Long Term Follow Up of Laparoscopic Tep Hernia Repair Using Slit Medium Size Polypropylene Mesh

Sugandi Hardjanto, MD. Kasih Ibu Hospital

Objectives: Concerning shrinkage of polypropylene mesh about 40% after 6 weeks (invitro), so the size of mesh graft is very important to avoid the development of recurrence. The objectives of the study is to determine whether medium (12×8 cm) slit polypropylene mesh is an adequate size for reinforcement inguinal hernia (Gilbert type 2 classification which the defect ≤ cm) for Asian people.

Methods: A retrospective review over eight and a half years period from January 2002 to June 2009, 235 consecutive patients of inguinal hernia Gilbert type 2 classification underwent totally extraperitoneal (TEP) inguinal hernia repair and were performed by a single surgeon. These surgery cases consisted of 226 male patients (age range 32-79 years old) and 9 female patients (age range 45-56 years old). After reduction of hernia’s sac and appropriate dissection of the pre-peritoneal space, followed by placement of a medium (12×8 cm) slit polypropylene micropore heavy weight mesh with 2 sutures (vicryl 2-0) were already placed at the upper border adjacent to the slit on the mesh. The two sutures were retrieved with 14 gauge injection needle one by one via the same point on the abdominal wall and adequately tied externally to secure the mesh to abdominal wall and the knot is buried subcutaneously.

Result: The follow up was complete (telephone interview) in 92%, partial (interview & physical examination) in further 6%, there were 1,3% cases of hernia recurrence. The operating time averaged between 55 to 110 minutes. There was no chronic pain so far. There were 1,7% cases that required conversion to Stoppa method.

Conclusion: The use of slit medium size mesh graft with single fixation in laparoscopic TEP Hernia repair for inguinal hernia Gilbert type 2 classification is quite effective & simple for Asian people. However its long term result must be evaluated more fully.

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