Original Article

J Minim Invasive Surg 2015; 18(1): 14-18

Published online March 15, 2015

https://doi.org/10.7602/jmis.2015.18.1.14

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh

Dong Jin Park, M.D., Yeong Cheol Im, M.D., Sung Soo Yang, M.D., Gyu Yeol Kim, M.D.

Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Received: September 5, 2014; Revised: October 15, 2014; Accepted: October 15, 2014

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: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. Methods: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. Results: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. Conclusion: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

Keywords TEP, Inguinal hernia, Fixation, Mesh

  1. Bracale U, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 2012;26(12):3355-3366.
    Pubmed CrossRef
  2. Kuhry E, et al. Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 2007;21(2):161166.
    Pubmed CrossRef
  3. Langeveld HR, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 2010;251(5):819-824.
    Pubmed CrossRef
  4. Teng YJ, et al. A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc 2011;25(9):2849-2858.
    Pubmed CrossRef
  5. Garg P, et al. Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India. Surg Endosc 2011;25(10):3300-3306.
    Pubmed CrossRef
  6. Yilmaz I, et al. A rare cause of mechanical bowel obstruction:mesh migration. Hernia 2013;17(2):267-269.
    Pubmed CrossRef
  7. Chen MJ, Tian YF. Intraperitoneal migration of a mesh plug with a small intestinal perforation: report of a case. Surg Today 2010;40(6):566-568.
    Pubmed CrossRef
  8. Hamouda A, et al. Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? Hernia 2010;14(3):317-319.
    Pubmed CrossRef
  9. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc 2009;23(3):482-486.
    Pubmed CrossRef
  10. Schwab R, et al. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 2006;10(3):272-277.
    Pubmed CrossRef
  11. Shah NS, Bandara AI, Sheen AJ. Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal (TEP) groin hernia repairs using fibrin glue (TisseelTM): a United Kingdom experience. Hernia 2012;16(6):647-653.
    Pubmed CrossRef
  12. Miserez M, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2014;18(2):151-163.
    Pubmed CrossRef
  13. Taylor C, et al. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc 2008;22(3):757-762.
    Pubmed CrossRef
  14. Ismail M, Garg P. Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh fixation in 1,220 hernia repairs. Hernia 2009;13(2):115-119.
    Pubmed CrossRef
  15. Morrison JE, Jacobs VR. Laparoscopic preperitoneal inguinal hernia repair using preformed polyester mesh without fixation:prospective study with 1-year follow-up results in a rural setting. Surg Laparosc Endosc Percutan Tech 2008;18(1):33-39.
    Pubmed CrossRef
  16. Garg P, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009;23(6):1241-1245.
    Pubmed CrossRef
  17. Messaris E, Nicastri G, Dudrick SJ. Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results. Arch Surg 2010;145(4):334338.
    Pubmed CrossRef
  18. Felix E, et al. Causes of recurrence after laparoscopic hernioplasty. A multicenter study. Surg Endosc 1998;12(3):226-231.
    Pubmed CrossRef
  19. Chu L, Averch TD, Jackman SV. Testicular infarction as a sequela of inguinal hernia repair. Can J Urol 2009;16(6):4953-4954.
    Pubmed

Article

Original Article

J Minim Invasive Surg 2015; 18(1): 14-18

Published online March 15, 2015 https://doi.org/10.7602/jmis.2015.18.1.14

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

Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh

Dong Jin Park, M.D., Yeong Cheol Im, M.D., Sung Soo Yang, M.D., Gyu Yeol Kim, M.D.

Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Received: September 5, 2014; Revised: October 15, 2014; Accepted: October 15, 2014

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: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. Methods: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. Results: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. Conclusion: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

Keywords: TEP, Inguinal hernia, Fixation, Mesh

References

  1. Bracale U, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 2012;26(12):3355-3366.
    Pubmed CrossRef
  2. Kuhry E, et al. Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 2007;21(2):161166.
    Pubmed CrossRef
  3. Langeveld HR, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 2010;251(5):819-824.
    Pubmed CrossRef
  4. Teng YJ, et al. A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc 2011;25(9):2849-2858.
    Pubmed CrossRef
  5. Garg P, et al. Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India. Surg Endosc 2011;25(10):3300-3306.
    Pubmed CrossRef
  6. Yilmaz I, et al. A rare cause of mechanical bowel obstruction:mesh migration. Hernia 2013;17(2):267-269.
    Pubmed CrossRef
  7. Chen MJ, Tian YF. Intraperitoneal migration of a mesh plug with a small intestinal perforation: report of a case. Surg Today 2010;40(6):566-568.
    Pubmed CrossRef
  8. Hamouda A, et al. Mesh erosion into the urinary bladder following laparoscopic inguinal hernia repair; is this the tip of the iceberg? Hernia 2010;14(3):317-319.
    Pubmed CrossRef
  9. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc 2009;23(3):482-486.
    Pubmed CrossRef
  10. Schwab R, et al. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 2006;10(3):272-277.
    Pubmed CrossRef
  11. Shah NS, Bandara AI, Sheen AJ. Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal (TEP) groin hernia repairs using fibrin glue (TisseelTM): a United Kingdom experience. Hernia 2012;16(6):647-653.
    Pubmed CrossRef
  12. Miserez M, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2014;18(2):151-163.
    Pubmed CrossRef
  13. Taylor C, et al. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc 2008;22(3):757-762.
    Pubmed CrossRef
  14. Ismail M, Garg P. Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh fixation in 1,220 hernia repairs. Hernia 2009;13(2):115-119.
    Pubmed CrossRef
  15. Morrison JE, Jacobs VR. Laparoscopic preperitoneal inguinal hernia repair using preformed polyester mesh without fixation:prospective study with 1-year follow-up results in a rural setting. Surg Laparosc Endosc Percutan Tech 2008;18(1):33-39.
    Pubmed CrossRef
  16. Garg P, et al. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009;23(6):1241-1245.
    Pubmed CrossRef
  17. Messaris E, Nicastri G, Dudrick SJ. Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results. Arch Surg 2010;145(4):334338.
    Pubmed CrossRef
  18. Felix E, et al. Causes of recurrence after laparoscopic hernioplasty. A multicenter study. Surg Endosc 1998;12(3):226-231.
    Pubmed CrossRef
  19. Chu L, Averch TD, Jackman SV. Testicular infarction as a sequela of inguinal hernia repair. Can J Urol 2009;16(6):4953-4954.
    Pubmed

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