 2 years after the technique was introduced (1.8%). During subsequent years, the recurrence rate settled to approximately 0.3%. Regarding intraoperative complications, we observed eight injuries to the bladder. At this writing, no bowel injuries or damage to iliac vessels has been seen. Postoperatively, we noted only a single case of mesh infection. In 14 cases (0.4%), postoperative hemorrhage necessitated either inguinal or endoscopic reoperation. As a further major complication, a small bowel obstruction caused by inadequate closure of a peritoneal lesion occurred in two patients (0.05%). The overall reoperation rate for the 3,868 patients was 0.6%. Conclusions: We consider TEP to be a procedure that carries an acceptably low complication rate, combining the advantages of minor access surgery and mesh reinforcement of the groin. This approach is associated with early postoperative return to usual activities and a very low recurrence rate.
Clujul Medical, 2015
The surgical repair of inguinal hernia represents one of the most frequent procedures used in general surgery. The new surgical techniques are simpler, with a lower morbidity and recurrence of less than 2%. The laparoscopic totally extra-peritoneal (TEP) technique is contraindicated in complicated hernias (occlusion, incarceration) and in voluminous inguino-scrotal hernias.Purpose. the evaluation of the TEP technique, of the risk factors and of the postoperative results on the group of patients who have undergone surgery in the Surgical Clinic 2 Cluj Napoca.Material and method. The study is prospective, on a group of 40 patients operated with the TEP technique in the Surgical Clinic 2 during the period May 2013 – July 2014. The following have been assessed: the demographic data, the risk factors, the immediate complications, the recurrence of the hernias.Results. The average duration of hospitalization was 6.79 days. The intraoperative incidents were: 7 minimal peritoneal lesions wi...
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Hernia repair is one of the common general surgical operations. Open mesh repair method (Lichtenstein's repair) is known as "Gold Standard" for inguinal hernia. Slowly another technique Total Extra-Peritoneal (TEP) repair emerged. TEP repair is considered to be an "advanced" laparoscopic procedure and still not available widely. MATERIALS AND METHODS Our study compared outcomes of laparoscopic inguinal hernia repair with open mesh hernia repair. Total of 75 patients in each group included in study. RESULTS The mean age of patients presenting with hernia was 36.96 years and 37.08 years, while mean weight was 58.4 kg and 61.56 kg for laparoscopic and open group respectively with age ranged from 21 to 55 years. Mean operative time was 90 minutes (Unilateral), 117 minutes (Bilateral) and 70 minutes for laparoscopic and open mesh hernioplasty respectively. Analgesic dose required for laparoscopic group and open group was 3.58 and 3.16 respectively. The cost of surgery in laparoscopic group was 11000-14000 Rs. (Mean-12,000 Rs.), while in open group was 6000-8500 Rs. (Mean-7000 Rs.). CONCLUSION Although laparoscopic totally extraperitoneal hernia repair has many advantages over open mesh repair, but when it comes to availability of the technical expertise, operative time, cost of surgery, open hernioplasty seems better.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2020
A hernia, an abnormal protrusion of an organ or tissue through a defect in its surrounding wall is a very common surgical problem. Approximately 75% of all hernias are usually groin hernias, among which 95% are inguinal region hernias. Various methods of repair have been employed which have progressed from open repair to various laparoscopic approaches. There is insufficient data to draw conclusions about the relative effectiveness of the two laparoscopic methods. Overall superiority of the two laparoscopic methods has not been demonstrated in available literature. AIM: The purpose of this study is to compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. MATERIALS AND METHODS: Hospital based comparative randomised study on 100 patients admitted in General Surgical wards with Inguinal hernia at a tertiary care centre of Eastern India. Randomization in two groups was done by lottery system. A well designed prof...
Open New Simplified Totally Extraperitoneal (ONSTEP) Technique for Inguinal Hernia Repair
Updates in surgery series, 2017
Introduction-Aim: The Open New Simplified Totally Extra-Peritoneal (ONSTEP) inguinal hernia repair involves placing the greater part of a pre-shaped mesh in the preperitoneal space covering all hernia defects and the rest of it in the inguinal canal. Its advantages over the existing techniques include shorter operative time, faster learning curve, less postoperative pain, speedier return to normal activities, better cosmetic result and a lower recurrence rate. The purpose of this study is to present our initial experience of this novel method. Patients-Methods: Adult patients underwent inguinal hernia repair with the ONSTEP procedure. Patients were followed up for one year for pain, wound complications and recurrence. The pre-shaped mesh used for repairing the hernia defect was the Polysoft TM hernia patch. Results: During a 1.5-year period (between the 1 st January 2013 and the 30 th June 2014) thirty three (33) patients underwent inguinal hernia repair with the ONSTEP procedure. The mean operative time was 33.28 (± 11.69) minutes, the time to discharge was 24h for all patients and the return to normal activity was between three and seven days. The overall wound complication rate was minimal and the overall recurrence rate was zero. No patient experienced residual or chronic pain at six months. Three patients had mild discomfort related to the memory ring; however, the pain subsided and did not necessitate its removal. The cosmetic result was very good immediately postoperatively, as well as at one and six months. All patients were very satisfied owing to minimal discomfort, good cosmetic result, no chronic pain and speedy return to normal activity. Conclusions: ONSTEP repair of inguinal hernia is a new technique which is fast to learn and perform, with a low complication rate and minimal recurrence rate. The overall cosmetic result and patient satisfaction is excellent. It is a safe alternative to other open and laparoscopic techniques.
Mædica, 2023
Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods: We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair-TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results: Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic
Laparoscopic Inguinal Hernia Repair; Sohag Experience
The Egyptian Journal of Hospital Medicine, 2021
Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many centers. Objective: We aimed with this study to evaluate the technique regarding its advantages and disadvantages in Sohag University Hospital. Patients and Methods: This was a prospective observational study included 50 patients suffering from inguinal hernia admitted electively to Sohag University Hospital between September 2019 and April 2020. Patients were enrolled for laparoscopic Trans Abdominal Pre Peritoneal (TAPP) repair. Patients were evaluated regarding demographic criteria, clinical picture, operative, and postoperative course after an outpatient follow-up period of 6 months. Results: The mean operative time in minutes ±SD was (125±12.5) for the early 10 patients while it was (69.8± 24) for the last 25 patients. Intraoperative complications were encountered in two cases of visceral injury and one case of bleeding arising from the inferior epigastric artery that was managed laparoscopically without surgical sequelae. The duration of hospital stay ranged from 24-48 hours. Postoperative complications were encountered in 3 patients whom had surgical emphysema which resolved conservatively. Patients returned to full activities in 7.14 ± 0.96 days and returned to their work in 14 ±2.5 days. On follow-up, recurrence was not encountered allover the period of 6 months postoperatively. Conclusion: TAPP repair for inguinal hernias is justified as a feasible, reproducible, and safe technique with rapid recovery and early return to work as well as comparable morbidities to other techniques. It is recommended as the procedure of choice in elective groin hernia repair especially in bilateral cases, with short learning curve requiring little facilities in the center.