Laparoscopic Totally Extraperitoneal Hernia Repair Versus Open Lichtenstein Hernia Repair: Results and Complications

Abstract

Whereas open Lichtenstein inguinal herniorrhaphy is generally accepted as a safe, well-understood method with a high success rate, the laparoscopic repair of a inguinal hernia is a fairly recent technique. Although the laparoscopic approach to a hernia repair procedure is associated with less pain and faster recovery than open repair, many surgeons are not familiar with this technique owing to technical demands and a long learning curve. This study compares the results and complications between open tension-free mesh (Lichtenstein) repair and laparoscopic total extraperitoneal (TEP) repair. The study cohort was comprised of 345 consecutive patients who underwent an inguinal herniorraphy procedure. An open hernia repair was performed on one group of patients (n = 233), whereas TEP repair was performed on the other (n = 112), and then the comparison of intra- and postoperative complications and results obtained from both techniques was done. The mean hospital stay was similar in both groups. The average operative time in the TEP group was 58.6 +/- 18.1 minutes, and the average operative time in the open group was 58.2 +/- 17.8 minutes. There was no difference in postoperative complication rates between the two groups, except for urinary retention, which patients who underwent TEP repair were more likely to get. The following major complications were recorded: 2 cases of urinary bladder perforation-1 during TEP repair and the other during Lichtenstein repair, but both with good postoperative outcome-and 1 case of pneumothorax, which occurred during the TEP procedure. Despite the fact that TEP is a demanding procedure, it may be performed efficiently with an acceptable operating time and a low complication rate.

Laparoscopic transabdominal preperitoneal approach for inguinal hernia repair: A five-year experience at a single center

“…The recurrence rates are very low after both open and laparoscopic mesh repairs, and randomized studies have not shown any signifi cant difference with regard to either adverse effects or recurrence. 10,18,19 In a TEP repair the peritoneum is not penetrated, and the trocars are placed preperitoneally in a space created between the peritoneum and the fascia. The TEP approach involves the creation of a preperitoneal space posterior to the inguinal canal either with a telescope or, more commonly, with a preperitoneal distention balloon system.…”

“…1,3,4,18,22 Nevertheless, the laparoscopic approach has been slow in gaining popularity among surgeons for several reasons. First, more advanced technical skills are required compared with a conventional Lichtenstein repair.…”

Retzius and Bogros Spaces: A Prospective Laparoscopic Study and Current Perspectives

“…Poor familiarity with posterior perspective of the complex inguinal anatomy is an important factor for the steep learning curve for the laparoscopic inguinal hernioplasty. [4][5][6][7] A lot of confusions and misunderstandings abound regarding the retropubic space of Retzius and the subinguinal space of Bogros. [8][9][10][11][12] Space of Bogros was first described in 1823 by French anatomist Annet Jean Bogros.…”

Comparison of Single Incision Laparoscopic Totally Extraperitoneal and Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: Initial Experience

“…In our first few cases, incision was placed in the midline a few centimeters below the umbilicus, as described for LAP-TEP. 4 Later, we placed a horizontal incision within the umbilicus. By moving the skin incision closer to the umbilicus, we created a longer channel to the extraperitoneal space, and initial CO 2 leakage problems were minimized.…”