Laparoscopic transabdominal preperitoneal repair versus open mesh plug repair for bilateral primary inguinal hernia

Comparison of Clinical Outcomes of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in Bilateral Inguinal Hernia Repair: A Retrospective Study

OBJECTIVE

This study compared the clinical outcomes of two commonly used laparoscopic techniques, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair, in the treatment of bilateral inguinal hernias.

MATERIALS AND METHODS

This retrospective cohort study included 250 patients who underwent laparoscopic bilateral inguinal hernia repair using either the TEP or TAPP technique between May 2009 and May 2024. The patients were divided into two groups: 50 patients in the TEP group and 200 in the TAPP group. Data were collected from patient records, including demographics, type of hernia, surgical details, intraoperative and postoperative complications, conversion rates, and early hernia recurrence. Statistical analysis was performed to compare outcomes between the two groups.

RESULTS

Among the 250 patients included in the study, the mean age was 51.62 ± 8.79 years, and 94% (n=235) were male. The mean operative time was significantly longer in the TEP group (93.2 ± 13.0 minutes) than in the TAPP group (57.95 ± 7.5 minutes) (p <.001). The mean hospital stay was also longer in the TEP group (1.36 ± 0.48 days) compared to the TAPP group (1.07 ± 0.25 days) (p <.001). The TEP group had a higher rate of conversion to open surgery 18%(n=9) and conversion to TAPP 10% (5) than the TAPP group, which had no conversions (p <.0001). Postoperative complications were more frequent in the TEP group, with urinary retention being significantly higher at 16%(n=8) than in the TAPP group at 2% (n=4) (p <.0004). Additionally, the TAPP group experienced two (1%) notable intraoperative complications that required reoperation: arterial injury and small bowel injury.

CONCLUSION

The findings suggest that, while both TEP and TAPP effectively repair bilateral inguinal hernia, TAPP is associated with shorter operative times, shorter hospital stays, and fewer postoperative complications. However, the TAPP technique also presented notable intraoperative risks, including arterial and bowel injury. The choice between TEP and TAPP should be based on the surgeon's experience, patient characteristics, and the specific clinical context.

Outcomes from Early Experience with Laparoscopic Inguinal Hernia Repair Versus Open Technique: Navigating the learning curve

Objectives

This study aimed to evaluate the outcomes of laparoscopic inguinal hernia repair (LIHR) regarding postoperative pain, recurrence rates, duration of hospital stay and other postoperative outcomes within the context of a tertiary care teaching hospital in South India, and the initial experience of laparoscopic repairs. The current consensus in the literature often suggests LIHR as superior to open inguinal hernia repair (OIHR).

Methods

This single-centre, retrospective, observational study was conducted at the Jawaharlal Institute of Postgraduate Education and Research, Puducherry, India, from January 2011 to September 2020. All patients who underwent elective OIHR and LIHR were included. Data on the patients demographics, comorbidities, hernia type, mesh characteristics, surgery duration, hospital stay and immediate postoperative complications were collected and analysed.

Results

A total of 2,690 OIHR and 158 LIHR cases were identified. The demographic profiles, hospital stay and complication rates were similar in both groups. However, surgical site infection was present exclusively in the OIHR group (3.55% versus 0.0%; P <0.05). The timeline for returning to normal activities was statistically shorter for the LIHR group (6 versus 8 days; P <0.05). The most frequent immediate complication in the LIHR group was subcutaneous emphysema (6.54% versus 0.0%; P <0.05). Recurrence (9.23% versus 3.61%; P = 0.09) and chronic pain (41.53% versus 13.55%; P <0.05) were higher in the LIHR group.

Conclusion

Lower recurrence and chronic pain rates were observed with OIHR in the initial experience with LIHR in the hospital. However, LIHR had significant advantages concerning faster patient recovery and lower rates of surgical site infections. While the results contribute an interesting deviation from the standard narrative, they should be interpreted within the context of a learning curve associated with the early experience of the research team with LIHR.

[Laparoscopic preperitoneal and Lichtenstein inguinal hernia repair. What method is preferable?]

This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.

Outcomes of Open Versus Laparoscopic Technique in Primary Inguinal Hernia Repair: A Retrospective Study

Inguinal hernia repair is one of the most common surgical procedures worldwide. In clinical practice, there are two different routes to repair inguinal hernias: laparoscopic mesh repair and open. Reducing the hernia and preventing recurrence remains the mainstay treatment option of both procedures. This study aims to compare postoperative outcomes and recurrence rates for patients who had primary, non-recurrent, laparoscopic, or open hernia repair in a single tertiary hospital. A retrospective cohort study was done on 468 patients. The study was conducted at King Abdulaziz University Hospital (KAUH) between 2013 and 2022. The distribution of our study population was divided into open hernia repair 378 participants (80.8%) while the rest did laparoscopic hernia repair 90 (19.2%). Operation duration in minutes was 107.158 ± 41.402 in the open hernia repair group and was noted to be significantly higher in the laparoscopic hernia repair group, with 142.811 ± 52.102 minutes p-value (0.000). The hospital length of stay was shown to be shorter in laparoscopic hernia repair (1.58 ±1.27) compared to open hernia repair (2.05±5.33). The most common postoperative complication was scrotal swelling, commonly associated with laparoscopic (5.55%) compared to 2.11% in open hernia repair. Open repair showed a risk of scrotal hematoma with a percentage of 0.52% compared to 0% in the laparoscopic method with a p-value (0.033). Hernia recurrence was non-related with any specific group, although noted to be higher in the laparoscopic group (7.77%), while in the open group (3.4%) with a p-value (0.081). The study conducted showed no alarming percentages for recurrence in either technique, open or laparoscopic, yet the open approach had a better outcome when it comes to scrotal pain and swelling post-operatively, chronic groin pain, and readmission rate as compared to laparoscopic technique, despite having a longer hospital stay. Future larger studies should be conducted to provide equal population inclusivity.

FUN-SIS: A Fully UNsupervised approach for Surgical Instrument Segmentation

Automatic surgical instrument segmentation of endoscopic images is a crucial building block of many computer-assistance applications for minimally invasive surgery. So far, state-of-the-art approaches completely rely on the availability of a ground-truth supervision signal, obtained via manual annotation, thus expensive to collect at large scale. In this paper, we present FUN-SIS, a Fully-UNsupervised approach for binary Surgical Instrument Segmentation. FUN-SIS trains a per-frame segmentation model on completely unlabelled endoscopic videos, by solely relying on implicit motion information and instrument shape-priors. We define shape-priors as realistic segmentation masks of the instruments, not necessarily coming from the same dataset/domain as the videos. The shape-priors can be collected in various and convenient ways, such as recycling existing annotations from other datasets. We leverage them as part of a novel generative-adversarial approach, allowing to perform unsupervised instrument segmentation of optical-flow images during training. We then use the obtained instrument masks as pseudo-labels in order to train a per-frame segmentation model; to this aim, we develop a learning-from-noisy-labels architecture, designed to extract a clean supervision signal from these pseudo-labels, leveraging their peculiar noise properties. We validate the proposed contributions on three surgical datasets, including the MICCAI 2017 EndoVis Robotic Instrument Segmentation Challenge dataset. The obtained fully-unsupervised results for surgical instrument segmentation are almost on par with the ones of fully-supervised state-of-the-art approaches. This suggests the tremendous potential of the proposed method to leverage the great amount of unlabelled data produced in the context of minimally invasive surgery.

A new approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair

BACKGROUND

To investigate the feasibility, safety and efficacy of the right-side approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair.

METHODS

Retrospective analysis was performed on 189 patients who were diagnosed with bilateral inguinal hernia preoperatively or intraoperatively and underwent selective TAPP in the General Surgery I Section of Shaanxi Provincial People's Hospital from January 2015 to September 2020. 94 cases were performed using the right-side approach (research group), and 95 cases with conventional approach (control group). Intraoperative and postoperative conditions of the two groups were observed and compared.

RESULTS

All operation were completed successfully. The operative time of research group was significantly shorter than that of control group (128.8 ± 35.4 vs 144.1 ± 40.9 min, P = 0.006). There were no significant differences in postoperative hospital stay, VAS score on first postoperative day, incidence of seroma and hematoma, urinary retention and other complications (P > 0.05). None of the patients occured hernia recurrence, mesh infection, intestinal obstruction and other complications.

CONCLUSIONS

The right-side approach to enter Retzius space is safe and feasible in TAPP surgery of bilateral inguinal hernia. Compared with the conventional approach, it can shorten the operative time and has certain advantages.

Evaluation of long-term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair

Aim

This study has two aims: to evaluate long-term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C-TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases.

Methods

A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C-TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10-point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long-term chronic pain and complications.

Results

The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate-to-severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest (P = .726), at movement (P = .712), or mesh discomfort (P = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post-match comparison, no differences in complications with Clavian-Dindo classification ≥III (U Group 0.7%, B Group 2.1%, P = .622) were detected.

Conclusion

C-TAPP, which focuses on the layered structure, showed acceptable results for long-term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.

Laparoscopic versus open mesh repair of bilateral primary inguinal hernia: A three-armed Randomized controlled trial

PURPOSE

The best approach for simultaneous repair of bilateral inguinal hernia is controversial. The aim of this study is to compare the outcomes after laparoscopic versus open mesh repair of bilateral primary inguinal hernia.

METHODS

this prospective study included 180 patients with bilateral primary inguinal hernia; randomized by sealed envelopes into 3 groups; each includes 60 patients. Group I treated by laparoscopic trans-abdominal pre-peritoneal (TAPP) repair using 2 separate meshes, Group II treated by open pre-peritoneal (PP) single mesh repair, while Group III treated by bilateral Lichtenstein repair.

RESULTS

In comparison to open PP and bilateral Lichtenstein repair, Laparoscopic TAPP repair had significantly longer operative time and superior early postoperative outcomes including significantly less postoperative pain, hospital stay, time till return to normal activity and to work. Chronic groin pain and mesh sensation was lower in Laparoscopic TAPP group with significantly higher satisfaction rate compared to open groups. No significant difference between study groups in 3 years recurrence rate.

CONCLUSION

Simultaneous laparoscopic TAPP repair of uncomplicated primary bilateral inguinal hernia has superior early postoperative outcome, less chronic pain and higher patients' satisfaction rate compared to open approaches with similar low recurrence rate.