Laparoscopic transabdominal preperitoneal technique versus open surgery with the ULTRAPRO Hernia System for the repair of female primary femoral hernias-an observational retrospective study

Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case

BACKGROUND

Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment.

METHODS

Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups.

RESULTS

A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0 days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0 days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270).

CONCLUSIONS

Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.

The fascial connections of the pectineal ligament

In clinical settings, the pectineal ligament forms a basic landmark for surgical approaches. However, to date, the detailed fascial topography of this ligament is not well understood. The aim of this study was to describe the morphology of the pectineal ligament including its fascial connections to surrounding structures. The spatial-topographical relations of 10 fresh and embalmed specimens were dissected, stained, slice plastinated, and analyzed macroscopically, and in three cases histological approaches were also used. The pectineal ligament is attached ventrally and superiorly to the pectineus muscle, connected to the inguinal ligament by the lacunar ligament and to the tendinous origin of rectus abdominis muscle and the iliopubic tract. It forms a site of origin for the internal obturator muscle, and throughout its curved course, the ligament attaches to both the fasciae of iliopsoas and the internal obturator muscle. However, dorsally, these fasciae pass free from the bone, while the pectineal ligament itself is adhered to it. The organ fasciae are seen apart from the pectineal ligament and its connections. The pectineal ligament seems to form a connective tissue junction between the anterior and medial compartment of the thigh. This ligament, however, is free to other compartments arisen from the embryonal gut and to the urogenital ridge. These features of the pectineal ligament are important to consider during orthopedic and trauma surgical approaches, in gynecology, hernia and incontinence surgery, and in operations for pelvic floor and neovaginal reconstructions. Clin. Anat. 32:961-969, 2019. © 2019 Wiley Periodicals, Inc.

Resection of mesothelial cyst of uterine round ligament by laparoscopic transabdominal preperitoneal procedure alone or combined with open surgery

Objective

Surgical treatment of a mesothelial cyst of the uterine round ligament (MCURL), an uncommon entity, has been rarely documented. In this article, we present our experience with excision of MCURLs.

Methods

The records of all female patients undergoing surgical removal of a groin mass in our department from March 2013 to November 2018 were retrospectively reviewed. Demographic information, clinical data, and follow-up outcomes were collected and analyzed.

Results

Among 298 women who underwent groin hernia repair, 17 (5.7%) had MCURLs. Of these 17 patients, 13 were aged 30 to 45 years and 15 had a normal body mass index (18.5–23.9 kg/m²). MCURLs occurred predominantly on the right side (11/17). Approximately half of the patients (9/17) were preoperatively misdiagnosed with inguinal hernias. Approximately 70% (12/17) of the lesions were localized medially to the inner ring of the inguinal canal and excised by a laparoscopic transabdominal preperitoneal (TAPP) procedure alone. Five patients required open surgery following the TAPP procedure because the cyst extended distally beyond the inner ring. No recurrence was noted during the entire follow-up period.

Conclusion

Most MCURLs were localized medially to the inner ring of the inguinal canal and could be excised by a TAPP procedure.