DOI: http://dx.doi.org/10.18203/2349-2902.isj20180822

Laparoscopic totally extraperitoneal repair of inguinal hernia using three-dimensional mesh: a 5 years experience at a tertiary care hospital in Kashmir, India

Iqbal Saleem Mir, Tajamul Rashid, Irfan Nazir Mir, Suhail Nazir, Imtiyaz Ali, Mansoor Ul Haq

Abstract


Background: Inguinal hernia repair by laparoscopy is gaining acceptance worldwide. A flat mesh used in laparoscopic inguinal hernia repair is associated with more complications especially early and late postoperative pain owing to the need of mechanical fixation of this mesh. A three-dimensional mesh in this context is an emerging alternative which needs no or minimal fixation.

Methods: A retrospective study of 123 patients was carried out from July 2012 to August 2017. All patients who underwent TEP by a single surgical team using three-dimensional mesh were included in the study. Data collected was analysed retrospectively.

Results: Out of a total of 123 patients, 114 patients had unilateral hernia and 9 had bilateral hernia. A total of 132 laparoscopic hernia repairs were done using three-dimensional mesh. All the patients were male aged 29 to 75 years with a mean age of 51.5 years. Indirect hernias were more common comprising of 87.7%. The mean operative time was 46.9 minutes. The average mesh fixation time was 12.6 minutes. No major intraoperative complications were noted in any of the patients. Three patients (2.45%) experienced severe postoperative pain. Most of the patients 117 (95.12%) were discharged within 24 hours of surgery. Mean hospital stay in our study was 1 day. The mean length of follow-up was 12 months. Mild persistent groin pain was found in four patients (3.25%). Seroma was noted in five patients (4.06%). Hematoma and wound infection was noted in none. One patient (0.81%) had recurrence after completion of follow up. We found use of 3D mesh costly.

Conclusions: Laparoscopic inguinal mesh hernioplasty using 3D mesh is a viable alternative of hernioplasty with minimal post-operative pain and recurrence and using 3D mesh has a technical advantage of easy insertion in an anatomically correct position with minimal fixation.


Keywords


Hernia, Mesh fixation, TEP

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References


Kingsnorth A, Leblanc K. Hernias: Inguinal and Incisional. Lancet. 2003;362(9395):1561-71.

Usher F. Hernia Repair with Marlex Mesh Arch. Surg. 1962;84:325-8.

Ger R. The Management of certain abdominal hernias by intra-abdominal closure of the neck. Ann. R. Coll. Surg. Engl. 1982;64;342-4.

Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc. 2012;26:3355-66.

Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238(3):391-9.

Takata MC, Duh QY. Laparoscopic Inguinal Hernia Repair. Surg Clin North Am. 2008;88(1):157-78.

Eriksen JR, Gögenur, Rosenberg J. Choice of Mesh for Laparoscopic Ventral Hernia Repair. Hernia. 2007;11(6):481-92.

Champault G, Bernard C, Rizk N. Inguinal hernia repair: the choice of prosthesis outweighs that of technique. Hernia. 2007 Apr;11(2):125-8.

Shah BC, Goede MR, Bayer R. Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia? Am J Surg. 2009 Dec;198(6):759-64.

Millat B. Inguinal hernia repair. A randomized multicentric study comparing laparoscopic and open surgical repair. J Chir. 2007;144:94-5.

Dulucq JL, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3100 hernia repairs over 15 years. Surg Endosc. 2009;23:4826.

European Hernia Society Guide-lines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343-403.

Bringman S, Blomqvist P. Intestinal obstruction after inguinal and femoral hernia repair: a study of 33,275 operations during 1992-2000 in Sweden. Hernia. 2005;9:178-83.

Heikkinen TJ, Haukipuro K, Koivukangas P. A prospective randomized outcome and cost comparison of totally extra-peritoneal endoscopic hernioplasty versus Lichtenstein operation among employed patients. Surg Laparosc Endosc. 1998;8:338-44.

Pawanindra L, Kajla RK, Chander J. Randomized controlled study of laparoscopic total extra-peritoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc. 2003;17:850-6.

Edwards CC, Bailey RW. Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech. 2000;10:149-53.

Swanstrom LL. Laparoscopic hernia repairs. The importance of cost as an outcome measurement at the century’s end. Surg Clin North Am. 2000;80:1341-51.

Bowne WB, Morgenthal CB, Castro AE. The role of endoscopic extraperitoneal herniorrhaphy: where do we stand in 2005? Surg Endosc. 2007;21:707-12.

Tamme C, Scheidbach H, Hampe C. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc. 2003;17:190-5.

Aliyazicioglu T, Yalti T, Kabaoglu B. Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Using 3-dimensional Mesh Without Mesh Fixation. Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 2017 Aug 1;27(4):282-4.

Laparoscopic Groin Hernia Repair Using a Curved Prosthesis without Fixation. Le Journal de Celio-Chirurgie. 1998;28:64-8.

Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R. Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surgical endoscopy. 2010 Dec 1;24(12):3026-30.

Melzack R, Wall PD. The Challenge of Pain. 2nd Edition, Penguin Books, New York: 1996;17-19.

Ferzli GS, Frezza EE, Pecoraro AM, Ahern KD. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair 1. Journal of the American College of Surgeons. 1999 May 1;188(5):461-5.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons Jr R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine. 2004 Apr 29;350(18):1819-27.

Carter J, Duh QY. Laparoscopic Repair of Inguinal Hernias. World Journal of Surgery. 2011;35:1519-25.

Mir IS, Alfer AN, Aijaz AM, Muntakhab N, Yawar W, et al. An Experience of Short - term Results of Laparoscopic Inguinal Hernioplasty Using 3D Mesh. International Journal of Clinical Medicine. 2015;6(1):64-9.

Bell RC, Price JG. Laparoscopic Inguinal Hernia Repair using an anatomically Contoured Three- Dimensional mesh Surg Endosc. 2003;17(11):1784-8.