DeGarengeot hernia: transabdominal preperitoneal hernia repair and appendectomy.

BACKGROUND: The incarcerated appendix in the femoral hernia represents a rare clinical case that was first described by the Frenchman de Garengeot in 1731. Besides the open procedures, laparoscopy presented itself as a treatment option. CASE REPORT: Our case concerns a 38-year-old patient with a right femoral hernia with an inflamed incarcerated appendix. Because of the clinically inconclusive finding, we chose transperitoneal preperitoneal hernia repair (TAPP) combined with a laparoscopic appendectomy. The intra- and postoperative course was uneventful. This case shows that a laparoscopic procedure is possible even in the case of an incarceration in conjunction with an appendicitis that has not spread to the adjacent peritoneum. DISCUSSION: Compared with open interventions, the subjective social advantages (shorter hospital stay, earlier return to work, less need for pain killers, and others) of laparoscopic hernia treatment have been extensively studied. The use of both methods in the case of an incarcerated hernia is open to dispute, though various small series confirm the feasibility. CONCLUSION: Here, TAPP seems to be the more reliable method in terms of patient safety because of the simultaneous possibility of using laparoscopy.     

Pain during sexual activity and ejaculation following hernia repair: A retrospective comparison of transabdominal preperitoneal versus Lichtenstein repair

Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.     

Two cases of early recurrence after transabdominal preperitoneal inguinal hernia repair

We performed transabdominal preperitoneal inguinal hernia repair in 46 patients (58 diseases), two of whom experienced early recurrence after mesh repair. Case 1 was a 76‐year‐old man with a bilateral inguinal hernia (recurrence site, left indirect hernia) after appendectomy. The recurrence occurred 1 month after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using the direct Kugel ® patch with an anterior technique. Case 2 was a 79‐year‐old man with a bilateral inguinal hernia (recurrence site, right direct hernia with an orifice >3 cm) after appendectomy. The recurrence occurred 3 months after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using an ULTRAPRO ® Plug with an anterior technique under laparoscopic observation. We believe the recurrences resulted from insufficient internal exfoliation and fixation affected by complicated exfoliation of the preperitoneal space with omental adhesion after intraperitoneal surgery.     

腹腔镜下不同术式与开放手术疝修补术治疗腹股沟疝的疗效

目的比较腹腔镜下经腹腔腹膜前疝修补法（TAPP）、完全腹膜外疝修补法（TEP）与开放式无张力疝修补术（Lichtenstein）治疗腹股沟疝的疗效及安全性。 方法选择2015年3月至2017年8月就诊于松滋市人民医院的150例腹股沟疝患者,按照随机数字表法分为3组,Lichtenstein组、TAPP组、TEP组,各50例。对比3组手术相关指标、并发症及术后6个月复发率,并观察围手术期患者应激反应[皮质醇（Cor）、去甲肾上腺素（NE）、醛固酮（ALD）]变化。 结果3组手术时间、术后并发症发生率比较,差异均无统计学意义（P>0.05）;Lichtenstein组术中出血量、术后12 h疼痛数字评分（NRS）、术后下床活动时间及住院时间均比TAPP组和TEP组高,住院费用比TAPP组和TEP组低,差异有统计学意义（P<0.05）;TEP组术后12 h NRS评分、术后下床活动时间及住院费用比TAPP组低,差异有统计学意义（P<0.05）;Lichtenstein组术后3 d Cor、NE及ALD水平,复发率比TAPP组和TEP组高,差异均有统计学意义（P<0.05）。 结论Lichtenstein术治疗腹股沟疝操作相对简单、费用低,腹腔镜下TAPP、TEP术具有应激创伤小、疼痛轻、并发症少、复发率低等特点,临床应结合患者具体病情选择适宜的手术修补方式。     

Comparison of biomaterials in the early postoperative period

Background: Laparoscopic hernia repair necessitates the use of biocompatible materials. A prospective, double-blind study was conducted to compare two different polypropylene meshes. Methods: The study included 40 men with primary inguinal hernia undergoing transabdominal preperitoneal polypropylene mesh repair. In 20 of these men, a monofile, heavy-weight, rigid mesh was implanted (group A), and in the remaining 20 men, a smooth, heavy-weight variant of polypropylene mesh was implanted (group B). Complications, pain development, inability to work, physical conditions, testicular volume, and blood circulation were documented. Results: Reconvalescence in group A was slower than in group B. In group A, the postoperative values of the visual scales for pain development were higher; inability to work was 7.3 days longer; urologic disorders were worse; activities of everyday life were more reduced; and SF-36 data showed a significant reduction of physical problems (p < 0.05). Conclusions: The polypropylene mesh variant seems to be more compatible with the human organism than conventional mesh. Not only the material, but also the structure seems to influence the comfort of the mesh.     

Preperitoneal herniation and bowel obstruction post laparoscopic inguinal hernia repair: case report and review of the literature

Laparoscopic inguinal hernia repairs, both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP), are associated with peritoneal defects or tears. Nonclosure of the tears can lead to bowel obstruction. I present a case of an early (48 h) bowel obstruction related to a peritoneal defect post TAPP inguinal hernia repair. The literature on peritoneal closure and bowel obstruction related to laparoscopic inguinal hernia repair is reviewed as well as options for repairing defects.     

Comparing fibrin sealant with staples for mesh fixation in laparoscopic transabdominal hernia repair: a case control-study

Background

Laparoscopic hernia repair is not as popular as cholecystectomy. We have performed more than 3,000 laparoscopic herniorrhaphies using the trans-abdominal (TAPP) technique. To prevent recurrences we fix the polypropylene mesh with staples. The use of fibrin glue for graft fixation is a possible alternative.

Methods

We have performed 3,130 laparoscopic hernia repairs over 14 years. For mesh fixation we used titanium clips and observed a small number of complications. In July 2003 we started using fibrin glue (Tissucol®). The purpose of this retrospective longitudinal study was to evaluate if the use of fibrin sealant was as safe and effective as conventional stapling and if there were differences in post-operative pain, complications and recurrences.

Results

From July 2003 to June 2006 we performed 823 laparoscopic herniorrhaphies. Fibrin glue (Tissucol®) was used in 88 cases. Two homogeneous groups of 68 patients (83 cases) treated with fibrin glue and 68 patients (87 cases) where the mesh was fixed with staples, were compared. Patients with relevant associated diseases or large inguino-scrotal hernias were excluded. Operative times were longer in the group treated with fibrin glue with a mean of 35 minutes (range 22–65 mins) compared to the group treated with staples (25 minutes, range 14–50 mins). The time of hospital stay was the same (24 hours). Post-operative complications, that were more frequent in the stapled group, included trocar site pain, hematomas, intra-operative bleedings and incisional hernias. No significant difference was observed concerning seromas, chronic pain and recurrence rate.

Conclusions

Less post-operative pain, and a faster return to usual activities are the main advantages of laparoscopic repair compared to the traditional approach. The use of fibrin sealant reduces in our experience the risk of post- and intra-operative complications such as bleeding and incisional hernia; recurrence rates are similar, but the operative time is longer.

     

Die „spannungsfreie“ Reparation der Leistenhernie: laparoskopisch (TAPP) versus offen (Lichtenstein)

Zusammenfassung. Im Rahmen einer prospektiven Beobachtungsstudie wurden im Zeitraum Juni 1992 bis Februar 1994 94 Patienten mit 100 Leistenhernien laparoskopisch (TAPP) und von M?rz 1993 bis November 1994 100 Patienten mit 108 Leistenhernien offen mit einem Lichtenstein-Patch versorgt. In bezug auf Operationsdauer, postoperative Schmerzen und Komplikationen sowie Krankenstand wurden nur geringe Unterschiede festgestellt. Aufgrund der schwierig erlern- und lehrbaren Technik wurde die TAPP-Operation nur von einem Operateur, die Lichtenstein-Operation von allen 11 Mitarbeitern durchgeführt, was die Einfachheit des offenen Vorgehens demonstriert. Bislang zeichnet sich eine h?here Rezidivh?ufigkeit für die TAPP-Gruppe (8 vs. 0) ab, wobei jedoch die Lernphase zu berücksichtigen ist. Die Lichtenstein-Operation ist in Lokalanaesthesie einfach auszuführen, leicht erlern- und lehrbar, sicher, effizient und kostensparend (DM 750,–) und deshalb der laparoskopischen Methode überlegen. Eine geplante randomisierte Studie wurde verworfen, laparoskopische Hernienreparationen werden in unserer Klinik seither nicht mehr durchgeführt. Schlüsselw?rter: Laparoskopische Hernienreparation (TAPP) – Lichtenstein-Operation – spannungsfreie Leistenbruchoperation.

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Summary. In a prospective study, from June 1992 to February 1994 94 patients with 100 hernias were treated laparoscopically (TAPP) and from March 1993 to November 1994 100 patients with 108 hernias were treated with a Lichtenstein patch. Concerning duration of operation, postoperative outcome, complications and return to work, only minor differences were noted. Because of the more demanding and difficult technique, all TAPP procedures were performed by one surgeon, whereas all 11 surgeons of the department performed the Lichtenstein procedure without any learning curve, which demonstrates the simplicity of the procedure. A higher recurrence rate was found for the TAPP procedure (8 vs 0), however the learning curve has to be considered. The Lichtenstein operation is easy to learn and perform, safe, efficient, cheaper (750 DM) and therefore superior to the TAPP procedure. A planned randomized study was cancelled; laparoscopic hernia repair is no longer carried out in our department.

     

Laparoscopic hernioplasty

This study compares the results of two laparoscopic hernioplasties: the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP). Over a 43-month period 1,115 laparoscopic hernioplasties, 733 TAPP and 382 TEP, were performed in 866 patients. There were 11 major complications in the TAPP group (2 recurrences, 6 trocar hernias, 1 small-bowel obstruction, 1 trocar, and 1 dissection injury of the small bowel) compared to 1 recurrence and no intraperitoneal complications in the TEP group. Five TEP procedures required conversion to the TAPP approach, resulting in one umbilical hernia. The median time to return to work did not vary with the approach, but was prolonged in patients compensated for time off, 16 vs 8 days for noncompensated patients.Results suggested that both techniques shortened recovery and eliminated most early failures, but the totally extraperitoneal approach reduced the potential for intraperitoneal complications and may be the procedure of choice in most situations.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery

Background Many practicing surgeons claim that hernias after previous lower abdominal surgery should be treated by transabdominal preperitoneal repair (TAPP). Moreover, previous radical prostatectomy contraindicates the laparoscopic approach for hernia repair. This prospective study was designed to examine the feasibility and to evaluate the surgical outcome of laparoscopic totally extraperitoneal (TEP) hernia repair in patients who had undergone previous lower abdominal surgery or radical prostatectomy, and to compare this group to all patients who underwent laparoscopic TEP without previous surgery during the study period. Methods Patients undergoing elective inguinal hernia repair, by one staff surgeon, in the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS, Bordeaux) between September 2003 and December 2004 were prospectively enrolled to this study. Three groups were defined—patients with previous radical prostatectomy, patients with previous lower abdominal surgery, and patients without previous surgery—and their data were analyzed and compared. Results A total of 256 laparoscopic inguinal hernia repairs were performed in 202 patients. Of these, 148 patients had unilateral hernia (143 right and 113 left) and 54 patients had bilateral hernias. There were 166 male patients and 36 female patients with a mean age of 61 ± 16 years. Of these, 10 patients had inguinal hernia after prostatectomy and 15 patients had inguinal hernia after previous lower abdominal surgery. The mean operative time was significantly longer in the patients with previous prostatectomy than in the two other groups. Two patients after prostatectomy were converted to TAPP due to surgical difficulties. There were no major intraoperative complications in all patients except for three cases of bleeding arising from the inferior epigastric artery: two in the postprostatectomy group and one in a patient without previous surgery. Both ambulation and hospital stay were similar for all groups. Only one patient without previous surgery had postoperative bleeding and was reoperated on several hours after the hernia repair. During the follow-up period of 8 ± 4 months, there was no recurrence of the hernia in any group. Conclusions Laparoscopic TEP for inguinal hernia repair in patients after previous low abdominal surgery has good results, similar to those in patients without previous surgery. Despite a longer operative time, TEP repairs can be performed efficiently and safely in patients after prostatectomy by skilled and experienced laparoscopic surgeons.