The Safety and Usefulness of Single Incision Laparoscopic Tapp

Hideya Kashihara, title, Mitsuo Shimada, title, Nobuhiro Kurita, title, Takashi Iwata, Masanori Nishioka, Kozo Yoshikawa, Tomohiko Miyatani, Chie Mikami, Tohru Utsunomiya. Tokushima University

Introduction Laparoscopic surgery for inguinal hernia has been widely performed. Recently, single incision laparoscopic surgery (SILS) is prevailing in terms of minimizing surgical trauma and improving cosmetic effect. However, the safety and usefulness of SILS-TAPP (trans-abdominal preperitoneal repair) remains unclear. The aim of this study is to clarify the safety and usefulness of SILS-TAPP compared with standard laparoscopic TAPP and TEPP (Totally extraperitoneal preperitoneal repair).

Patients and Method Fifty-nine patients have undergone laparoscopic inguinal hernia repairs (TEPP (group E): 30 patients, TAPP (group A): 18 patients, SILS-TAPP (group S): 11 patients) during the period from 2007 to 2010. We measured operative outcome of three groups (operation time, postoperative hospital stay, convert to conventional methods, intra and postoperative complication, recurrence).

Results The average ages of three groups were 68, 60, 63 years respectively (E : A : S). In group S, A patient had bilateral hernia while all other patients had unilateral hernia. Eight patients had indirect hernia and four patients had direct hernia in group S. Two patients had previous laparotomy in group S. There was no difference in patients’ characteristics among three groups. Group A was longer than the other two groups in operation time (E : A : S = 92 (32 – 171) : 110 (70 -220) : 81 (85 – 177) min, N.S.). The postoperative hospital stay showed no significant difference among three groups (E : A : S = 3 (1 – 6) : 4 (1 – 8) : 6 (3 – 9) days, N.S.). No patients were converted to conventional methods in group S. There were no intra and postoperative complications except for seroma formation in three patients resolved spontaneously in group S. And there was no recurrence in group S. The intraoperative points of SILS-TAPP are the dissection of peritoneum and the peritoneal repair. We will show the technique in our video.

Conclusion SILS-TAPP is comparable to standard laparoscopic TAPP and TEPP in terms the safety and usefulness. We consider SILS-TAPP is an useful procedure for inguinal hernia repair.