Simultaneous TEP (totally extraperitoneal approach) for inguinal hernia and cholecystectomy – A feasible and safe procedure

Norimasa Koide, Takao Kuno, Takahiro Mizukawa, Kenji Kato. Inazawa Municipal Hospital

Introduction: Laparoscopic inguinal hernia repair and cholecystectomy are the most common surgical procedures in the world. Simultaneous performing both procedures are rare conditions. This study shows the safety and the possibility of performing a simultaneous TEP and cholecystectomy thought the different extraperioneal and intraperitoneal approach.

Methods and procedures: Three male patients with inguinal hernia and cholelithiasis were included in this study. Mean age of the patients was 68.7 years (ranging from 65-75). Simultaneous laparoscopic cholecystectomy and TEP (seven wounds and 4 trocars) was performed in all patients. The PDB balloon, hernia staple and clip were not used in this procedure. Intra and postoperative complications were analyzed to assess the safety and feasibility of the procedure.

Result: Mean operating time was 392 minutes (ranging from 364-441), mean blood loss was 7.0 ml (ranging from 4-10) and average length of postoperative day was 4.3 days (ranging from 4-5). Two peritoneal tears were occurred during TEP procedure and repaired by hand sowing. No postoperative complications were observed.

Conclusions: Simultaneous TEP and cholecystectomy was a safe and feasible procedure except for longer operative time and intraoperative peritoneal tear. However this procedure may be more cost effective and less postoperative complications.

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