Endo-laparoscopic inguinal hernia repair: What is its role?

Endoscopic Hernia Repair: A Novel Technique for the Repair of Inguinal Hernia in a Cadaver Model

BACKGROUND

The techniques of total extraperitoneal and transabdominal preperitoneal hernia repair have been conducted for laparoscopic repair of inguinal hernia since long. However, they offer significant disadvantages of requiring general anesthesia, producing negative cosmetic outcomes, and other serious complications. We examined the feasibility of applying an endoscopic method alternative to total extraperitoneal and transabdominal preperitoneal for laparoscopic repair of inguinal hernia in a cadaver model so as to overcome the disadvantages of the presently available techniques.

METHODS

A total of 4 male and 2 female cadavers [aged 18 y and above, body mass index (BMI) <40 kg/m2], who were planned for a routine autopsy between January 24 and 26, 2020 were selected for the present study conducted at the Forensic Medicine Institute. Twelve laparoscopic repair surgeries of inguinal hernia were performed in 6 of these cadavers using both the inguinal areas.

RESULTS

We conducted a total of 12 surgeries on 4 male (mean age: 43.25 y; BMI: 29.05 kg/m2) and 2 female cadavers (mean age: 76.50 y; BMI: 26.60 kg/m2). A 7×5-cm-shaped mesh was used for both the sexes. For the fixation of the mesh, a titanium tacker was used in pubic tubercle and tendon conjoint, whereas for the fixation of ligamentum inguinale, 2/0 PDS was used in 3 surgeries, 2/0 15-cm V-Loc was used in another 3 surgeries, and titanium tacker was used in 6 surgeries.

CONCLUSIONS

We demonstrated that the technique of endoscopic surgery that offers the advantages of open inguinal surgery in a cadaver model can be combined with the presently used laparoscopic intervention so as to combine all the advantages, especially for patients who are not suitable for general anesthesia, who are experiencing a recurrence after laparoscopic intervention, and who do not want any visible scares resultant from the surgery. For future studies, we suggest that the proposed technique be applied to inguinal hernia patients to ascertain clearer results.

[Positioning of mesh implants in endoscopic inguinal hernia repair]

OBJECTIVE

To improve the results of endoscopic inguinal hernia repair by determining the optimal access to inguinal region and method of positioning of the mesh implant.

MATERIAL AND METHODS

There were 221 patients with inguinal hernia who underwent 278 operations. We formed 2 groups: the main group A consisted of 92 (41.6%) patients who underwent extraperitoneal interventions (TEP/e-TEP); the control group B - 129 (58.4%) patients after transabdominal surgery (TAPP). In each group, 3 subgroups were identified depending on the method of mesh implant positioning: subgroups A1 and B1 - stapler reduced fixation at 1-3 points, subgroups A2 and B2 - glue fixation, subgroups A3 and B3 - vacuum positioning without fixation. Acute, chronic pain syndrome and quality of life were evaluated using visual-analogue scale (VAS), Short-Form Inguinal Pain Questionnaire (sf-IPQ) and SF-36 questionnaire, respectively.

RESULTS

All interventions were completed in minimally invasive fashion. Regression of acute pain syndrome after 3, 24, 48, 72 hours and 7 days was as follows: in group A - from 3.39±0.37 to 0.53±0.18 scores, in group B - from 4.47±0.34 to 0.94±0.24 scores. The lowest values were observed in subgroups with non-invasive positioning (p<0.05). Chronic pain syndrome was evaluated by all patients as less than 2 scores in 6 months after surgery. SF-36 values after 6 months ranged from 78±1.5 to 92±1.0 at TEP/e-TEP and from 75±1.6 to 92±1.1 at TAPP. Between-group and within-group differences were not significant (p>0.05). Control examination within 0.5-2 years was performed in 189 (85.5%) patients. No relapses were detected.

CONCLUSION

E-TEP technology is a priority. Glue fixation increases the congruence of mesh implants with inguinal region due to enlarged area of immobilization. This ensures safety and reliability of hernia repair, comfort for patients.