Norihito Wada, MD, PhD, FACS, Toshiharu Furukawa, MBA, MD, PhD, Yuko Kitagawa, MD, PhD, FACS. Department of Surgery, keio University School of Medicine
Introduction: Inguinal hernia is a benign disease. The indication for surgical treatment is relative. For the elderly patients with inguinal hernia, the lifestyle is not so active and the life expectancy is limited. If the symptom of hernia is minimal, the risk may exceed the benefit of surgery. We have developed a novel minimally invasive technique of single-port in the lower abdomen laparoscopic TEP inguinal hernioplasty under local anesthesia which have the potential to expand the indication of laparoscopic surgery for inguinal hernia.
Materials & Methods: From January 2012 to June 2018, a consecutive group of 169 patients with bilateral inguinal hernia was included. The clinical data of the patients aged 80 or older (group E, n=23) were compared with those of the patients aged less than 80 (group Y, n=146). Obese patients, patients with giant hernia or irreducible hernia were excluded. We used 0.5% lidocaine with epinephrine as local anesthesia. An incision of 30 mm in the lower abdomen was made and a wound protector with sealing silicon cap was installed. We used three 5-mm trocars and a 5-mm flexible laparoscope. A flat self-fixating mesh with resorbable microgrip was placed over the myopectineal orifice. No tacking devices were used.
Results: The mean ± SD [range] age of group E and Y were 84.0 ± 4.0 [80-96] and 65.6 ± 9.9 [27-79], respectively. Female sex of group E and Y were 17.4% and 11.0%, respectively (P=0.59). The mean ± SD [range] operating time of group E and Y were 162 ± 38 [76-300] and 164 ± 42 [100-254] minutes, respectively. Surgical complications were not observed except for 7 cases of minor seromas (4.1 %). Pneumoperitoneum due to peritoneal injury was occurred in 18 cases (10.7%) and managed by closing the defect. During median follow-up of 45 months, we observed 1 hernia recurrence (0.59 %) in group Y. No 30-day mortality was observed.
Conclusions: The mid-term outcomes of elderly patients were comparable to those of younger patients. Surgical invasiveness of this technique was minimal because the area of dissection in the preperitoneal space is smaller than that of umbilical TEP. Postoperative recovery was rapid and patients can walk soon after surgery. This novel procedure may be feasible in elderly patients. The indication of TEP may be expanded to the elderly patients at high risk of general anesthesia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94007
Program Number: P567
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster