An Improved Transabdominal Preperitoneal Alloplasty for Recurrent Inguinal Hernias After Lichtenstein’s Surgery

Abstract

The aim. Improve results of the surgical treatment of recurrent inguinal hernias after Lichtenstein's surgery by using an advanced TAPP technique. Materials and methods. An analysis of the surgical treatment of patients with recurrent inguinal hernias after Lichtenstein's surgery using traditional and improved preperitoneal transabdominal alloplasty (TAPP), for the period of 2012–2019, was performed. The traditional TAPP technique was performed for 52 patients who made up the 1st group. An improved TAPP technique was implemented for 53 patients who composed the 2nd group. The features of the improved TAPP technique, which was different from the traditional one, were by additional mobilization of the parietal peritoneum by 3–4 cm along the upper edge of the defect, the mesh implant was used with a larger size in comparison to the classical one – 15×15 cm and fixed, besides the traditional points, additionally on the lower and lateral edges with medical glue Sulfacrylate. Results. The results of surgical treatment in the early postoperative period were not significantly different and were comparable. During the long-term period, 51 patients from the 1st group, and 50 patients from the 2nd group were examined. Thus, in the first group in 4 (7.9 %) cases during 6 months period after the application of the traditional TAРР technique, chronic pain was observed on the site of the implanted mesh; among the 2nd group of patients chronic inguinal pain was not observed. In 5 (9.8 %) patients of the 1st group, the recurrence of inguinal hernia was diagnosed, instead of the 2nd group, where relapse was observed in 1 (2 %) case. Conclusions. Thereby, the results of the traditional and improved TAPP techniques confirm the higher efficiency of the improved technique, due to the absence of the chronic inguinal pain and a lower rate of relapses, which is achieved by wider mobilization of the parietal peritoneum along the upper edge of the defect, and usage of the larger mesh and its additional fixation by gluing it at the lower lateral edge.

Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

“…At first, the laparoscopic inguinal hernia repair (LIHR) was introduced by R. Ger et al in 1990 [5]. LIHR has become popular worldwide because laparoscopic placement of mesh behind the defect where, according to Laplace's Law, the same forces that cause hernia are used to reinforce the repair [4]. The totally extraperitoneal method (TEP) established by J. L. Dulucq in Europe allows access to the pre-peritoneal space and avoids the need for a peritoneal incision [3].…”