Inguinal hernia repair in a community hospital setting--have attitudes changed because of laparoscopy? A review of a general surgeon's experience over the last 5 years

Laparoscopic transabdominal inguinal hernia repair in community hospital settings: a general surgeon's last 10 years experience

Numerous studies have documented the laparoscopic TransAbdominal Pre-Peritoneal (TAPP) approach as an excellent choice for inguinal hernia repair, especially with an experienced surgeon. A cohort population of patients who underwent TAPP laparoscopic surgery for inguinal hernias over the last 10 years, with follow-up, were evaluated, focusing on the feasibility, safety and benefits of this procedure in a community hospital setting.

MATERIALS AND METHODS

A total of 533 patients underwent TAPP for inguinal hernias between January 2003 and March 2013 in two community hospitals in the Northeast of Italy-"Civil Hospital" in Vittorio Veneto (TV) and "Civil Hospital" in Adria (RO).

RESULTS

The total number of hernias treated was 1,000. The overall mean operative time was 43.50 min (±13.2). All but three of the procedures were done on a day surgery basis. There were no conversions to open repair or deaths in our series. We had two cases of small bowel obstruction and eight relapses (0.8 %) in our series. The mean follow-up was 59.4 months (±5.6; range 3-120). No patients reported severe pain at 10 days, 21 patients (3.9 %) reported mild pain at 3-month follow-up. Over 90 % of the patients had a return of physical work capacity within 2 weeks, the remaining within 30 days. All patients were completely satisfied (numerical rating scale 10/10) 3 months after the operation.

CONCLUSIONS

The analysis of the short- and long-term post-operative outcomes of our experience enabled us to conclude that in an appropriate setting, TAPP is feasible, effective, safe and beneficial for patients. It should be incorporated into general surgeons' expertise and selectively used for the management of patients with hernias, as long as adequate training is obtained and appropriate preparation performed.

Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons' last five years experience over 932 cases

Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth-5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.

Inguinal-scrotal hernias in young patients: is laparoscopic repair a possible answer? Preliminary results of a single-institution experience with a transabdominal preperitoneal approach

OBJECTIVES

The laparoscopic trans-abdominal preperitoneal (TAPP) approach to inguinal hernia repair is well documented as an excellent choice in numerous studies, especially when conducted by an experienced surgeon. Its full list of specific indications is still under debate. Generally, the repair of scrotal hernias demands a higher level of experience on the part of the surgeon, irrespective of the applied surgical technique. In this report, we evaluate our preliminary experience of TAPP laparoscopic repair for inguinoscrotal hernias in young patients in a Community Hospital setting, focusing on the feasibility of the technique and the incidence of complications.

MATERIALS AND METHODS

Between January 2008 and January 2009 a total of ten consecutive young patients at the "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic repair of bilateral inguinoscrotal hernias.

RESULTS

The overall mean operative time was 65 (+/-15) min. All procedures were performed on a day surgery basis. There were no conversions to open repair, no mortality/morbidity or relapsing hernias. The mean follow-up was 14 (+/-2) months. No patients reported severe pain at 10 days, There were no reports of night pain at 30 days. All patients had a return to physical-work capacity within 14 days. All patients were completely satisfied at the 3-month follow up.

CONCLUSIONS

Analysis of the short-term post-operative outcomes of our experience enabled us to conclude that, in the proper setting, TAPP can be performed for inguinoscrotal hernia repair with an efficiency comparable to that of normal inguinal hernia repair.