Significance of umbilical trocar size and intra‐abdominal pressure on postoperative pain after transabdominal preperitoneal repair for inguinal hernia

Abstract

Introduction: Laparoscopic inguinal hernia repair is reported to be associated with lower postoperative pain than open repair. However, in the actual clinical setting, some patients experience relatively severe pain. This study aimed to elucidate surgical factors that affect pain after transabdominal preperitoneal (TAPP) repair. Methods: We evaluated 199 patients who underwent elective TAPP for inguinal hernia from 2014 to 2019 in Heisei Memorial Hospital. The umbilical trocar size was changed from 12 to 5 mm from October 2017. The pneumoperitoneum intra-abdominal pressure was changed from 10 to 8 mmHg from 2019. Postoperative pain scores and analgesics were compared between patients who were grouped according to trocar size and intra-abdominal pressure, as well as 80 patients who received open repair. Results: Patients with a 12 mm trocar had significantly higher pain than open repair patients (P < .0001). Patients with a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure had significantly lower pain than a 12 mm trocar (P = .025) and did not significantly differ with pain after open repair. Analgesic use significantly decreased in patients using a 5 mm trocar than 12 mm (P = .002). Conclusion: Umbilical trocar size and pneumoperitoneum intra-abdominal pressure were significantly associated with post-TAPP pain. Using a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure achieved pain levels as comparatively low as open repair.

Proposal of a Novel Index of Abdominal Compliance and the Association With Postoperative Pain After Laparoscopic Inguinal Hernia Repair

“…However, precise measurements of the abdomen require such equipment as a flowmeter, manometer, and computer recording system,17 or a motion tracking system,18 or a tensiometer,19 and other factors such as gas leakage during continuous insufflation may interfere with the accuracy of the measurement. Furthermore, as reported before, despite the relatively low-pressure settings, increasing insufflation pressure even from 8 to 10 mm Hg can cause significantly higher pain 20. So, it would defeat the purpose of measuring AC to predict and prevent postoperative pain if the abdominal wall were to be overextended with high insufflation pressure during measurement.…”

“…Furthermore, as reported before, despite the relatively low-pressure settings, increasing insufflation pressure even from 8 to 10 mm Hg can cause significantly higher pain. 20 So, it would defeat the purpose of measuring AC to predict and prevent postoperative pain if the abdominal wall were to be overextended with high insufflation pressure during measurement. Therefore, we aimed to evaluate the change of the abdominal cavity, from the rest state to the establishment of lowpressure pneumoperitoneum, in a single measurement.…”

Senhance Robotic Platform System for Gynecological Surgery

“…Use of smaller trocars (Յ 5 mm) is associated with less postoperative pain, reduced postoperative pain medication, less risk of vascular injury, less risk of trocar site herniation, and smaller scars. [14][15][16] The improved scar cosmesis from use of 3 mm or 5 mm trocars in a mini-laparoscopic hysterectomy is barely noticeable and drives patient satisfaction. Use of the robotic system has an advantage over the traditional TLH because of its precise movements, small ports, and excellent visualization of the tissues.…”