Laparoscopic Hernia: Umbilical-Pubis Length Versus Technical Difficulty

Abstract

Laparoscopic hernia repair is more difficult than open hernia repair. The totally extraperitoneal procedure with 3 trocars on the midline is more comfortable for the surgeon. We studied the impact of the length between the umbilicus and the pubis on the totally extraperitoneal procedure (95 hernias operated on in 70 patients). This length did not influence the totally extraperitoneal procedure in this study.Background:The laparoscopic repair of hernias is considered to be difficult especially for the totally extra-peritoneal technique (TEP) due to a limited working space and different appreciation of the usual anatomical landmarks seen through an anterior approach. The aim of our study has been to answer a question: does the umbilical-pubic distance, which influences the size of the mesh, affect the TEP technique used in the treatment of inguinal hernias?Methods:From January 2001 to May 2011, the umbilical-pubic (UP) distance was measured with a sterile ruler graduated in centimeters in all patients who underwent a symptomatic inguinal hernia by the TEP technique in two hernia surgery centers. The sex, age, BMI, hernia type, UP distance, operation time, hospital stay and complications were prospectively examined based on the medical records.Results:Seventy patients underwent 95 inguinal hernia repairs by the TEP technique. The umbilical-pubic distance average was 14 cm (10 to 22) and a 25 kg/m2 (16–30) average concerning the body mass index (BMI). Seventy percent of patients were treated on an outpatient basis. The postoperative course was very simple. There was no recurrence of hernia within this early postoperative period.Conclusion:The umbilical-pubic distance had no influence on the production of TEP with 3 trocars on the midline in this study.

Intramesosigmoid hernia complicated by strangulated small-bowel obstruction

“…Laparoscopic repair of hernias is notably more difficult to perform,12 13 particularly when the small working space is further limited by dilated bowel loops and there is a lack of tactile feedback. In the event of bowel gangrene, conversion to laparotomy is still required10 and hence if there is high preoperative suspicion of gangrene, a laparotomy approach in an emergency setting will still be prudent.…”

Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique

“…However, it is a demanding technique 14 and requires an average of 60-70 procedures per surgeon to achieve a plateau of operative time 5 . Besides the steep learning curve, laparoscopic techniques are not routinely taught to general surgeons and may be challenging due to the limited space especially for those who are unfamiliar with pelvic anatomy 2 , 3 , 8 .…”

Laparoscopic treatment for inguinal hernia combined with cryptorchidism: Totally extraperitoneal repair with orchiectomy under the same operative view

“…Because we considered that the major merit of TEP is the unnecessity of approaching into the abdominal cavity, we have been routinely performing TEP repair for patients with inguinal hernia since 1997 in our hospital. Regarding the selection of procedure, we recommend that the surgeon chooses the technique with which he or she feels most comfortable [8] .…”