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Effective rectus sheath canal: does it affect total extraperitoneal approach for inguinal mesh hernioplasty?

DOI: 10.5455/jeim.071212.br.012

Keywords: Inguinal hernia , Laparoscopic hernioplasty , Rectus sheath canal , Total extraperitoneal approach

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Abstract:

Objectives: This study aimed to compare the effects of the 1st port placement at two different levels below umbilicus during the total extraperitoneal (TEP) laparoscopic repair of inguinal hernia and to check the hypothesis that shorter effective rectus sheath canal would facilitate the TEP procedure. Methods: Eighteen adult males underwent TEP repair for uncomplicated primary inguinal hernia in one year. First (optical) port was placed 1 cm and 2.5 cm below the umblicus in the two groups (I and II, respectively). Effective rectus sheath canal (ERSC) was measured. Primary outcome measures (endoscopic vision, ease of the procedure and operating time) were compared between the two groups. Results: ERSC (mean ± SD) was found 3.24 ± 0.41 and 2.08 ± 0.27 cm in group I (n = 7) and group II (n = 11), respectively (P < 0.05). Endoscopic vision was found significantly better in group II compared to group I; visual analogue score (VAS) 8.82 ± 0.41 vs 4.57 ± 0.45, respectively (P < 0.05). Procedure was found significantly easier in group II compared to group I (VAS 8.91 ± 0.44 vs 5.5 ± 0.65; P < 0.05). Operating time was found significantly lower in group II compared to group I (1.83 ± 0.3 vs 2.71 ± 0.42 h; P < 0.05). Conclusions: Shorter effective rectus sheath canal of ≤ 2 cm greatly facilitates the TEP hernioplasty in terms of endoscopic vision, ease of the procedure and operating time, and is highly recommended, especially for the beginners. [J Exp Integr Med 2013; 3(1): 73-76]

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