Single site, totally extra-peritoneal (TEP) inguinal hernia repair utilizing a self-fixating mesh.

Alfredo D Guerron, MD, Shaina Eckhouse, MD, Nova Szoka, MD, Dana Portenier, MD, Jin Yoo, MD, Ranjan Sudan, MD, Keri Seymour, MD, Chan Park, MD. Department of Surgery, Duke University Health System

Background: Inguinal hernias are a common problem. 20 million repairs are performed worldwide every year. Since the 1990’s the proportion of laparoscopic repairs has increased markedly. Patient education and demand for better cosmetic results after surgical procedures have led to an increased interest in single incision surgery. 

Single site laparoscopic surgery has been applied to numerous operations, and has been demonstrated to provide comparable surgical outcomes and with enhanced cosmesis and possibly reduced post-operative pain. Self-fixating mesh has also been safely applied in laparoscopic TEP procedures, but this mesh has not been described in single site TEP surgery; possibly due to the potential difficulty with mesh deployment. 

This self-fixating mesh delivers tack-free fixation over the entire anatomy, including below the inguinal ligament where traditional tacks cannot be placed. We sought to determine the technical feasibility of a single site laparoscopic TEP repair of inguinal hernias and to discuss our techniques and patient outcomes. 

Patient and Methods: We conducted a review of a prospectively maintained database of patients who received single site laparoscopic TEP herniorrhaphy from August 2012 until present. Patient characteristics and demographics data, along with perioperative and post-operative data were analyzed. 

Results: 34 patients, ages 55.2±14.1, 82.4% were males and 17.6% were females. Mean BMI 26.2 ±3.8. Mean operative time 99.45±30.5 minutes, 41.2% were left-sided repairs, 8.8% right-sided, and 50% bilateral. Estimated blood loss (EBL) 18.38±14.1 ml. Primary hernias were encountered in 85.3%, and 26.5% patients received a combination surgery – most common was concurrent umbilical hernia repair. The most common short-term post-operative complication was urinary retention (4 patients; 11.7%), and mean post-operative follow-up was 21.53±9.4 days. One patient presented with persistent swelling, and 3 had inguinal/scrotal pain that did not require surgical intervention. Long-term complications (> 30 days) included hydrocele (3 patients) and stitch abscess/wound drainage 1 patient. Two patients were followed up to one year due to pain. No recurrences or mortality were reported. 

Conclusions: Single site total extraperitoneal hernia repair is a feasible and safe procedure that provides excellent cosmesis and may have some benefit with mesh placement and intra-operative instrument deployment. There were no mortality or recurrences. Urinary retention was the most common postoperative complication. Hydrocele was the most common > 30 day complication. Chronic pain was only present in 2 patients.

« Return to SAGES 2016 abstract archive