Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.     

An inguinal hernia that arose after robot-assisted radical prostatectomy and the repair of an intraoperative external iliac vein injury: A case report

This case involved a 63-year-old man. He underwent robot-assisted radical prostatectomy (RARP) for prostate cancer. One year after the operation, he consulted our hospital about left inguinal swelling. Under a diagnosis of a left external inguinal hernia, transabdominal preperitoneal repair (TAPP) was performed under general anesthesia. The inside of the hernia orifice had been damaged by the RARP, and the resultant fibrosis was so marked that it was difficult to dissect the preperitoneal space. Furthermore, an external iliac vein injury occurred during the operation. The bleeding was controlled, and we used laparoscopic continuous non-absorbable sutures to repair the external iliac vein injury. The number of TAPP procedures performed after radical prostatectomy has been increasing in recent years, but dissecting the preperitoneal space inside a hernia orifice is difficult. Although external iliac vein injuries are rare complications of TAPP procedures, they can be laparoscopically repaired.     

腹腔镜经腹膜腹股沟斜疝无张力修补手术方式的体会（附23例报告）

目的：探讨腹腔镜经腹膜腹股沟斜疝无张力修补手术（TAPP）的方式。方法：显露腹膜前间隙的“三管”（输精管、精索血管和腹壁下血管）和“三带”（Cooper韧带、腹横筋膜带和髂耻束带），将生物补片同定于输精管和精索血管所夹锐角以外的“三带”上。结果：通过抓住“三管”及“三带”结构．把深环周边及腹膜前的复杂解剖关系简单化，把副损伤降低到最低点，使手术时间缩短，操作得心应手。结论：TAPP的操作虽然复杂，但只要吃透腹膜前解剖，抓住重要的解剖要点，可使手术变得相对容易，使更多的腹腔镜医生得以掌握，腹腔镜疝修补术得以推广。     

Erfahrungen mit der laparoskopischen transabdominellen präperitonealen (TAPP) Technik bei Versorgung von „Rezidiv-Leisten-Hernien“

Zusammenfassung. Einleitung: Berichtet wurde über 276 Operationen, welche aufgrund eines Erst-, Zweit- oder Mehrfachrezidivs in transabdomineller pr?peritonealer laparoskopischer Technik (TAPP) durchgeführt worden waren mit der Fragestellung der Evaluierung der transabdominellen pr?peritonealen Operationstechnik in besonderer Hinsicht auf die Behandlung der Rezidiv-Leistenhernien. Methoden: Die Patienten wurden in unserer Klinik nach zwei Wochen und einem Jahr nachuntersucht. Die Nachbeobachtungsrate ein Jahr nach Operation lag bei 78,1 %. Die Behandlungs- und Operationsdaten wurden prospektiv erhoben. Ergebnisse: Die Komplikationen wurden in unwesentliche und wesentliche unterteilt. Die Gesamtkomplikationsrate lag bei 9 %, wobei 5,3 % der Kranken wesentliche Komplikationen erlitten. Neben den allgemeinen Vorteilen der laparoskopischen Chirurgie zeigt sich eine sehr geringe Re-Rezidivrate mit nur 0,4 % nach einer Beobachtungszeit von einem Jahr. Schlussfolgerung: Neben der Indikation bei Prim?rleistenhernien mit ausgedehntem Hinterwanddefekt sowie doppelseitigen Leistenhernien bevorzugen wir die transabdominelle pr?peritoneale (TAPP) Methode bei Versorgung von Rezidivhernien.      

Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study

Background The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. Methods For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. Results There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Conclusion Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.     

Laparoscopic transabdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3017patients

BACKGROUND: This report reviews our experience with 3530 transabdominal preperitoneal (TAPP) hernia repairs in 3017 patients (513 bilateral) over the 7-year period from May 1992 to July 1999. We have continually audited our practice and modified the techniques in response. METHODS: Unless contraindicated, laparoscopic TAPP repair is considered the procedure of choice at our institution for all reducible inguinal hernias. We initially stapled an 11 x 6 cm polypropylene mesh in the preperitoneal space but now place a 15 x 10 cm mesh in the preperitoneal space with sutured peritoneal closure. RESULTS: There have been a total of 22 recurrences, of which 17 were identified in the first 325 repairs (5%) using the 11 x 6 cm mesh. Five recurrences occurred in the later 3205 repairs (0.16%) (median follow up of 45 months). There was one 30-day death unrelated to the procedure. There have been seven conversions (four due to irreducibility, two due to extensive adhesions, one due to bleeding). Bladder perforations have occurred in seven cases, of which six were recognized immediately and treated laparoscopically without sequelae. There have been seven cases of small bowel obstruction from herniation through the peritoneal closure. Sutured repair of the peritoneum has reduced the incidence of this complication. Four patients had mesh infections, of whom three were treated conservatively. The incidence of postoperative seroma and hematoma was 8%. Median operation time remains at 40 min with a mean hospitalization of 0.9 nights. Sixty percent of TAPP hernia repairs are now performed on the Day Surgical Unit with a 3% admission rate. Median return to normal activities is 7 days. Forty percent of patients require no postoperative analgesia. These figures remain the same whether the hernia is primary, recurrent, unilateral, or bilateral. Consultants performed most operations early in the series, but latterly surgical trainees have performed the majority of these procedures under supervision. CONCLUSIONS: Laparoscopic TAPP hernia repair is technically difficult, but in the hands of a well-trained surgeon, it is safe and effective with a high degree of patient satisfaction. The low recurrence rate compares favorably to other tension-free mesh hernia repairs.     

Diagnosis and classification of inguinal hernias

Background: The aim of this prospective clinical study was to determine whether the presence of a hernia, its size, and its type can be established preoperatively by clinical and ultrasound, examination. Methods: The study population comprised 220 consecutive patients referred to our department for the surgical management of an inguinal hernia. On admission, both inguinal regions were examined clinically and by ultrasound. All patients were operated on laparoscopically. Results: In regard to the intraoperative findings for both inguinal regions, clinical and ultrasound examination for the diagnosis of inguinal hernia yielded a high total rate of accuracy of 93% respective 94%. However, when the same methods were used to differentiate between lateral and medial hernia, the total rate of accuracy fell to only 54% respective 62%. In the determination of inguinal hernia size, it was even lower: 50% respective 53%. Conclusions: Although a diagnosis of inguinal hernia can be established reliably by clinical and ultrasound examination, only an approximate classification is possible by these methods.     

腹腔镜经腹腹膜前修补术对睾丸血供及生精功能影响的临床研究

目的 观察腹经腹腹膜前修补术对睾丸血供及生精功能影响。方法 2017年6月~2019年1月,收集在医院行腹腔镜经腹腹膜前修补术患者,共41例,比较其术前、术后7天、术后6月精子浓度、精子活力、血清卵泡刺激素（FSH）、血清抑制素B（IHN-B）、睾丸体积、睾丸动脉收缩期峰值血液流速（PSV）的差异。结果 与术前相比,术后7天及术后6月精子浓度、精子活力、血清卵泡刺激素、血清抑制素B、睾丸体积均无明显差异,而PSV在术后6天较术前有明显降低,差异有统计学意义,而术后6个月差异无统计学意义。术后血肿、手术时间延长是术后睾丸血供异常的风险因素。结论 经腹腹膜前修补术对睾丸生精功能无显著影响。