A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction

Li, Weiming; Li, Yijun; Ding, Lili; Xu, Qianqian; Chen, Xiongzhi; Li, Shumin; Lin, Yueying; Xu, Pan; Sun, Dingyong; Sun, Yucheng

doi:10.1007/s00464-019-07303-x

Cited by 14 publications

(25 citation statements)

References 18 publications

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“…We have recommended that in cases where the indirect sac is extremely large, adherent and difficult to dissect completely from the cord structures that it should be partially and carefully separated from the cord, transected and the distal end be abandoned and left in the scrotum. Whether dissecting completely the sac or abandon the distal part it results in less postoperative seromas is an ongoing debate 7 , 12 . We feel however that for most cases transection of those huge sacs is safer than over-dissection of the cord structures and possible devascularization of the testicle and/or hematoma 6 , 9 .…”

Section: Resultsmentioning

confidence: 99%

Challenges to the 10 Golden Rules for a Safe Minimally Invasive Surgery (Mis) Inguinal Hernia Repair: Can We Improve?

Claus

Cavazolla

Furtado³

et al. 2021

ABCD, arq. bras. cir. dig.

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Background: Since publication of our paper “Ten Golden Rules for a Safe MIS Inguinal Hernia Repair” we have received many questions. As the authors, we feel it is important to address these topics as a follow-up to our paper. Aim: To discuss in more details the main points of controversy, review the rules and update de recommendations. Method: The questions and discussions came mainly over five rules, numbered 3, 5, 6, 7, 10. We analyzed all the comments about recommendations and update some technical principles. Results: Rule 3 - Removing normal fat plugs from the obturator canal is unnecessary and therefore is not recommended; Rule 5 - transection of the uterine round ligament (1 cm proximal to the deep ring) facilitates adequate dissection. When performed in this way it does not appear to be associated with complications; Rule 6 - transection of huge sacs are safer than over-dissection of the cord structures. Whether dissecting completely the sac or abandon the distal part it results in less postoperative seromas is an ongoing debate; Rule 7 - any retroperitoneal structure traversing the internal ring is or play a role like a hernia. Failing to identify and remove the lipoma will ultimately result in the patient experiencing a recurrence; Rule 10 - in TAPP peritoneum should preferably be closed with suture than tackes. Conclusion: 10 Golden Rules emphasize the most important surgical tips and technical steps that allow the safe performance of MIS repairs of inguinal hernias, regardless the technique.

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Section: Resultsmentioning

confidence: 99%

Challenges to the 10 Golden Rules for a Safe Minimally Invasive Surgery (Mis) Inguinal Hernia Repair: Can We Improve?

Claus

Cavazolla

Furtado³

et al. 2021

ABCD, arq. bras. cir. dig.

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“…In a similar study, patients were randomized and divided into 2 groups, but no difference was found in scrotal hernias in terms of intraoperative and postoperative complications, except for the duration of surgery, between the transection and reduction groups. 35 These 2 studies excluded scrotal hernias that could not be reduced into the abdomen. In our study, conversion was seen in 11 patients in 57 scrotal hernia cases.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Karabulut

Dönmez

Şahbaz

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. Materials and Methods: We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. Results: The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. Conclusion: Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.

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“…However, the complete reduction of the hernia sac group had higher hydrocele as well as testicular atrophy and cutaneous sensory deficit rates. Therefore, it’s important to state that opting for an abandon of the hernia sac technique does not conjecture higher rates of seroma or pseudo hydrocele at all, on the contrary, reduces the operation time and possibly avoid complications such as chronic pain 14 . Among variables regarding reducing seroma formation, only the use of surgical drains met the criteria to be significantly effective 3 .…”

Section: Discussionmentioning

confidence: 99%

Primary Abandon-of-the-Sac (Pas) Technique: Preliminary Results of a Novel Minimally Invasive Approach for Inguinoscrotal Hernia Repair

Morrell

Malcher

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the “primary abandon-of-the-sac” (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.

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A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction

Cited by 14 publications

References 18 publications

Challenges to the 10 Golden Rules for a Safe Minimally Invasive Surgery (Mis) Inguinal Hernia Repair: Can We Improve?

Challenges to the 10 Golden Rules for a Safe Minimally Invasive Surgery (Mis) Inguinal Hernia Repair: Can We Improve?

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Primary Abandon-of-the-Sac (Pas) Technique: Preliminary Results of a Novel Minimally Invasive Approach for Inguinoscrotal Hernia Repair

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