Searching for a Suitable Approach for Laparoscopic Inguinal Hernia Repair: Inicial Experience

Ezequiel Sadava, Martin Galvarini, Rudolf Von Buxhoeveden, Belen Castro Fuentes, Romina Reino, Florencia Ocariz, Francisco Schlottmann. Hospital Aleman of Buenos Aires

Introduction: Since its introduction laparoscopic inguinal hernia repair has obtained worldwide acceptance. Although totally extraperitoneal (TEP) technique offers no-entry into abdominal cavity with similar outcomes compared to transabdominal preperitoneal (TAPP) technique, the latter one is preferred by most of the surgeons. In the era of tailored treatments, we aimed to evaluate whether TEP is more adequate approach in the treatment of inguinal hernia.  

Methods and procedures: From June 2012 to February 2015 all charts of consecutive patients underwent to laparoscopic inguinal hernia repairs were revised. Patients who had clinical history of pelvic surgeries and femoral hernias, and also those with less than 6 months of-follow-up were excluded. Demographics, operative features and post-operative complications were analyzed comparing totally extraperitoneal (TEP) and trans-abdominal preperitoneal (TAPP) techniques. Also mid- and long-term follow-up was evaluated with focus in hernia recurrence and chronic pain.

Results: A total of 297 laparoscopic inguinal hernia repairs were included in the study: 50 (17 %) TEP and 247 (83 %) TAPP repairs with synthetic prosthesis. There was no difference in gender, age, BMI and ASA score between groups (p=NS). The mean defect size was 4 cm in TEP and 4.5 cm in TAPP (p=NS). All TEP repairs were performed by the same surgeon. The rate of peritoneal tears was 15 % and there was no conversion to TAPP. Length of hospital stay was similar between groups (TEP: 0.4 days vs TAPP: 0.6 days, p=NS). No difference was found in thirty-day postoperative complications: TEP: 6 % (3 patients) vs TAPP 3 % (7 patients), p=NS.  With a mean follow up of 18 (6-30) months, the incidence of recurrence was 2 % in both groups (p=NS) and 1 patient in TAPP group had chronic pain (> 6 months).

Conclusions: Both laparoscopic hernia repairs are safe and effective procedures. In this series we failed to find differences in postoperative outcomes when comparing TEP and TAPP techniques. Prospective investigations would provide new insights in this controversial issue to make the right choice for the most suitable surgical technique.  

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