Original Article

J Minim Invasive Surg 2012; 15(4): 149-155

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.149

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

복강경 전복막외 서혜부 탈장 수술의 장기 성적

최요한ㆍ설지영

충남대학교 의학전문대학원 외과 의학연구소

Received: August 20, 2012; Revised: October 13, 2012; Accepted: October 17, 2012

Long-term Outcomes of Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

Yo-Han Choi, M.D., Ji-Young Sul, M.D., Ph.D.

Department of Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence to : Ji-Young Sul
Department of Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 33, Munhwa-ro, Jung-gu, Daejeon 302-721, Korea
Tel:+82-42-280-7175, Fax:+82-42-257-8024 E-mail:jysul@cnu.ac.kr

Received: August 20, 2012; Revised: October 13, 2012; Accepted: October 17, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery, have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up, we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair.
Methods: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled.
Results: A total of 196 TEP procedures in 180 patients (age range 15∼88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55∼120 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11), moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%) were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results.
Conclusion: According to the long-term results of the study, laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications, mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

Keywords Inguinal hernia, Laparoscopic surgery, Totally extraperitoneal repair, Outcomes, Long-term

  1. Nathan JD, Pappas TN . Inguinal hernia: an old condition with new solutions. Ann Surg 2003;238(6 Suppl):S148-157.
    Pubmed CrossRef
  2. Statistical indicators of Kor ean major surgery by National Health Insurance; the high frequency and major surgical disease ranked within 20th. 2010.
  3. Filipi CJ, Fizgibbons RJ Jr, Salerno GM, Hart RO. Laparoscopic herniorrhaphy. Surg Clin North Am 1992;72:11091124.
  4. Fizgibbons RJ Jr, Salerno GM, Folipi CJ, Hnunter WJ, Watson P. A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg 1994;219:144-156.
    CrossRef
  5. Merskey H. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Monograph for the Sub-committee on Taxonomy. International Association for the Study of Pain. Pain Suppl 1986;3(Suppl):S1-226.
  6. Cunningham J, Temple WJ, Co operative Hernia Study. Pain in the postrepair patient. Ann Surg 1996;224:598-602.
    Pubmed KoreaMed CrossRef
  7. Daniel CS. Laparoscopic totally extraperitoneal inguinal hern ia repair. J Optechgensurg 1999;1:185-196.
  8. Ramshaw B. Laparoscopic totally extraperitoneal inguinal hernia repair. J Optechgensurg 2006;8:34-44.
  9. Cho SW, Hur KY, Jang YS, et al. Laparoscopic totally extraperitoneal herniorrhaphy for adult inguinal hernia: initia l 20 cases. J Korean Soc Endosc Laparosc Surg 2002;5:49-54.
  10. Chang WY, Choi SH, Chun HK. Compare laparoscopic adult inguinal hernia repair with conventional surgery. J Korean Soc Endosc Laparosc Surg 1999;2:85-89.
  11. Kim JH, Sul JY. Laparoscopic totally extraperitoneal inguina l herniorrhaphy: a personal experience at a tertiary care center. J Korean Soc Endosc Laparosc Surg 2007;10:83-88.
  12. Bisgaard T, Bay-Nielsen M, Christensen IJ, et al. Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 2007;94:10381040.
    Pubmed CrossRef
  13. Liem MS, van Duyn EB, van der Graaf Y, et al. Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 2003;237:136141.
    CrossRef
  14. Taylor CJ, Wilson T. Long-term results of Laparoscopic total ly extraperitoneal inguinal herniorrhaphy. ANZ J Surg 2005;75:637-639.
    Pubmed CrossRef
  15. Czechowski A, Schafmayer A. TAPP versus TEP: a retrospective analysis 5 years after laparoscopic transperitoneal and total endoscopic extraperitoneal repair in inguinal and femoral hernia. Chirurg 2003;74:1143-1149.
    Pubmed CrossRef
  16. EU Hernia Trialists Collaborations. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87:860-867.
    Pubmed CrossRef
  17. Poobalan AS, Bruce J, King PM, et al. Chronic pain and quality of life following open inguinal hernia repair. Br J Sur g 2001;88:1122-1126.
    Pubmed CrossRef
  18. Lau H, Patil NG, Yuen WK, Lee F. Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 2003;17:1620-1623.
    Pubmed CrossRef
  19. Agnew DC, Merskey H. Words of chronic pain. Pain 1976;2:73-81.
    CrossRef
  20. Loos MJA, Houterman S, Scheltinga MR, Roumen RMH. Evaluating postherniorrhaphy groin pain: visual analogue or verbal rating scale? Hernia 2008;12:147-151.
    Pubmed CrossRef
  21. Yeo AE, Berney CR. Carolinas comfort scale for mesh repair of inguinal henria. ANZ J Surg 2012;82:285-286.
    Pubmed CrossRef
  22. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  23. Taylor SG, O’Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty Br J Surg 1999;86:562-565.
    Pubmed CrossRef
  24. Moon V, Chaudry GA, Choy C, Ferzli GS. Mesh infection in era of laparoscopy. J Laparoendoscopic Adv Surg Tech A 2004;14:349-352.
    Pubmed CrossRef
  25. Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007;11:15-17.
    Pubmed CrossRef
  26. Mavros MN, Athanasiou S, Alexiou VG, et al. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 2011;35:23892398.
    Pubmed CrossRef
  27. Lledo JB, Quesada YS, Gavara IG, et al. Prosthetic infection after hernioplasty. Five years experience. CIR ESP 2009;85:158-164.
    CrossRef
  28. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  29. Fry DE. Infected abdominal wall prosthesis. In: Robert Bendavid, editor. Abdominal W all Hernias: Principles and Management, New York: Springer-Verlag; 2001. p.721-725.
    CrossRef
  30. Leber GE, Garb JL, Alescander AI, et al. Long-term complications associated with prostheti c repair of incisional hernias . Arch Surg 1998;133:378-382.
    Pubmed CrossRef
  31. Peterson S, Henke G, Freitag M, et al. Deep prosthesis infection in incisiona l hernia repair: predictive factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2012; 15(4): 149-155

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.149

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

복강경 전복막외 서혜부 탈장 수술의 장기 성적

최요한ㆍ설지영

충남대학교 의학전문대학원 외과 의학연구소

Received: August 20, 2012; Revised: October 13, 2012; Accepted: October 17, 2012

Long-term Outcomes of Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

Yo-Han Choi, M.D., Ji-Young Sul, M.D., Ph.D.

Department of Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence to:Ji-Young Sul
Department of Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, 33, Munhwa-ro, Jung-gu, Daejeon 302-721, Korea
Tel:+82-42-280-7175, Fax:+82-42-257-8024 E-mail:jysul@cnu.ac.kr

Received: August 20, 2012; Revised: October 13, 2012; Accepted: October 17, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery, have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up, we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair.
Methods: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled.
Results: A total of 196 TEP procedures in 180 patients (age range 15∼88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55∼120 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11), moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%) were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results.
Conclusion: According to the long-term results of the study, laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications, mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

Keywords: Inguinal hernia, Laparoscopic surgery, Totally extraperitoneal repair, Outcomes, Long-term

References

  1. Nathan JD, Pappas TN . Inguinal hernia: an old condition with new solutions. Ann Surg 2003;238(6 Suppl):S148-157.
    Pubmed CrossRef
  2. Statistical indicators of Kor ean major surgery by National Health Insurance; the high frequency and major surgical disease ranked within 20th. 2010.
  3. Filipi CJ, Fizgibbons RJ Jr, Salerno GM, Hart RO. Laparoscopic herniorrhaphy. Surg Clin North Am 1992;72:11091124.
  4. Fizgibbons RJ Jr, Salerno GM, Folipi CJ, Hnunter WJ, Watson P. A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg 1994;219:144-156.
    CrossRef
  5. Merskey H. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Monograph for the Sub-committee on Taxonomy. International Association for the Study of Pain. Pain Suppl 1986;3(Suppl):S1-226.
  6. Cunningham J, Temple WJ, Co operative Hernia Study. Pain in the postrepair patient. Ann Surg 1996;224:598-602.
    Pubmed KoreaMed CrossRef
  7. Daniel CS. Laparoscopic totally extraperitoneal inguinal hern ia repair. J Optechgensurg 1999;1:185-196.
  8. Ramshaw B. Laparoscopic totally extraperitoneal inguinal hernia repair. J Optechgensurg 2006;8:34-44.
  9. Cho SW, Hur KY, Jang YS, et al. Laparoscopic totally extraperitoneal herniorrhaphy for adult inguinal hernia: initia l 20 cases. J Korean Soc Endosc Laparosc Surg 2002;5:49-54.
  10. Chang WY, Choi SH, Chun HK. Compare laparoscopic adult inguinal hernia repair with conventional surgery. J Korean Soc Endosc Laparosc Surg 1999;2:85-89.
  11. Kim JH, Sul JY. Laparoscopic totally extraperitoneal inguina l herniorrhaphy: a personal experience at a tertiary care center. J Korean Soc Endosc Laparosc Surg 2007;10:83-88.
  12. Bisgaard T, Bay-Nielsen M, Christensen IJ, et al. Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 2007;94:10381040.
    Pubmed CrossRef
  13. Liem MS, van Duyn EB, van der Graaf Y, et al. Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 2003;237:136141.
    CrossRef
  14. Taylor CJ, Wilson T. Long-term results of Laparoscopic total ly extraperitoneal inguinal herniorrhaphy. ANZ J Surg 2005;75:637-639.
    Pubmed CrossRef
  15. Czechowski A, Schafmayer A. TAPP versus TEP: a retrospective analysis 5 years after laparoscopic transperitoneal and total endoscopic extraperitoneal repair in inguinal and femoral hernia. Chirurg 2003;74:1143-1149.
    Pubmed CrossRef
  16. EU Hernia Trialists Collaborations. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87:860-867.
    Pubmed CrossRef
  17. Poobalan AS, Bruce J, King PM, et al. Chronic pain and quality of life following open inguinal hernia repair. Br J Sur g 2001;88:1122-1126.
    Pubmed CrossRef
  18. Lau H, Patil NG, Yuen WK, Lee F. Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 2003;17:1620-1623.
    Pubmed CrossRef
  19. Agnew DC, Merskey H. Words of chronic pain. Pain 1976;2:73-81.
    CrossRef
  20. Loos MJA, Houterman S, Scheltinga MR, Roumen RMH. Evaluating postherniorrhaphy groin pain: visual analogue or verbal rating scale? Hernia 2008;12:147-151.
    Pubmed CrossRef
  21. Yeo AE, Berney CR. Carolinas comfort scale for mesh repair of inguinal henria. ANZ J Surg 2012;82:285-286.
    Pubmed CrossRef
  22. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  23. Taylor SG, O’Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty Br J Surg 1999;86:562-565.
    Pubmed CrossRef
  24. Moon V, Chaudry GA, Choy C, Ferzli GS. Mesh infection in era of laparoscopy. J Laparoendoscopic Adv Surg Tech A 2004;14:349-352.
    Pubmed CrossRef
  25. Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007;11:15-17.
    Pubmed CrossRef
  26. Mavros MN, Athanasiou S, Alexiou VG, et al. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 2011;35:23892398.
    Pubmed CrossRef
  27. Lledo JB, Quesada YS, Gavara IG, et al. Prosthetic infection after hernioplasty. Five years experience. CIR ESP 2009;85:158-164.
    CrossRef
  28. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  29. Fry DE. Infected abdominal wall prosthesis. In: Robert Bendavid, editor. Abdominal W all Hernias: Principles and Management, New York: Springer-Verlag; 2001. p.721-725.
    CrossRef
  30. Leber GE, Garb JL, Alescander AI, et al. Long-term complications associated with prostheti c repair of incisional hernias . Arch Surg 1998;133:378-382.
    Pubmed CrossRef
  31. Peterson S, Henke G, Freitag M, et al. Deep prosthesis infection in incisiona l hernia repair: predictive factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef

Metrics for This Article

Share this article on

  • kakao talk
  • line

Related articles in JMIS

Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248