An Experience of Short-Term Results of Laparoscopic Inguinal Hernioplasty Using 3D Mesh in a Developing Country

Abstract

Background: The experience of short term results of laparoscopic inguinal hernia repair using 3D mesh in a developing country is reviewed. Methods: From January 2012 to February 2014, 53 patients underwent laparoscopic inguinal hernioplasty. A retrospective case series of 53 consecutive patients undergoing TEP/TAPP by a single surgical team was followed prospectively with a focused physical examination and interview. 4 out of 53 patients had recurrent hernia following open repairs and 49 had primary hernias. Data collected included operative time, intraoperative bleeding, intraoperative difficulties, immediate postoperative pain, chronic groin pain, recurrence, sensory disturbance, activity or occupational limitation and personal satisfaction. Results: All the patients were male aged 32 to 75 years with a mean age of 53.5 years. Mean operative time was 37.4 minutes; intraoperative dissection, blood loss were less; and immediate postoperative pain was negligible as assessed by VAS. There was no mortality or major morbidity. Mean follow-up was 12 months (2 to 18 months). Follow-up was completed by interview and physical examination. Hernia was not found to recur during the follow up period. Chronic pain occurred in 2 patients (3.7%), which was mild in nature. Ninety-seven percent of patients were satisfied with their repair and would or had recommended TEP/TAPP to others using 3D Mesh. Conclusions: Short-term results of TEP/TAPP hernia repair using 3D mesh demonstrated to be an effective and safe procedure with low prevalence of chronic pain that is generally of a mild, infrequent nature. It was also concurred that there is decrease in operative time. Manipulation of mesh was significantly reduced. Intraoperative bleeding and use of post operative analgesia was reduced considerably. There was no recurrence, however the cost of the mesh increased the overall cost of the procedure acting as a limiting factor in a developing country.

A comparative study of three-dimensional mesh (3D mesh) and polypropylene mesh in laparoscopic inguinal hernia repairs in adults

“…Such alternatives, however, would require further investigation to ensure that reduced fixation does not come at the expense of increased recurrence. 21,30 In the present study authors have found a higher recurrence rate at 18 months in both groups with a recurrence rate of 3.3% in 3D mesh and 6.7% in polypropylene mesh. The difference in present study failed to reach any statistical significance (p-value-1.00), however it needs further investigation.…”

“…20 Mir I.S et al, in their study of 3D mesh in laparoscopic inguinal hernia reported immediate severe postoperative pain rate of 1.88%. 21 The reduced postoperative pain in case of 3D mesh is supported by the fact that the use of 3D mesh eliminates the use of sutures or tacks as is needed with the flat mesh thereby avoiding nerve entrapment. 22 However an increased incidence of immediate severe postoperative pain with the use of 3D mesh in present study can be attributed to small cohort and lack of extensive research data.…”

“…This is consistent with the findings of Mir I.S et al, who found an incidence 3.77% of chronic groin pain using 3D mesh during a mean follow up period of 12 months. 21 It was found the incidence of chronic groin pain at 3.7% in lightweight poylpropylene mesh and 7.1% in heavyweight polypropylene mesh. 28 Authors have reported pain scores in patients receiving lightweight polypropylene mesh were consistently lower than the control group receiving heavyweight polypropylene mesh over a follow up of 1 year.…”

“…Study of laparoscopic inguinal hernia repair using 3D mesh reported a sensory impairment incidence of 1.8%. 21 The study of laparoscopic inguinal hernia repair using a flat polypropylene reported no neuralgia or sensory impairment on follow up. 20 The higher incidence of sensory impairment in polypropylene mesh in present study could be attributed to the method of intraoperative mesh fixation, usually spiral tacks.…”

“…23 Mir I.S et al, in their study of short term outcomes of laparoscopic inguinal hernioplasty using 3D mesh on 53 consecutive patients, reported a postoperative seroma development rate of 3.77%. 21 With regard to seroma formation in polypropylene mesh in laparoscopic inguinal hernia repairs, B Adil et al, conducted a study on 192 patients using composite polypropylene mesh and lightweight polypropylene mesh in TAPP repair for inguinal hernias. The frequency of seroma formation was higher in the composite polypropylene group (6.25%).…”