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Original Article

J Minim Invasive Surg 2016; 19(1): 25-31

Published online March 15, 2016

https://doi.org/10.7602/jmis.2016.19.1.25

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Single-Port Laparoscopic Total Extraperitoneal Inguinal Hernia Repair without Fixation of the Mesh

Sung Uk Bae, M.D.1, Byung Soh Min, M.D.2, Seung Hyuk Baik, M.D.2, Nam Kyu Kim, M.D.2, Hyuk Hur, M.D.2

Author Info. +

Division of Colorectal Surgery, Department of Surgery, 1School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, 2Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to : Hyuk Hur
Division of Colorectal Surgery, Department of Surgery, ColorectalCancer Clinic, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 41931, Korea
Tel: +82-2-2228-2139 Fax: +82-2-313-8289
E-mail: hhyuk@yuhs.ac

Received: October 2, 2015; Revised: December 14, 2015; Accepted: December 29, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Go to

Purpose: Single-port laparoscopic surgery has been used increasingly in treatment of a variety of conditions, and one recently introduced technique is single-port laparoscopic total extraperitoneal (SPLTEP) hernia repair. The aim of this study was to evaluate the safety and technical feasibility of SPLTEP hernia repair without fixation of the mesh. Methods: From June 2010 to October 2012, 112 consecutive patients underwent SPLTEP hernia repair. Results: We performed 129 inguinal hernia repairs in 112 patients, 17 were bilateral and 95 unilateral. There were 107 indirect hernias (83.0%), 20 direct hernias, and 2 hernias had both of types. Successful SPLTEP hernia repair was performed in 110 patients, with two conversions to an open surgical approach. Median operative times for unilateral and bilateral hernias were 70 minutes (40~145 minutes) and 90 minutes (67~135 minutes), respectively, and the hospital stay was 1 day (1~5 days). Postoperative complications included 10 patients with wound seromas or hematomas, 2 with urinary retention, 4 with groin pain, and 1 with bleeding from the incision site. There were 3 early recurrences (2.4%) during a median follow-up period of 42 months (range, 6~55). Conclusion: SPLTEP inguinal hernia repair without fixation of the mesh is both safe and technically feasible, and provides acceptable operative outcomes. Conduct of a prospective randomized study with long-term follow-up is needed to confirm the benefit of this technique in patients with inguinal hernia.

Keywords Hernia, Inguinal herniorrhaphy, Laparoscopy

REFERENCES

Go to
  1. Ger R, Monroe K, Duvivier R, Mishrick A. Management of in direct inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg 1990;159:370-373.
    CrossRef
  2. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2003;90:1479-1492.
    Pubmed CrossRef
  3. Langeveld HR, van't Riet M, Weidema WF, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 2010;251:819-824.
    Pubmed CrossRef
  4. Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford TB. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 2011;254:709-714; discussion 714-705.
  5. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc 1998;12:177-178.
    Pubmed CrossRef
  6. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 1999;9:361-364.
    Pubmed CrossRef
  7. Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 2009;23:920-921.
    Pubmed CrossRef
  8. Agrawal S, Shaw A, Soon Y. Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 2010;24:952-956.
    Pubmed CrossRef
  9. Chung SD, Huang CY, Wang SM, et al. Laparoendoscopic singlesite totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 2011;25:3579-3583.
    Pubmed CrossRef
  10. Kim JH, Park SM, Kim JJ, Lee YS. Initial experience of single port laparoscopic totally extraperitoneal hernia repair: nearlyscarless inguinal hernia repair. J Korean Surg Soc 2011;81:339343.
    Pubmed KoreaMed CrossRef
  11. Tsai YC, Ho CH, Tai HC, Chung SD, Chueh SC. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 2013;27:4684-4692.
    Pubmed CrossRef
  12. Do M, Liatsikos E, Beatty J, et al. Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients. J Endourol 2011;25:963-968.
    Pubmed CrossRef
  13. Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995;221:3-13.
    CrossRef
  14. Vogt DM, Curet MJ, Pitcher DE, Martin DT, Zucker KA. Preliminary results of a prospective randomized trial of laparoscopic onlay versus conventional inguinal herniorrhaphy. Am J Surg 1995;169:84-89;discussion 89-90.
    CrossRef
  15. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2005:CD004703.
    CrossRef
  16. Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM. Single-incision laparoscopic right hemicolectomy:safety and feasibility in a series of consecutive cases. Surg Endosc 2010;24:2613-2616.
    Pubmed CrossRef
  17. Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC. Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 2011;25:1251-1256.
    Pubmed CrossRef
  18. Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009;55:1198-1204.
    Pubmed CrossRef
  19. Targarona EM, Pallares JL, Balague C, et al. Single incision approach for splenic diseases: a preliminary report on a series of 8 cases. Surg Endosc 2010;24:2236-2240.
    Pubmed CrossRef
  20. Kim JH, An CH, Lee YS, Kim HY, Lee JI. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia 2015;19:417-422.
    Pubmed CrossRef
  21. Tran H, Turingan I, Tran K, Zajkowska M, Lam V, Hawthorne W. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 2014;18:731-744.
    Pubmed CrossRef
  22. Kim JH, Lee YS, Kim JJ, Park SM. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 2013;37:746-751.
    Pubmed CrossRef
  23. Surgit O. Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients. Surg Laparosc Endosc Percutan Tech 2010;20:114-118.
    Pubmed CrossRef
  24. 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;145:334-338.
    Pubmed CrossRef
  25. Schwab R, Willms A, Kroger A, Becker HP. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 2006;10:272-277.
    Pubmed CrossRef
  26. Topart P, Vandenbroucke F, Lozac'h P. Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 2005;19:724727.
    Pubmed CrossRef
  27. Tran H. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. JSLS 2011;15:4752
    Pubmed KoreaMed CrossRef

Article

Original Article

J Minim Invasive Surg 2016; 19(1): 25-31

Published online March 15, 2016 https://doi.org/10.7602/jmis.2016.19.1.25

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

Single-Port Laparoscopic Total Extraperitoneal Inguinal Hernia Repair without Fixation of the Mesh

Sung Uk Bae, M.D.1, Byung Soh Min, M.D.2, Seung Hyuk Baik, M.D.2, Nam Kyu Kim, M.D.2, Hyuk Hur, M.D.2

Division of Colorectal Surgery, Department of Surgery, 1School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, 2Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to:Hyuk Hur
Division of Colorectal Surgery, Department of Surgery, ColorectalCancer Clinic, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 41931, Korea
Tel: +82-2-2228-2139 Fax: +82-2-313-8289
E-mail: hhyuk@yuhs.ac

Received: October 2, 2015; Revised: December 14, 2015; Accepted: December 29, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Single-port laparoscopic surgery has been used increasingly in treatment of a variety of conditions, and one recently introduced technique is single-port laparoscopic total extraperitoneal (SPLTEP) hernia repair. The aim of this study was to evaluate the safety and technical feasibility of SPLTEP hernia repair without fixation of the mesh. Methods: From June 2010 to October 2012, 112 consecutive patients underwent SPLTEP hernia repair. Results: We performed 129 inguinal hernia repairs in 112 patients, 17 were bilateral and 95 unilateral. There were 107 indirect hernias (83.0%), 20 direct hernias, and 2 hernias had both of types. Successful SPLTEP hernia repair was performed in 110 patients, with two conversions to an open surgical approach. Median operative times for unilateral and bilateral hernias were 70 minutes (40~145 minutes) and 90 minutes (67~135 minutes), respectively, and the hospital stay was 1 day (1~5 days). Postoperative complications included 10 patients with wound seromas or hematomas, 2 with urinary retention, 4 with groin pain, and 1 with bleeding from the incision site. There were 3 early recurrences (2.4%) during a median follow-up period of 42 months (range, 6~55). Conclusion: SPLTEP inguinal hernia repair without fixation of the mesh is both safe and technically feasible, and provides acceptable operative outcomes. Conduct of a prospective randomized study with long-term follow-up is needed to confirm the benefit of this technique in patients with inguinal hernia.

Keywords: Hernia, Inguinal herniorrhaphy, Laparoscopy

References

  1. Ger R, Monroe K, Duvivier R, Mishrick A. Management of in direct inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg 1990;159:370-373.
    CrossRef
  2. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2003;90:1479-1492.
    Pubmed CrossRef
  3. Langeveld HR, van't Riet M, Weidema WF, et al. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 2010;251:819-824.
    Pubmed CrossRef
  4. Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford TB. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 2011;254:709-714; discussion 714-705.
  5. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc 1998;12:177-178.
    Pubmed CrossRef
  6. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 1999;9:361-364.
    Pubmed CrossRef
  7. Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 2009;23:920-921.
    Pubmed CrossRef
  8. Agrawal S, Shaw A, Soon Y. Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 2010;24:952-956.
    Pubmed CrossRef
  9. Chung SD, Huang CY, Wang SM, et al. Laparoendoscopic singlesite totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 2011;25:3579-3583.
    Pubmed CrossRef
  10. Kim JH, Park SM, Kim JJ, Lee YS. Initial experience of single port laparoscopic totally extraperitoneal hernia repair: nearlyscarless inguinal hernia repair. J Korean Surg Soc 2011;81:339343.
    Pubmed KoreaMed CrossRef
  11. Tsai YC, Ho CH, Tai HC, Chung SD, Chueh SC. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 2013;27:4684-4692.
    Pubmed CrossRef
  12. Do M, Liatsikos E, Beatty J, et al. Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients. J Endourol 2011;25:963-968.
    Pubmed CrossRef
  13. Fitzgibbons RJ Jr, Camps J, Cornet DA, et al. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995;221:3-13.
    CrossRef
  14. Vogt DM, Curet MJ, Pitcher DE, Martin DT, Zucker KA. Preliminary results of a prospective randomized trial of laparoscopic onlay versus conventional inguinal herniorrhaphy. Am J Surg 1995;169:84-89;discussion 89-90.
    CrossRef
  15. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2005:CD004703.
    CrossRef
  16. Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM. Single-incision laparoscopic right hemicolectomy:safety and feasibility in a series of consecutive cases. Surg Endosc 2010;24:2613-2616.
    Pubmed CrossRef
  17. Chung SD, Huang CY, Wang SM, Tai HC, Tsai YC, Chueh SC. Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 2011;25:1251-1256.
    Pubmed CrossRef
  18. Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol 2009;55:1198-1204.
    Pubmed CrossRef
  19. Targarona EM, Pallares JL, Balague C, et al. Single incision approach for splenic diseases: a preliminary report on a series of 8 cases. Surg Endosc 2010;24:2236-2240.
    Pubmed CrossRef
  20. Kim JH, An CH, Lee YS, Kim HY, Lee JI. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia 2015;19:417-422.
    Pubmed CrossRef
  21. Tran H, Turingan I, Tran K, Zajkowska M, Lam V, Hawthorne W. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 2014;18:731-744.
    Pubmed CrossRef
  22. Kim JH, Lee YS, Kim JJ, Park SM. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 2013;37:746-751.
    Pubmed CrossRef
  23. Surgit O. Single-incision Laparoscopic surgery for total extraperitoneal repair of inguinal hernias in 23 patients. Surg Laparosc Endosc Percutan Tech 2010;20:114-118.
    Pubmed CrossRef
  24. 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;145:334-338.
    Pubmed CrossRef
  25. Schwab R, Willms A, Kroger A, Becker HP. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 2006;10:272-277.
    Pubmed CrossRef
  26. Topart P, Vandenbroucke F, Lozac'h P. Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 2005;19:724727.
    Pubmed CrossRef
  27. Tran H. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. JSLS 2011;15:4752
    Pubmed KoreaMed CrossRef
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