Laparoscopic transabdominal preperitoneal and totally extraperitoneal in inguinal hernia surgery: comparison of intraoperative and postoperative early complications of two techniques

Comparison of anatomical polyester mesh without fixation and conventional flat mesh with fixation in laparoscopic total extraperitoneal repair for inguinal hernia

PURPOSE

Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-established technique. In Taiwan, the National Health Insurance (NHI) covers the fees of the procedure and conventional mesh (polypropylene mesh), whereas the anatomical polyester mesh (Parietex™) requires additional self-pay. This study aimed to compare the outcomes of the conventional mesh with fixation versus the polyester mesh (without fixation) in laparoscopic TEP repair.

METHODS

We retrospectively reviewed the medical records of male patients who underwent laparoscopic TEP repair between 2017 and 2021. Patients could choose between the conventional mesh with fixation (conventional mesh group) or self-paid Parietex™ mesh without fixation (anatomical polyester mesh group). The outcomes included operation (OP) time, prolonged length of stay (LOS), and postoperative complications.

RESULTS

A total of 74 patients with 123 hernias were included, of which 36 patients (67 hernias) underwent the anatomical mesh without fixation, while 38 patients (56 hernias) underwent the conventional mesh with fixation. The mean OP time was 102.6 ± 45.6 and 88.5 ± 42.0 min in the conventional and the anatomical polyester mesh group. After adjusting for body mass index, diabetes mellitus, cardiovascular disease, and hernia type, no significant differences were observed between the two groups in OP time (p = 0.152) and the risk of acute pain (p = 0.337), chronic pain (p = 0.816), seroma (p = 0.941), hydrocele (p = 0.423), or hematoma (p = 0.347).

CONCLUSIONS

The conventional mesh demonstrates non-inferior outcomes compared to the anatomical polyester mesh. Given that the anatomical polyester mesh is not reimbursed by Taiwan's National Health Insurance (NHI), the use of the conventional mesh with fixation in TEP inguinal hernia repair may be a more cost-effective option in Taiwan.

Transabdominal Preperitoneal (TAPP) Compared to Totally Extraperitoneal (TEP) for Primary Inguinal Hernia Repair in a Military Hospital: A Retrospective Cohort Study

Background

Inguinal hernias are encountered commonly, but there is a lack of uniformity and standardization in repair techniques. There are a variety of repair methods, from open methods to laparoscopic approaches. The available laparoscopic techniques that exist for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. This study aims to compare the outcomes of these two laparoscopic procedures.

Methods

The study was initiated after receiving ethical clearance. This single-centric retrospective study included the patients that underwent laparoscopic inguinal hernia repair from January 1, 2020, to December 31, 2023. Patient records were reviewed and assessed against the inclusion criteria of the study. Systematic random sampling was applied to select patients from the records. A structured questionnaire was prepared for the purpose of data collection. The data were refined and analyzed using the SPSS software.

Results

A total of 200 patients (100 in each group) who underwent laparoscopic repair of an inguinal hernia were part of this study. The median (IQR) age of patients in the TAPP group was 50 (41.25-64.75) years, and that in the TEP group was 48.5 (39.25-64.75) years. The TAPP procedure took a median (IQR) time of 81 (77-88) min, while the TEP procedure took 69 (66-73) min to finish. The patients in the TAPP group returned to their normal activities after 15 (14-16) days of surgery, and the patients in the TEP group returned after 13 (11-14) days. The pain score at 1 week was found to be better in the TEP group. No difference was observed in complications or recurrence.

Conclusion

TEP repair was found to be superior to TAPP repair in terms of procedural time, return to normal activities, and pain score at 1 week.

Comparison of Clinical Outcomes of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in Bilateral Inguinal Hernia Repair: A Retrospective Study

OBJECTIVE

This study compared the clinical outcomes of two commonly used laparoscopic techniques, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair, in the treatment of bilateral inguinal hernias.

MATERIALS AND METHODS

This retrospective cohort study included 250 patients who underwent laparoscopic bilateral inguinal hernia repair using either the TEP or TAPP technique between May 2009 and May 2024. The patients were divided into two groups: 50 patients in the TEP group and 200 in the TAPP group. Data were collected from patient records, including demographics, type of hernia, surgical details, intraoperative and postoperative complications, conversion rates, and early hernia recurrence. Statistical analysis was performed to compare outcomes between the two groups.

RESULTS

Among the 250 patients included in the study, the mean age was 51.62 ± 8.79 years, and 94% (n=235) were male. The mean operative time was significantly longer in the TEP group (93.2 ± 13.0 minutes) than in the TAPP group (57.95 ± 7.5 minutes) (p <.001). The mean hospital stay was also longer in the TEP group (1.36 ± 0.48 days) compared to the TAPP group (1.07 ± 0.25 days) (p <.001). The TEP group had a higher rate of conversion to open surgery 18%(n=9) and conversion to TAPP 10% (5) than the TAPP group, which had no conversions (p <.0001). Postoperative complications were more frequent in the TEP group, with urinary retention being significantly higher at 16%(n=8) than in the TAPP group at 2% (n=4) (p <.0004). Additionally, the TAPP group experienced two (1%) notable intraoperative complications that required reoperation: arterial injury and small bowel injury.

CONCLUSION

The findings suggest that, while both TEP and TAPP effectively repair bilateral inguinal hernia, TAPP is associated with shorter operative times, shorter hospital stays, and fewer postoperative complications. However, the TAPP technique also presented notable intraoperative risks, including arterial and bowel injury. The choice between TEP and TAPP should be based on the surgeon's experience, patient characteristics, and the specific clinical context.

Robotic Totally Extraperitoneal Hernia Repair: An Initial Experience with Cambridge Medical Robotics Versius

Background: Total extraperitoneal approach for laparoscopic inguinal hernia repair (L-TEP) allows for better dissection, lesser chance of bowel injury, and quicker operating time. However robotic groin hernia repair is currently performed only through transabdominal route as it allows for more mobility of the arms. This study is aimed at studying the feasibility and outcomes of robotic totally extraperitoneal (R-TEP). Methods: A prospective nonrandomized comparative study was conducted to compare R-TEP with L-TEP. Out of a total of 88 patients with inguinal hernia, 44 patients underwent R-TEP and other 44 patients underwent L-TEP over a period of 15 months. All R-TEP were performed with Cambridge Medical Robotics (CMR) Versius. The outcomes were analyzed over a minimum follow-up period of 6 months. Results: All patients were males with a mean age of 45.9 years. Average body mass index was 28.7. Mean docking time for R-TEP was 12.7 minutes. Overall time taken for R-TEP (mean 60.47 minutes) was significantly higher (P < .001) than L-TEP (mean 38.45 minutes). When the console time of R-TEP and overall time of L-TEP were compared, there was no significant difference (P = .053). A RCT (RIVAL Trial) conducted by Prabhu et al. showed their robotic transabdominal preperitoneal (R-TAPP) time of median 75.5 (59.0-93.8) minutes. Kimberly et al. had their overall time of 77.5 minutes and Andre Luiz et al. had a console time of 58 minutes. When we compared the data, the overall time of R-TEP is lesser compared with R-TAPP. Postoperative pain on POD-1 showed that the robotic group had significantly lower pain. There were no recurrences noted in the study period. Conclusion: With our study, we have shown that R-TEP performed using the principle of laparoscopic triangulation technique with CMR Versius is feasible and reproducible. Although the overall time is significantly more in R-TEP when compared with L-TEP, console times of R-TEP and overall times of L-TEP were very similar. Console times of R-TEP are much lesser compared with other studies on R-TAPP. R-TEP can be a better alternative to R-TAPP and can be considered at par with L-TEP. A systematic RCT would provide a better picture.

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Inguinal hernia repairs are one of the most common procedures in general surgery. In addition to classical open surgery, laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) hernia repair, have gained acceptance and are increasingly used for inguinal hernia repairs, and these three techniques are the only standards for inguinal hernia repairs. This study aimed to compare the results of inguinal hernia repairs in adult patients using the TAPP patch technique and Lichtenstein techniques regarding the level of pain perceived one day after surgery and the number of days of hospitalization. A two-year study was performed on 129 patients who underwent TAPP vs. 109 patients who underwent Liechtenstein hernia repair. Our results revealed statistical significance for both variables (Tpain(233) = -7.12, p< 0.001, d=2.92; Tdays of hospitalization(233) = -31.34, p< 0.001, d=4.01). TAPP is a safe method for inguinal hernia repairs, allowing quick recovery and less postoperative pain than the classical Liechtenstein technique.

Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1-year follow-up

Background and Aim

Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium- or long-term studies that have compared outcomes between these two techniques.

Methods

This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques.

Results

A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died.

Conclusions

Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively.

Lichtenstein and Total Extraperitoneal Techniques in Inguinal Hernia Surgery: A Comparison of the Intraoperative and Early Postoperative Complications Between the Two Approaches

Background and objective

The Lichtenstein technique (LSt) and total extraperitoneal technique (TEPt) are the most frequently performed surgical procedures for inguinal hernia (IH). This study aimed to compare LSt and TEPt in terms of intraoperative and postoperative complications as well as recurrence rates.

Methods

This retrospective study involved patients hospitalized for IH repair. The study included a total of 262 patients (LSt group: n=125; TEPt group: n=137). 

Results

The follow-up period of the patients ranged between 16 and 30 months (mean: 22.3 months). While intraoperative complications were more commonly reported in the TEPt group, postoperative complications were more common in the LSt group (2.9% vs. 1.6%). Postoperative bleeding/hematoma developed in three (2.4%) patients in the LSt and three (2.2%) in the TEPt group. One of the patients in the LSt group was reoperated due to persistent bleeding. Two patients in the LSt and two in the TEPt group were reoperated for postoperative recurrence (1.6% vs. 2.4%). One patient was reoperated due to chronic persistent pain. Seroma was aspirated in three (2.4%) patients in the LSt and two (1.5%) in the TEPt group.

Conclusion

This study revealed no significant difference between TEPt and LSt groups regarding intraoperative and postoperative complications. We propose that both TEPt and LSt could be safely performed in cases of primary and complex IH by selecting the appropriate method based on the hernia type and patient and with sufficient surgical experience.