Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

The Effect of Tension-Free Herniorrhaphy in the Preperitoneal Space on the Treatment of Hernia

Objective:To explore the clinical effect of tension-free herniorrhaphy in the preperitoneal space in patients with hernia.Methods:The study period was from January 2020 to December 2022.198 samples of hernia patients admitted to our hospital were selected and divided into a research group(n=99)and a control group(n=99).Patients in the control group underwent tension-free herniorrhaphy with plain films,and patients in the study group underwent tension-free herniorrhaphy in the preperitoneal space.The surgical and postoperative recovery-related indicators,incidence of complications,and recurrence rate were compared between the two groups.Results:The intraoperative and postoperative recovery indexes of the study group were better than those of the control group(P<0.05);the incidence of complications in the study group was lower than that of the control group(P<0.05),and there was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion:Tension-free herniorrhaphy in the preperitoneal space shortens the operation and postoperative recovery time of hernia patients and reduces the incidence of postoperative complications,so it should be popularized.

Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature

A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal(TAPP) procedure with the self-gripping Parietex ProG rip? mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semiliquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.

Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair

AIM:To investigate the use of the V-Loc wound closure device for transabdominal preperitoneal hernia repair. METHODS:We performed conventional transabdominal preperitoneal hernia repair in 19 patients, including one single incisional case using V-Loc. Except for the use of V-Loc for peritoneal closure, the procedures were the same as those used in conventional techniques. RESULTS:Although the operators included 2 residents who have no experience in laparoscopic herniorrhaphy and intracorporeal suture, the operations were completed. We believe that V-Loc is especially suitable for inexperienced surgeons and the use of V-Loc reduces the operative time by a small amount but reduces operator stress significantly. CONCLUSION:We conclude that V-Loc is the ideal peritoneal closure device for transabdominal preperitoneal hernia repair.

Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty:A case report and review of literature

BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.

Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.

Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience

Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.

A New Alternative Technique for Preperitoneal Inguinal Hernia Repair: Using Groin Innominate Fascial Island Flap

Aim: Despite the fact that reported low recurrence rates and improvement results, optimal surgical technique for in-guinal hernia repair was not found and recurrence was not eliminated. We used firstly groin innominate fascial island flap to reinforce the weak inguinal tissue for the repair. Methods: From the February 2010 to December 2010, 15 patients (13 male and 2 female) with inguinal hernia underwent repair with using island groin innominate fascial flap. The follow-up period ranged from 8 to 12 months (mean, 10 months). Results: Seroma developed in one case. Others had not any complications. Conclusion: Because of our technique avoids from the complications and drawbacks of the prosthetic mesh, autograft and abdominal wall flaps, we think that the groin deep fascial flap can be a good alternative to prosthetic meshes for reconstruction of inguinal hernia repair.

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures

Purpose:Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality.This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.Methods:This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019.All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study.The indication was persistent systolic blood pressure90 mmHg during initial resuscitation and after transfusion of two units of red blood cells.Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded.Their demographic characteristics,clinical features,laboratory results,therapeutic interventions,adverse events,and prognostic outcomes were collected from digital information system of electronic medical records.Statistics were described as mean±standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.Results:The patients’average age was 41.6 years,ranging from 10 to 88 years.Among them,45 cases were male(67.2%)and 22 cases were female(32.8%).Significant difference was found regarding the systolic blood pressure(mmHg)in the emergency department(78.4±13.9)and after preperitoneal pelvic packing in the surgery intensive care unit(100.1±17.6)(p<0.05).Simultaneously,the arterial base deficit(mmol/L)were significantly lower in the surgery intensive care unit(median-6,interquartile range-8 to-2)than in the emergency department(median-10,interquartile range-14 to-8)(p<0.05).After preperitoneal pelvic packing,15 patients(22.4%)underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage.The overall mortality rate was 29.5%(20 of 67).Conclusions:Preperitoneal pelvic packing,as a useful surgical technique,is less invasive and can be very efficient in early intra-pelvic bleed control.

Open transinguinal preperitoneal mesh repair of inguinal hernia:a targeted systematic review and meta-analysis of published randomized controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing transinguinal preperitoneal(TIPP)and Lichtenstein repair(LR)for inguinal hernia.Methods:Randomized,controlled trials comparing TIPP vs LR were analysed systematically using RevMan®and combined outcomes were expressed as risk ratio(RR)and standardized mean difference.Results:Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases.There were 714 patients in the TIPP repair group and 723 patients in the LR group.There was significant heterogeneity among trials(P<0.0001).Therefore,in the random effects model,TIPP repair was associated with a reduced risk of developing chronic groin pain(RR,0.48;95%CI,0.26,0.89;z=2.33;P<0.02)without influencing the incidence of inguinal hernia recurrence(RR,0.18;95%CI,0.36,1.83;z=0.51;P=0.61).Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR.In addition,duration of operation was statistically similar in both groups.Conclusion:TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain.It is comparable with LR in terms of risk of hernia recurrence,postoperative complications,duration of operation and intensity of postoperative pain.

Transabdominal Pre-Peritoneal Mesh for Inguinal Hernia Repair with External Fixation versus Mesh Stapling

Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.

Evaluation of Visceral and Subcutaneous Fat by Ultrasound and Its Relationship with Clinical and Metabolic Parameters of Insulin Resistance and Subclinical Atherosclerosis

Objective: this study set out to investigate the association between abdominal obesity ultrasound measurements, waist circumference and body mass index (BMI), metabolic syndrome (MS) components and subclinical atherosclerosis. Methods: sixty patients were recruited and divided equally into two groups, according to the presence of MS. All subjects had an ultrasound examination for measurement of visceral and subcutaneous fat thickness and carotid IMT. Results: the values of visceral fat thickness, preperitoneal circumference and carotid IMT were higher in patients with MS than in control subjects. Visceral fat thickness showed significant correlations with many cardiovascular risk factors (waist circumference, BMI, fasting plasma glucose, HDL and LDL cholesterol). All abdominal obesity measurements were correlated with BMI. Carotid IMT showed correlations with age, visceral fat and preperitoneal circumference. Visceral fat was independently associated with systolic and diastolic blood pressures and fasting plasma glucose. Systolic and diastolic blood pressures and BMI were independent determinants of carotid IMT. Conclusion: visceral fat thickness showed the best correlation with MS components, suggesting that it could be a useful parameter in cardiovascular risk assessment. Age, systolic and diastolic blood pressures and BMI were independent determinants of subclinical atherosclerosis. MS was associated with a higher carotid IMT.