Would the ability to diagnose unexpected secondary findings be a crucial factor to choose TAPPS over TEPPS? The primary surgeon of this abstract incidentally diagnosed a liver malignancy that prompted this question. Over the years, debate between the two approaches has been an on-going issue. Neither surgery has demonstrated definitive superiority over the other. One potential benefit in TAPPS is the ability to survey the abdominal cavity.
Retrospective evaluation of single institutional series of laparoscopic inguinal hernias performed trans-abdominally over a 3 year period. The patients’ charts with unexpected secondary findings during the TAPPS were further evaluated and determined the impact in the patients’ medical care or course.
From Jan 8, 2003 to Aug 8, 2006, of the 208 patients who underwent TAPPS, 32 unexpected intra-abdominal findings 15.3%. Adhesions 4.3%, incarcerated bowel 2.9%, incarcerated omentum 2.9%, and undiagnosed ventral hernias 2.4%. Remaining 2.8% were of other miscellaneous findings. Preperitoneal cord lipomas 16.8% were found.
Adhesions and abdominal wall hernias are important findings, but none of the cases were problematic postoperatively. Although the viability concerns made bowel incarceration the most significant finding, none required resection. Overall most common finding were cord lipomas which are pre-peritoneal and can be found with TEPPS as well. Although our retrospective review revealed that TAPPS did diagnose secondary findings, the significance of those findings is debatable.
Program Number: P350