DOI: http://dx.doi.org/10.18203/2349-2902.isj20193332

Inguinal hernia repair in patients with liver cirrhosis: Lichtenstein repair versus laparoscopic total extra-peritoneal approach

Ahmed Mohamed Abdelaziz Hassan, Mohamed Emad Esmat, Magdy M. A. Elsebae, Magid M. Nasr

Abstract


Background: The optimal surgical approach of inguinal hernia in patients with liver cirrhosis; laparoscopic or open; is still undefined. Whether laparoscopic inguinal hernia repair is safe and potentially affords superior outcomes in patients with liver disease is unknown. Aim of this study is to assess the outcomes of laparoscopic inguinal hernia repair compared to open procedures regarding postoperative complications and recurrence rate in patients with liver cirrhosis.

Methods: This study involves data of ninety patients with primary unilateral inguinal hernia and liver cirrhosis. 48 of them had Lichtenstein repair and 42 patients had laparoscopic inguinal hernia repair with the total extra-peritoneal (TEP) approach.

Results: The mean operation time was greater for the patients operated by TEP than that by Lichtenstein repair with a statistically significant difference (p=0.02). Wound infection, scrotal edema and hospital stay were greater for the patients operated by Lichtenstein repair (p=0.0001 for all). At a mean follow-up of 16.9 months (range: 2 –32 months); recurrence of hernia developed in 3 (3.1 %) with Lichtenstein repair but no recurrence of hernia occurred in the patients operated with TEP.

Conclusions: Elective Laparoscopic inguinal hernia repair is feasible option in liver cirrhosis patients. However; despite of some better outcomes with TEP; there is insufficient evidence to conclude its greater effectiveness than Lichtenstein repair.

 


Keywords


Inguinal hernia, Liver cirrhosis, Lichtenstein repair, Laproscopic TEP repair

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References


Belghiti J, Durand F. Abdominal wall hernias in the setting of cirrhosis. Semin Liver Dis. 1997;17:219-26.

Carbonell AM, Wolfe LG, DeMaria EJ. Poor outcomes in cirrhosis-associated hernia repair:a nationwide cohort study of 32,033 patients. Hernia. 2005;9(4):353-7.

Oh HK, Kim H, Ryoo S, Choe EK, Park KJ. Inguinal hernia repair in patients with cirrhosis is not associated with increased risk of complications and recurrence. World J Surg. 2011;35(6):1229-33.

Pei KY, Liu F, Zhang Y. A matched comparison of laparoscopic versus open inguinal hernia repair in patients with liver disease using propensity score matching. Hernia. 2018;22(3):419-26.

Rühling V, Gunnarsson U, Dahlstrand U, Sandblom G. Wound Healing Following Open Groin Hernia Surgery:The Impact of Comorbidity. World J Surg. 2015;39(10):2392-9.

De Goede B, Klitsie PJ, Lange JF, and Metselaar HJ, Kazemier G. Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis:a systematic review. Best Pract Res Clin Gastroenterol. 2012;26(1):47-59.

Franzetta M, Raimondo D, Giammanco M, Di Trapani B, Passariello P, Sammartano A, et al. Prognostic factors of cirrhotic patients in extra-hepatic surgery. Minerva Chir. 2003;58(4):541-4.

Bhandarkar DS, Shankar M, Udwadia TE. Laparoscopic surgery for inguinal hernia:current status and controversies. J Minim Access. 2006;2(3):178-86.

Simons MP, Aufenacker T, Bay-Nielsen M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Cavazzola LT, Rosen MJ. Laparoscopic versus open inguinal hernia repair. Surg Clin North Am. 2013;93(5):1269-79.

Trevisonno M, Kaneva P, Watanabe Y, Fried GM, Feldman LS, Andalib A, et al. Current practices of laparoscopic inguinal hernia repair:a population-based analysis. Hernia. 2015;19(5):725-33.

McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;1:Cd001785.

Meyer A, Blanc P, Balique JG, Kitamura M, Juan RT, Delacoste F, et al. Laparoscopic totally extraperitoneal inguinal hernia repair:twenty-seven serious complications after 4565 consecutive operations. Rev Col Bras Cir. 2013;40(1):32-6.

Grant AM, Scott NW, O'Dwyer PJ. MRC Laparoscopic Groin Hernia Trial Group. Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg. 2004;91(12):1570-4.

Eklund A, Montgomery A, Bergkvist L, Rudberg C. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97(4):600-8.

Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair:an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2019;33(2):418-28.

Vărcuş F, Duţă C, Dobrescu A, Lazăr F, Papurica M, Tarta C. Laparoscopic Repair of Inguinal Hernia TEP versus TAPP. Chirurgia (Bucur). 2016;111(4):308-12.

Köckerling F, Bittner R, Jacob DA. TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015;29(12):3750-60.

Bobo Z, Nan W, Qin Q, Tao W, Jianguo L, Xianli H. Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias. J Surg Res. 2014;192(2):409-20.

Wang WJ, Chen JZ, Fang Q, Li JF, Jin PF, Li ZT. Comparison of the effects of laparoscopic hernia repair and Lichtenstein tension-free hernia repair. J Laparoendosc Adv Surg Tech A. 2013;23(4):301-5.