Single Incision Laparoscopic Transabdominal preperitoneal mesh hernioplasty for complicated inguinal hernia

Kazuo Tanoue, MD, PhD, FACS, Hidenobu Okino, MD, PhD, Masamitsu Kanazawa, MD, PhD, Kiichiro Ueno, MD, PhD. Ueno Surgical Hospital

BACKGROUND: Transabdominal preperitoneal mesh hernioplasty (TAPP) for inguinal hernia has been popular surgical method. Recently, single incision laparoscopic TAPP repair (S-TAPP) has also spread in Japan. Herein, we report the assessment of S-TAPP for cases of complicated inguinal hernia compared with simple inguinal hernia.

PATIENTS AND METHODS: A consecutive series of 200 patients (73 male, 7 female) who underwent S-TAPP during June 2010 to June 2015 in a single institution. We evaluated operation time and morbidity of 15 cases of complicated unilateral hernia, which was defined as (1) a recurrent hernia (n=7), (2) hernia associated with a previous prostatectomy (n=2), or (3) an incarcerated omental or bowel hernia (n=6), compared with 147 cases of simple unilateral hernia.

Establishment of the ports: A 25-mm vertical intra-umbilical incision is made for port access. One 5-mm optical port and two 5-mm ports were placed side-by-side through the umbilical scar.

Surgical procedure: The procedure was carried out in the conventional fashion with a wide incision in the peritoneum to achieve broad and clear access to the preperitoneal space, and an appropriate placement of polypropylene mesh (3DMaxTM light, Bard) with fixation using the tacking device (AbsorbaTack®, Covidien). The hernia sac is usually reduced by blunt dissection, or is ligated and transected with ultrasound activated device. The peritoneal flap is closed by one suture with 3-0 PDS and the 6-7 tacks using AbsorbaTack®.

RESULTS: Seven patients were treated for a recurrent hernia that had been repaired previously by the McVay procedure (n=3) or with a mesh plug (n=2), 3DMax mesh (n=1), or UltraPro Hernia System (n=1). Two  patients were treated for hernia associated with a previous prostatectomy, and six patients were treated for incarcerated omental or bowel hernia. Operation times were consistently greater for the complicated hernias than for the simple hernias, but the time differed significantly only between prostatectomy-associated hernia and simple hernia (p=0.02). None of the complicated hernias required conversion to traditional laparoscopic repair. Seroma developed after surgery in three patients with a complicated hernia. The incidence of seroma was higher in the complicated hernia group than in the simple hernia group, but the difference was not significant.

DISCUSSION: Our results suggest that S-TAPP is a safe and feasible method without additional risk, even in complicated hernias. However, further evaluation for postoperative pain and long-term complications compared to S-TAPP mesh hernioplasty for simple hernia should be required.

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