Minoru Matsuda, MD, Atsushi Kawasaki, MD, Jun Okamura, MD, Tomoshige Shigyo, MD. Kagurazaka D.S. Mai Clinic
Introduction: In Japan, even hernia repair requires 3 days admission mainly due to the old fashion custom. We performed inguinal hernia repair with anterior open technique that assumes the short stay surgery. The anterior open technique is performed by a combination of local, intravenous and inhalation anesthesia and 29% were day surgeries last year in our institution. On the other hand, laparoscopic TAPP repair has several superiorities against the open approach, however, longer operative time and general anesthesia are the problems. For the day surgery based TAPP repair, reduction of the postoperative pain, shorter operative and anesthesia time are the important points.
We introduced the single port TAPP repair from July 2015 and performed for 20 lesions while 610 open and 159 hybrid techniques are done. Aim of this study is to compare the operative time and postoperative pain among 3 techniques, as well as introduce our recent needlescopic technique.
Results: Mean operative time was 60.3±11.3 min. in single port TAPP and was significantly longer (p<0.01) than open (23.8±5.9 min.) and hybrid technique (37.7±16.5 min.). Moreover, faces pain scale (FPS) at the end of operation and 1 hour after the surgery were significantly higher than the open and hybrid (0.24 vs. 1.35, 0.53 vs. 1.63: p<0.01).
Therefore, We introduced the 3mm needlescopic TAPP repair for the shorter operative time and reduction of postoperative pain.
3mm needlescopic TAPP:
We use 3.3mm scope (HOPKINS®II Telescope, KARL STORZ, Germany), 3.5mm forceps (ERAGON nodular mini, RICHARD WOLF, Germany)and 5mm instruments for the TAPP repair using lightweight mesh.
We started the 3mm needlescopic TAPP in December 2015 and 36 lesions were performed. Mean operative time was 39±11.8 min. and there were no intraoperative complications. There were no differences between the hybrid technique and 3mm needlescopic TAPP in postoperative FPS (0.24 vs. 0.72).
Conclusions: All patient was returned to home within 24 hours. The wound cosmesis is quite good and pain control was easy with the 3mm needlescopic TAPP repair. It was thought that the day surgery would become more popular in Japan by this procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79065
Program Number: P024
Presentation Session: Poster (Non CME)
Presentation Type: Poster