Laparoscopic Transabdominal Preperitoneal Technique for Inguinal Hernia Repair in Adults

Abstract

Background Inguinal hernia repair is one of the most commonly performed operations in general surgery, especially in the digestive field. Since the introduction of laparoscopic repair as well as using a synthetic mesh, the surgical trends have changed in the last decade in treating inguinal hernias. The laparoscopic transabdominal preperitoneal gives a better view of the inguinal anatomy, and the procedure also has a short learning curve. We aim to evaluate the safety and early outcome of the laparoscopic transabdominal preperitoneal technique for inguinal hernia repair using a Prolene ® mesh (Ethicon Somerville, NJ, USA). Methods A prospective study was carried out among 31 adult patients with 34 inguinal hernia cases. They underwent the laparoscopic transabdominal preperitoneal technique with a Prolene mesh at the Hue Central Hospital from December 2018 through May 2019. Results The mean age was 60.4 ± 11.8, and 96.8% of cases were male. Strangulated hernia and incarcerated hernia accounted for 2.9% and 8.8% of cases, respectively. The mean duration of unilateral inguinal hernia repair and bilateral inguinal repair was 57.1 ± 17.3 minutes and 80.3 ± 10.6 minutes, respectively. The mean duration of the postoperative hospital stay was 3.9 ± 1.4 days. One (3.2%) case with contralateral inguinal hernia was detected intraoperatively. An early and three-month postoperative evaluation showed that 93.5% and 96.8% of cases were categorized as "very good", respectively. At the three-month evaluation, one case was reported with sensation disorder of the inguinal area, and there was no recurrence. Conclusions Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and feasible technique. It allows surgeons to explore the opposite site and resolve the combined peritoneal diseases.

Early Outcomes of Laparoscopic Transabdominal Preperitoneal (TAPP) Repair

“…This result shows the general concept that the occurrence of inguinal hernia increases with age as predisposing factors for hernia are more in the elderly, such as chronic cough, constipation, and benign prostatic hyperplasia (BPH) [ 9 ]. The results are similar to other studies, such as those of Thanh Xuan and Huu Son [ 10 ], where the average age was 60.4±11.85 years, and Peitsch, with an average age of 59.1 years [ 11 ]. Right-side inguinal hernias were more common (29 (48.3%)) than left (17 (28.3%)) and bilateral (6 (10%)) hernias, which corresponds to other studies [ 10 ].…”

“…The results are similar to other studies, such as those of Thanh Xuan and Huu Son [ 10 ], where the average age was 60.4±11.85 years, and Peitsch, with an average age of 59.1 years [ 11 ]. Right-side inguinal hernias were more common (29 (48.3%)) than left (17 (28.3%)) and bilateral (6 (10%)) hernias, which corresponds to other studies [ 10 ]. Out of a total of 60 patients, 52 (86.6%) had a primary inguinal hernia, and eight (13.3%) had a recurrent hernia.…”

Reparación laparoscópica de hernia de Spiegel. ¿Cómo lo hacemos nosotros?

“…Se recomienda el cierre primario de la fascia cuando los defectos herniarios son mayores de 1 cm en TAPP, 14 esto ha demostrado disminución en la formación de seromas, disminución de infección del sitio quirúrgico y de la recurrencia de la hernia. 11 Cuando se cierra la fascia es de utilidad tomar parte del saco herniario, ya que nos ayuda a disminuir el espacio muerto. Por otro lado, no recomendamos la cauterización de saco herniario, ya que al momento la evidencia científica es débil con pocos estudios que demuestren algún beneficio.…”

“…Por otro lado, no recomendamos la cauterización de saco herniario, ya que al momento la evidencia científica es débil con pocos estudios que demuestren algún beneficio. 11 La malla ideal depende en gran medida de su disponibilidad institucional, costo y preferencia del cirujano. Se recomienda el uso de mallas macroporosas de polipropileno medianamente pesadas por su bajo costo-complicaciones.…”

“…Se crea un colgajo peritoneal similar al abordaje tipo TAPP utilizado para la reparación de hernia inguinal. 11 Se inicia la creación de flap, al menos 4 cm proximal al defecto en sentido horizontal, esto sucede en el espacio preperitoneal, con disección roma o cortante, ya que es un espacio mayormente avascular. El saco herniario debe visualizarse con claridad y disecarse de manera suave (Figura 4), teniendo cuidado para evitar lesiones en los vasos epigástricos inferiores, la línea semilunar y el contenido del saco, sugerimos realizar la disección preperitoneal rodeando el saco y al final atacar el mismo y reducir el saco, este paso previo permite con mayor facilidad la resolución del caso (Figura 5).…”