Totally Extraperitoneal Single Incision Laparoscopic Inguinal Hernia Repair

Nicole Sharp, MD, Justin Fried, BS, Rob Watson, MD, John F Eckford, MD, F. Paul Buckley, MD, Stephen Abernathy, MD, Richard Frazee, MD. Scott & White


Introduction: Several options exist for the surgical management of inguinal hernias. Laparoscopic inguinal hernia repair has been demonstrated to produce less postoperative pain compared to open inguinal hernia repair. Single incision laparoscopic surgery (SILS) inguinal herniorapphy offers a less invasive method for inguinal hernia repair. We present our initial results with SILS total extraperitoneal (TEP) inguinal herniorapphy in 86 patients.

Methods and Procedures: An IRB approved retrospective review of SILS TEP inguinal herniorapphy at our two sister institutions was performed. SILS herniorapphy was performed through a 1.5 cm infraumbilical incision and a planned preperitoneal approach. Operating time, need for admission, perioperative morbidity, and recurrence at time of follow-up were determined.

Results: 81 men and 5 women , age 17-85 years (mean age 55.5 years) underwent SILS inguinal herniorapphy between Oct 2009 and August 2011. BMI ranged from 17.6-36.9 kg/m2 (mean 25.5 kg/m2). Mesh fixation was performed with 3 or fewer hernia tacks in 96% of patients. Operating time ranged from 31-206 minutes (mean 74.9 minutes). 7 patients underwent additional unrelated surgical procedures including breast augmentation, cystocele repair, rectocele repair, incisional hernia repair, and groin mass excision. Excluding patients that underwent additional procedures, average operative time ranged from 31 to 129 minutes (mean 71.5 minutes).  9 patients (10%) required conversion to a SILS transabdominal pre-peritoneal (TAPP) approach.  There were no conversions to standard laparoscopic or open procedures.  84 procedures were performed as outpatients and 2 procedures were admitted for 2-3 days. Postoperative complications occurred in 13 patients and included urinary retention (4), seroma (4), bladder injury (1), stitch abscess (1), prostatis (2) groin hematoma requiring re-exploration (1). Follow-up is brief, but to date, there has been one recurrence.

Conclusions: SILS inguinal herniorapphy is another viable option for inguinal hernia repair and has comparable results to other techniques in the literature. It offers the advantages of the laparoscopic preperitoneal approach, is technically feasible, and minimizes incisional discomfort and scarring.

Session Number: Poster – Poster Presentations
Program Number: P279
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