Feasibility and safety of single incision totally extraperitoneal inguinal hernia repair after previous open inguinal hernia repair: A case-mached analysis

Masaki Wakasugi, Mitsuyoshi Tei, Toru Masuzawa, Kenta Furukawa, Yozo Suzuki, Kentaro Kishi, Masahiro Tanemura, Hiroki Akamatsu. Osaka Police Hospital

Purpose: To evaluate the feasibility and safety of single incision laparoscopic surgery for totally extraperitoneal repair (SILS-TEP) after previous open inguinal hernia repair.

Methods: A matched pair analysis of 260 patients who underwent SILS-TEP for unilateral inguinal hernia from January 2011 to June 2015 at Osaka Police Hospital was performed. The recurrent hernia group consisted of 15 patients (6%, 15/260) with a history of previous open inguinal hernia repair before undergoing SILS-TEP. Patients in the control group were matched in terms of age, gender, side of hernia, body mass index, American Society of Anesthesiologists scores with the same number of patients from the 245 primary inguinal hernia patients.

Results: The mean operative time in the recurrent and the control groups was 89 min and 93 min, respectively (p = 0.6). The mean postoperative hospital stay was 2.9 days for the recurrent group and 2.1 days for the control group (p = 0.2). Two cases in the recurrent group were converted to one conventional three-port TEP repair and one open repair. One case in the control group was converted to conventional three-port TEP repair. There was no significant difference in conversion to a different procedure between the two groups (p = 1). Complications were seen in 33% (5/15; 4 seromas and 1 wound infection) of patients in the recurrent group and 7% (1/15; 1 seroma) in the control group (p = 0.1). No other major complications and hernia recurrence were noted in the two groups.

Conclusions: SILS-TEP for patients with previous open inguinal hernia repair could be performed safely by experienced surgeons. Operative outcomes were comparable between both the primary inguinal and recurrent hernia groups.

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