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Laparoscopic Observations in Acquired Inguinal Hernia before and after Robotic-Assisted Laparoscopic Prostatectomy  [PDF]
Masahiko Kawaguchi, Yoshifumi Kadono, Masanari Shimada, Hideki Moriyama, Norihiko Ishikawa, Go Watanabe
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.54030
Abstract: Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.
Laparoscopic hernioplasty with epidural anesthesia; a report of 20 patients
Talebpour M,Niazie M,Jafari Javid M
Tehran University Medical Journal , 2007,
Abstract: Background: The incidence of inguinal hernia is 15 cases per 1,000 populations. The most common surgical methods of hernia repair are conventional open hernioplasty and laparoscopic hernioplasty. The advantages of laparoscopic hernioplasty are that the regional anatomy is observable, and bilateral herniorrhaphy can be performed at the same time. Since laparoscopic hernia is usually performed under general anesthesia, to shorten the length of hospital stay and to prevent complications, in this study, we evaluated the use of epidural anesthesia during hernioplasty. Methods: This study included 20 male patients treated by a single surgeon. We recorded the PCO2 levels before, during and after surgery, as well as the pain and intra-abdominal pressure. Results: Only one patient required conversion to general anesthesia. Three patients had hernia on the left side only, 14 patients on the right only and three patients had bilateral hernia. The PCO2 levels did not change (P=0.789). Fifty percent of patients had no postoperative pain. The median time to return to work or normal physical activity was 7 days. Conclusion: Laparoscopic inguinal herniorrhaphy is a feasible alternative to open surgical hernia repair. Employing epidural anesthesia prevents the complications of general anesthesia. This method achieves a shorter hospital stay and time to return to normal activity, as well as reduction in pain. Controlled trials comparing laparoscopic and tension-free open herniorrhaphy are needed to further assess the relative benefits of this procedure.
Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience  [PDF]
Mushtaq Chalkoo, Mujahid Ahmad Mir, Hilal Makhdoomi
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.72015
Abstract: Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.
An Experience of Short-Term Results of Laparoscopic Inguinal Hernioplasty Using 3D Mesh in a Developing Country  [PDF]
Iqbal Saleem Mir, Alfer Ah Nafae, Aijaz Ahmed Malyar, Muntakhab Nafae, Yawar Watali, Mudasir Farooq, Shahnawaz Bashir Bhat, Sheikh Viqar
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.61010
Background: The experience of short term results of laparoscopic inguinal hernia repair using 3D mesh in a developing country is reviewed. Methods: From January 2012 to February 2014, 53 patients underwent laparoscopic inguinal hernioplasty. A retrospective case series of 53 consecutive patients undergoing TEP/TAPP by a single surgical team was followed prospectively with a focused physical examination and interview. 4 out of 53 patients had recurrent hernia following open repairs and 49 had primary hernias. Data collected included operative time, intraoperative bleeding, intraoperative difficulties, immediate postoperative pain, chronic groin pain, recurrence, sensory disturbance, activity or occupational limitation and personal satisfaction. Results: All the patients were male aged 32 to 75 years with a mean age of 53.5 years. Mean operative time was 37.4 minutes; intraoperative dissection, blood loss were less; and immediate postoperative pain was negligible as assessed by VAS. There was no mortality or major morbidity. Mean follow-up was 12 months (2 to 18 months). Follow-up was completed by interview and physical examination. Hernia was not found to recur during the follow up period. Chronic pain occurred in 2 patients (3.7%), which was mild in nature. Ninety-seven percent of patients were satisfied with their repair and would or had recommended TEP/TAPP to others using 3D Mesh. Conclusions: Short-term results of TEP/TAPP hernia repair using 3D mesh demonstrated to be an effective and safe procedure with low prevalence of chronic pain that is generally of a mild, infrequent nature. It was also concurred that there is decrease in operative time. Manipulation of mesh was significantly reduced. Intraoperative bleeding and use of post operative analgesia was reduced considerably. There was no recurrence, however the cost of the mesh increased the overall cost of the procedure acting as a limiting factor in a developing country.
Effective rectus sheath canal: does it affect total extraperitoneal approach for inguinal mesh hernioplasty?  [cached]
Maulana Mohammad Ansari
Journal of Experimental and Integrative Medicine , 2013, DOI: 10.5455/jeim.071212.br.012
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]
Hernioplastia laparoscópica totalmente extraperitoneal com tela 3-D sem fixa o: técnica de Dulucq Laparoscopic totally extraperitoneal hernioplasty with nonfixation of three-dimensional mesh: Dulucq's technique
Alberto Meyer,Jean-louis Dulucq,Ahmad Mahajna
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2013,
Abstract: INTRODU O: A repara o da hérnia inguinal tem sido área controversa na prática cirúrgica, desde que desde que ela foi concebida. O fato de que inúmeros procedimentos diferentes est o em uso reflete a complexidade de hérnia inguinal e seu reparo. OBJETIVO: Descrever a técnica de Dulucq e as modifica es do uso da tela 3-D na corre o de hérnia inguinal laparoscópica totalmente extraperitoneal. MéTODOS: A técnica da corre o da hérnia laparoscópica totalmente extraperitoneal é detalhada no texto. CONCLUS O: Corre o laparoscópica totalmente extraperitoneal é preferível à corre o de hérnias transabdominais pré-peritoneais porque o perit nio n o é violado. A dissec o deve ser sempre realizada nos mesmos passos, sem utilizar cautério monopolar e o paciente em leve posi o de Trendelemburg. Com estas recomenda es, a hernioplastia laparoscópica totalmente extraperitoneal é factível com poucas complica es intra-abdominais. INTRODUCTION: The inguinal hernia repair has been a controversial area in the surgical practice ever since it has been conceived. The fact that numerous different procedures are in use reflects the complexity of inguinal hernia and its repair. AIM: The purposes of this study were to describe Dulucq's technique and the modifications of using 3-D mesh in laparoscopic totally extraperitoneal inguinal hernia repair. METHODS: Surgical technique of laparoscopic totally extraperitoneal hernia repair is detailed on the text. CONCLUSION: Laparoscopic totally extraperitoneal is preferred over transabdominal preperitoneal hernia as the peritoneum is not violated. The dissection must always be done with the same stages, without monopolar diathermy and the patient in a slight Trendelenburg position. Following these recommendations, the laparoscopic totally extraperitoneal hernioplasty is feasible with fewer intra-abdominal complications.
R. Van Hee
Jurnalul de Chirurgie , 2011,
Abstract: Inguinal hernia most probably has been a disease ever since mankind existed. In view of its existence in different kinds of animals, and in particular of primates, one can assume that already prehistoric human beings were affected with the disease. Inguinal hernia repair has made enormous progress throughout the ages. The main reasons for intervention however remained the same: continuous growth of the inguinal and/or scrotal swelling, the risk of incarceration of the hernia content and the bad results of conservative methods like truss placement. Surgical techniques have rapidly evolved since Eduardo Bassini proposed his first successful reconstruction of the inguinal floor. The various adaptations of his technique did however not result in a substantial reduction in the number of recurrences. The tension free repair, introduced by Irving Lichtenstein, caused a dramatic drop in the recurrence rate and became the procedure of choice. Since the introduction of laparoscopic techniques, these methods became equally accepted for inguinal hernia, in particular in western regions where financial aspects play a less prominent role. The future will tell how hernia repair will evolve in the next decades.
Tratamiento quirúrgico de una hernia inguinal gigante reproducida después de una plastia de Lichtenstein. Presentación de un caso Surgical treatment of a giant inguinal hernia, reproduced after a Lichtenstein hernioplasty. Presentation of a case  [cached]
Pedro Antonio Casanova Pérez
Revista M??dica Electr?3nica , 2013,
Abstract: La hernia inguinal es la enfermedad quirúrgica más tratada de forma electiva en muchos centros de salud, la complejidad de su tratamiento varía en dependencia de varios factores, dentro de estos el tama o de la hernia y la anatomía local deformada son de los más influyentes. El uso de las prótesis simplificó su tratamiento, pero se deben cumplir principios quirúrgicos establecidos pues la recurrencia luego de la colocación de una prótesis distorsiona aun más la anatomía. Se presenta el caso de un paciente masculino de 78 a os de edad, de raza blanca, intervenido de urgencia por hernia inguinal primaria atascada, donde se le realizó una plastia tipo Lichtenstein. Dos a os después acude a consulta portando una hernia inguinal reproducida que rebasa el tercio distal del muslo, se prepara para la operación y se le realiza una plastia por vía posterior tipo Stoppa, la evolución postoperatoria fue favorable y a los seis a os de operado se encuentra libre de la enfermedad. The inguinal hernia is the surgical disease most treated in an elective way in many health care institutions. Its treatment difficulty changes in dependence on several factors; the hernia size and the deformed local anatomy are the most important of them. The usage of prosthesis simplified its treatment, but there are established surgical principles that have to be fulfilled, because the recurrence after placing prosthesis distorts the anatomy even more. We present the case of a white male patient aged 78 years old, surgically treated in emergency by an obstructed primary inguinal hernia. It was used the Lichtenstein technique. Two years later he assisted to the consultation presenting a reproduced inguinal hernia exceeding the distal third of the thigh. He was prepared for the surgery and was operated by the posterior port using the Stoppa type surgery. The post surgery evolution was favorable, and after six year of the surgery he is free of the disease.
Giant recurrent retroperitoneal liposarcoma presenting as a recurrent inguinal hernia  [cached]
Ajay H. Bhandarwar,Girish D. Bakhshi,Ashok D. Borisa,Sachin S. Shenoy
Clinics and Practice , 2011, DOI: 10.4081/cp.2011.e130
Abstract: Retroperitoneal liposarcoma presenting as an inguinal hernia is a rare entity. We present the first case of Giant recurrent liposarcoma presenting as a recurrent inguinal hernia in a 40-year-old male. Physical examination showed an irreducible lump in the right inguinal region and a scar in the right lumbar and right inguinal region. Computed tomography (CT) scan of abdomen revealed it to be a retro peritoneal mass extending into the right inguinal region along and involving the cord structures. Wide local excision of the tumour with right orchidectomy and inguinal hernioplasty was performed. Histo-pathology confirmed it to be a liposarcoma. Patient received postoperative radio therapy. Follow up of two years has shown him to be disease free. Retroperitoneal liposarcoma can grow along cord structures into the inguinal canal and mimic an irreducible indirect inguinal hernia.
Irreducible inguinal hernia with appendices epiploicae in the sac  [cached]
Jain Mayank,Khanna Shashi,Sen Bimalendu,Tantia Om
Journal of Minimal Access Surgery , 2008,
Abstract: Inguinal hernia has a nature to surprise surgeons with its unexpected contents. Appendix epiploicae alone in the hernial sac is a rare entity and that too if hypertrophied and presenting as irreducible hernia is still more uncommon. We report a 52-year-old male with complains of irreducible inguinal mass with little pain on Left side for seven days. A diagnosis of irreducible inguinal hernia was made and the patient was treated laparoscopically by Trans-Abdominal Pre-Peritoneal Mesh Hernioplasty (TAPP). As a surprise, content of the hernial sac was enlarged / hypertrophied appendix epiploicae of sigmoid colon with appendigitis. Patient also had and incidental hernia on the other side, which was repaired in the same sitting. Postoperative recovery of the patient was excellent.
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