DOI: http://dx.doi.org/10.18203/2349-2902.isj20194409

Comparison of laparoscopic totally extraperitoneal mesh hernioplasty with Lichtenstein tension free mesh hernioplasty

Dhruv Kumar Sharma, Abhishek Thakur, K. J. S. Jaswal

Abstract


Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.

Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.

Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.

Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery. 


Keywords


Lichtenstein tension free mesh hernioplasty, Totally extraperitoneal mesh hernioplasty, Visual analogue scale

Full Text:

PDF

References


Rutkow M. Surgical operations in United States. In Arch Surg. 1997;132:983:90.

Amid PK. Lichtenstein tension free hernioplasty: its inception, evaluation and principles. Hernia. 2004;8(1):1-7.

Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A. Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc. 2004;18(3):518-22.

Kumar S, Nixon SJ, Macintyre IMC. Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit’s experience. J R Coll Surg Edinb. 1999;44:301-2.

Beet GL, Dirksen CD, Gom PM, Geisler FE, Baeten CG, Kootstra G. Open or laparoscopic mesh repair for recurrent inguinal hernia? A randomized controlled trial?. Surg Endosc. 1999;13:323-7.

Amid P, Shulman AG, Lichtenstein I. The Lichtenstein open tension-free hernioplasty. In: Arregui ME, Nagan RF, eds. Inguinal hernia. Advances or Controversies? Oxford, New York: Radcliffe Medical Press; 1994: 185-190.

Rulkow I. The recurrence rate in hernia surgery. Arch Surg. 1995;130:575-8.

Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The pathophysiology of recurrent hernia: a new concept introducing the tension-free repair. Contemp Surg. 1989;35:13-9.

Mameren H, Go MNYH. Surgical anatomy of the interior inguinal region. Surg Endosc. 1994;8:1212-15.

Johansson Bo, Hallerback B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh vs open preperitoneal mesh vs conventional technique for inquinal hernial repair; a radomized multicentre trial. Ann Surg. 1999;230:225-31.

Ramshaw BJ, Tucker JG, Duncan TD, Garcha I, Mason EM, Wilson JP, et al. Technical consideration of the different approaches to laparoscopic herniorrhaphy; an analysis of 500 cases. Am Surg. 1996;62:69-72.

Topal B, Hourlay P. Totally pre peritoneal endoscopic inguinal hernia repair. Br J Surg. 1997;84:61-3.

Spitz JD, Arregui ME. Suture less laparoscopic extraperitoneal inguinal herniorrhaphy unsing reusable instruments; 203 repairs without recurrence. Surg Laparosc Endosc Percutan Tech. 2000;10(1):24-9.

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

Kald A, Anderberg B, Smedh K, Karllsson M. Trans peritoneal or totally extraperitoneal approach in laparoscopic hernia repair: Results of 491 consecutive herniorrrhaphies. Surg Laparosc Endosc. 1997;7:80-9.

Chamspault GG, Rizk N, Catheline JM, Turner R, Boutelier P. Inguinal hernia repair, totally preperitoneal laparoscopic approach vs stoppa operation: randomized trial of 100 cases. Surg Laparosc Endosc. 1997;7(6):445-50.

Schrenk P, Woisetschlager R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after trans abdominal preperitoneal, total preperitonieal or Shouldice technique for inguinal hernia repair. Br J Sur. 1996;83:1563-6.

Gainant A, Geballa R, Bouvier S, Cubertafond P, Mathonnet M. Prosthetic treatment of bilateral inguinal hernias viz laparoscopic approach or Stoppa procedure. Ann Chir. 2000;125(6):560-5.

Liem MSL, Graff YVD, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, et al. Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. Eng J Med. 1997;336:1541-7.

Cohen RV, Alvarez G, Roll S, Garcia ME, Kawahara N, Schiavon CA, et al. Transabdominal or totally extraperitoneal laparoscopic hernia repair?. Surg Laparosc Endosc. 1998;8:264-8.

Halkic N, Ksontini R, Corpataus JM, Beslin MB. Laparoscopic inguinal hernia repair with extra peritoneal double mesh technique. J Laparosc Adv Surg Tech. 1999;9:492-4.

Vidovic D, Kirac I, Glavan E, Filipovic-Cugura J, Ledinsky M, Bekavac-Beslin M. Laparoscopic TEP vs open Lichtenstein hernia repair: results and complications. J Laparoendoscop Adv Surg Techn. 2007;17(5):585-90.

Lal P, Kajla R, Chander J, Saha R, Ramteke VK. Randomized controlled study of Laparoscopic TEP vs open Lichtenstein hernia repair. Surg Endoscopc. 2003;17(6):850-56.

Langveld HR, Vant M, Waidema WF, Stassen LP, Steyerberg EW, Lange J, et al. Total extraperitoneal inguinal hernia repair with Lichtenstein: a randomized control trial. Ann Surg. 2010;251(5):819-24.

Eker HH, Langeveld HR, Klitsie PJ, van't Riet M, Stassen LP, Weidema WF, Steyerberg EW, et al. Randomized clinical trial of total extraperitoneal mesh hernioplasty vs Lichtenstein repair. Arch Surg. 2012;147(3):256-60.

O’Riordain DS, Kelly P, Horgan PG, Keane FBV, Tanner WA. Laparoscopic extraperitoneal inguinal hernia repair in the day care setting. Surg Endoscopc. 1999;13(9):914-7.