Atsushi Urakami, MD, Munenori Takaoka, MD, Jiro Hayashi, MD, Kaori Shigemitsu, MD, Kazuhiro Yoshida, MD, Yoshio Naomoto, MD. Department of General Surgery, Kawasaki Medical School
Introduction:Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is associated with a decrease in postoperative pain, shortened hospital stay, and decrease in chronic pain. However, recent advances in minimally invasive surgery aimed at diminishing number of ports and incision size have led to the development of reduced port surgery (RPS). RPS has an increased level of complexity and requires a higher level of surgical skill compared to traditional laparoscopic surgery. We developed minilaparoscopic inguinal hernia repair (m-TAPP) in an attempt to further decrease postoperative pain and improve cosmetic outcome. It employs smaller instruments and has been associated with potentially decreased postoperative pain and improved cosmetic outcome, and overall patient satisfaction in elective cases of TAPP.
Methods:The study is a retrospective review of consecutive elective TAPP performed by three surgeons at a community teaching hospital over 24 months. All surgeries were performed using a 5mm trocar for the umbilical port with 5mm laparoscope, the right lateral port, and 2mm trocars for the left lateral port with 2mm grasper in standard TAPP style. After reduction of the hernia sac and dissection of the preperitoneal space, we placed polyester mesh (Parietex folding mesh), which can be inserted via 5mm port, with staple (Absorbatack) fixation. The peritoneum was closed with 3–0 Polysorb in continuous sutures.
Results: 51 patients underwent m-TAPP were retrospectively investigated. The mean operative time was 83.2 min for unilateral and 115.4 min for bilateral hernias. There was no conversion to open repair. Ten patients (20%) used postoperative analgesics. The mean length of hospital stay was 2.2 days. Regarding intraoperative complications, we observed no bowel injuries or major vessel injuries. Postoperative complications occurred in 1 patient (2%), who had a postoperative hemorrhage which required re-operation. There was no incidence of chronic pain or mesh infection.
Conclusions: m-TAPP was a safe and useful technique for inguinal hernia repair. Compared with standard TAPP, m-TAPP had similar operative times and similar length of stay. Large prospective, randomized controlled trials will be required to establish the benefit of m-TAPP.