Original Article

J Minim Invasive Surg 2013; 16(2): 21-25

Published online June 15, 2013

https://doi.org/10.7602/jmis.2013.16.2.21

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

서혜부 탈장 1,000예에 대한 복강경 수술결과

정춘식ㆍ이동근

한솔병원 외과

Laparoscopic Inguinal Hernia Repair: A Review of 1,000 Cases

Choon Sik Chung, M.D., Ph.D., Dong Keun Lee, M.D., Ph.D.

Department of Surgery, Hansol Hospital, Seoul, Korea

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: We reviewed our data compiled prospectively for evaluation of post-operative complications and recurrence of laparoscopic inguinal hernia repair.

Methods: Among the 1000 patients (age, ≥20 years old) who were undergone laparoscopic inguinal hernia surgery from January 2007 to July 2011, the age, sex, location, hernia type, operation time, postoperative morbidity, and conversion of 992 patients were analyzed.

Results: Among 992 patients, 919 (92.6%) were male and the mean age was 54.2 years (range, 20~90). Operation times (minutes) for unilateral and bilateral hernia were 40.0 and 53.4, respectively. Mean operation time (minutes) showed a decrease over time, as that for the first half of all cases was 43.5 and that for the second half was 39.7 (p<0.001). Seven cases of conversion (post-radical prostatectomy hernia=7) were recorded to TAPP (n=3) or IPOM (n=4) from TEP. Eleven cases of postoperative catheterization (1.1%), five cases of port site seroma (0.5%), one case of mesh removal due to infection, 24 cases of seroma/hematoma (2.4%), 26 cases of neuralgia (2.6%), and four cases of bleeding with a drop in hemoglobin of more than 3 mg% (0.4%) were also recorded. There were three cases of recurrence (0.35%) at the median follow-up of 46 months (range, 20 to 70 months).

Conclusion: Laparoscopic inguinal hernia repair can be performed safely, with low rates of complication and recurrence. This technique achieves good results combined with the benefits of minimally invasive surgery. We should be cautious in order to avoid postoperative bleeding, especially in cases of TEP.

Keywords Inguinal hernia, TEP, TAPP, Recurrence, Complication

  1. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989;157:188-193.
    CrossRef
  2. Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach:a preliminary report. Surg Laparosc Endosc 1992;2:53-58.
    Pubmed
  3. Lal Pawanindra, Kajla RK, Chander J, Saha R, Ramteke VK. Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 1996;17:850-856.
  4. Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. A randomized trial. Surg Endosc 2006;20:76-81.
    Pubmed CrossRef
  5. Vidovi? D, Kirac I, Glavan E, Filipovi?-Cugura J, Ledinsky M, Bekavac-Beslin M. Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. J Laparoendosc Adv Surg Tech A 2007;17:585-590.
    Pubmed CrossRef
  6. McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 2005;9:109-114.
    Pubmed CrossRef
  7. Evans MD, Williams GL, Stephenson BM. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009;250:354-355.
    Pubmed CrossRef
  8. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair:a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009;249:33-38.
    Pubmed CrossRef
  9. Chung CS, Lee JE, Joh YG, et al. A totally extraperitoneal (TEP) laparoscopic approach to incarcerated hernia. J Korean Soc Endosc Laparosc Surg 2010;13:139-143.
  10. Felix EL, Michas CA, Gonzalez MH Jr. Laparoscopic hernioplasty. TAPP vs TEP. Surg Endosc 1995;9:984-989.
    Pubmed CrossRef
  11. Khoury N. A comparative study of laparoscopic extraperitoneal and transabdominal preperitoneal herniorrhaphy. J Laparoendosc Surg 1995;5:349-355.
    Pubmed CrossRef
  12. Edwards CC 2nd, Bailey RW. Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 2000;10:149-153.
    Pubmed
  13. Pollak R, Nyhus LM. Complications of groin hernia repair. Surg Clin North Am 1983;63:1363-1371.
    Pubmed
  14. Tamme C, Scheidbach H, Hampe C, Schneider C, K?ckerling F. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Results of 5,203 hernia repair. Surg Endosc 2003;17:190-195.
    Pubmed CrossRef
  15. Finley RK Jr, Miller SF, Jones LM. Elimination of urinary retention following inguinal herniorrhaphy. Am Surg 1991;57:486-488.
    Pubmed
  16. Kozol RA, Mason K, McGee K. Post-herniorrhaphy urinary retention: a randomized prospective study. J Surg Res 1992;52:111-112.
    CrossRef
  17. Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 2004;18:221-227.
    Pubmed CrossRef
  18. Felix EL, Harbertson N, Vartanian S. Laparoscopic hernioplasty:significant complications. Surg Endosc 1999;13:328-331.
    Pubmed CrossRef
  19. Cohen RV, Alvarez G, Roll S, et al. Transabdominal or totally extraperitoneal laparoscopic hernia repair? Surg Laparosc Endosc 1998;8:264-268.
    Pubmed CrossRef
  20. Schultz C, Baca I, G?tzen V. Laparoscopic inguinal hernia repair. Surg Endosc 2001;15:582-584.
    Pubmed CrossRef
  21. Linderoth G, Kehlet H, Aasvang EK, Werner MU. Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Hernia 2011;15:521-529.
    Pubmed CrossRef
  22. Lovisetto F, Zonta S, Rota E, et al. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 2007;245:222-231.
    Pubmed KoreaMed CrossRef
  23. Seid AS, Amos E. Entrapment neuropathy in laparoscopic herniorrhaphy. Surg Endosc 1994;8:1050-1053.
    CrossRef
  24. Khajanchee YS, Urbach DR, Swanstrom LL, Hansen PD. Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 2001;15:1102-1107.
    Pubmed CrossRef
  25. Pokorny H, Klingler A, Schmid T, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 2008;12:385-389.
    Pubmed CrossRef
  26. Arvidsson D, Berndsen FH, Larsson LG, et al. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 2005;92:1085-1091.
    Pubmed CrossRef
  27. Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R. Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of the reoperation. J Am Coll Surg 2000;190:651-655.
    CrossRef
  28. Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995;221:3-13.
    CrossRef
  29. Felix E, Scott S, Crafton B, et al. Causes of recurrence after laparoscopic hernioplasty. A multicenter study. Surg Endosc 1998;12:226-231.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2013; 16(2): 21-25

Published online June 15, 2013 https://doi.org/10.7602/jmis.2013.16.2.21

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

서혜부 탈장 1,000예에 대한 복강경 수술결과

정춘식ㆍ이동근

한솔병원 외과

Laparoscopic Inguinal Hernia Repair: A Review of 1,000 Cases

Choon Sik Chung, M.D., Ph.D., Dong Keun Lee, M.D., Ph.D.

Department of Surgery, Hansol Hospital, Seoul, Korea

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: We reviewed our data compiled prospectively for evaluation of post-operative complications and recurrence of laparoscopic inguinal hernia repair.

Methods: Among the 1000 patients (age, ≥20 years old) who were undergone laparoscopic inguinal hernia surgery from January 2007 to July 2011, the age, sex, location, hernia type, operation time, postoperative morbidity, and conversion of 992 patients were analyzed.

Results: Among 992 patients, 919 (92.6%) were male and the mean age was 54.2 years (range, 20~90). Operation times (minutes) for unilateral and bilateral hernia were 40.0 and 53.4, respectively. Mean operation time (minutes) showed a decrease over time, as that for the first half of all cases was 43.5 and that for the second half was 39.7 (p<0.001). Seven cases of conversion (post-radical prostatectomy hernia=7) were recorded to TAPP (n=3) or IPOM (n=4) from TEP. Eleven cases of postoperative catheterization (1.1%), five cases of port site seroma (0.5%), one case of mesh removal due to infection, 24 cases of seroma/hematoma (2.4%), 26 cases of neuralgia (2.6%), and four cases of bleeding with a drop in hemoglobin of more than 3 mg% (0.4%) were also recorded. There were three cases of recurrence (0.35%) at the median follow-up of 46 months (range, 20 to 70 months).

Conclusion: Laparoscopic inguinal hernia repair can be performed safely, with low rates of complication and recurrence. This technique achieves good results combined with the benefits of minimally invasive surgery. We should be cautious in order to avoid postoperative bleeding, especially in cases of TEP.

Keywords: Inguinal hernia, TEP, TAPP, Recurrence, Complication

References

  1. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989;157:188-193.
    CrossRef
  2. Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach:a preliminary report. Surg Laparosc Endosc 1992;2:53-58.
    Pubmed
  3. Lal Pawanindra, Kajla RK, Chander J, Saha R, Ramteke VK. Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 1996;17:850-856.
  4. Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. A randomized trial. Surg Endosc 2006;20:76-81.
    Pubmed CrossRef
  5. Vidovi? D, Kirac I, Glavan E, Filipovi?-Cugura J, Ledinsky M, Bekavac-Beslin M. Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. J Laparoendosc Adv Surg Tech A 2007;17:585-590.
    Pubmed CrossRef
  6. McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 2005;9:109-114.
    Pubmed CrossRef
  7. Evans MD, Williams GL, Stephenson BM. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009;250:354-355.
    Pubmed CrossRef
  8. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair:a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009;249:33-38.
    Pubmed CrossRef
  9. Chung CS, Lee JE, Joh YG, et al. A totally extraperitoneal (TEP) laparoscopic approach to incarcerated hernia. J Korean Soc Endosc Laparosc Surg 2010;13:139-143.
  10. Felix EL, Michas CA, Gonzalez MH Jr. Laparoscopic hernioplasty. TAPP vs TEP. Surg Endosc 1995;9:984-989.
    Pubmed CrossRef
  11. Khoury N. A comparative study of laparoscopic extraperitoneal and transabdominal preperitoneal herniorrhaphy. J Laparoendosc Surg 1995;5:349-355.
    Pubmed CrossRef
  12. Edwards CC 2nd, Bailey RW. Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 2000;10:149-153.
    Pubmed
  13. Pollak R, Nyhus LM. Complications of groin hernia repair. Surg Clin North Am 1983;63:1363-1371.
    Pubmed
  14. Tamme C, Scheidbach H, Hampe C, Schneider C, K?ckerling F. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Results of 5,203 hernia repair. Surg Endosc 2003;17:190-195.
    Pubmed CrossRef
  15. Finley RK Jr, Miller SF, Jones LM. Elimination of urinary retention following inguinal herniorrhaphy. Am Surg 1991;57:486-488.
    Pubmed
  16. Kozol RA, Mason K, McGee K. Post-herniorrhaphy urinary retention: a randomized prospective study. J Surg Res 1992;52:111-112.
    CrossRef
  17. Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 2004;18:221-227.
    Pubmed CrossRef
  18. Felix EL, Harbertson N, Vartanian S. Laparoscopic hernioplasty:significant complications. Surg Endosc 1999;13:328-331.
    Pubmed CrossRef
  19. Cohen RV, Alvarez G, Roll S, et al. Transabdominal or totally extraperitoneal laparoscopic hernia repair? Surg Laparosc Endosc 1998;8:264-268.
    Pubmed CrossRef
  20. Schultz C, Baca I, G?tzen V. Laparoscopic inguinal hernia repair. Surg Endosc 2001;15:582-584.
    Pubmed CrossRef
  21. Linderoth G, Kehlet H, Aasvang EK, Werner MU. Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Hernia 2011;15:521-529.
    Pubmed CrossRef
  22. Lovisetto F, Zonta S, Rota E, et al. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 2007;245:222-231.
    Pubmed KoreaMed CrossRef
  23. Seid AS, Amos E. Entrapment neuropathy in laparoscopic herniorrhaphy. Surg Endosc 1994;8:1050-1053.
    CrossRef
  24. Khajanchee YS, Urbach DR, Swanstrom LL, Hansen PD. Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 2001;15:1102-1107.
    Pubmed CrossRef
  25. Pokorny H, Klingler A, Schmid T, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 2008;12:385-389.
    Pubmed CrossRef
  26. Arvidsson D, Berndsen FH, Larsson LG, et al. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 2005;92:1085-1091.
    Pubmed CrossRef
  27. Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R. Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of the reoperation. J Am Coll Surg 2000;190:651-655.
    CrossRef
  28. Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995;221:3-13.
    CrossRef
  29. Felix E, Scott S, Crafton B, et al. Causes of recurrence after laparoscopic hernioplasty. A multicenter study. Surg Endosc 1998;12:226-231.
    Pubmed CrossRef

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