Evaluation of long‐term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair

Abstract

Aim This study has two aims: to evaluate long‐term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C‐TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases. Methods A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C‐TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10‐point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long‐term chronic pain and complications. Results The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate‐to‐severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest (P = .726), at movement (P = .712), or mesh discomfort (P = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post‐match comparison, no differences in complications with Clavian‐Dindo classification ≥III (U Group 0.7%, B Group 2.1%, P = .622) were detected. Conclusion C‐TAPP, which focuses on the layered structure, showed acceptable results for long‐term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

“…The first method involved a linear incision cephalad 3–4 cm from the hernia orifice, which is consistent with the global standard 13 . The second method involved a circular incision near the hernia orifice, which is more commonly used by Japanese surgeons who perform L‐TAPP 14 . Although circular incision requires less dissection of the spermatic cord and vessels, which may reduce the dissection time, dissection toward the front of the ventral side may increase the effort required.…”

“…13 The second method involved a circular incision near the hernia orifice, which is more commonly used by Japanese surgeons who perform L-TAPP. 14 Although circular incision requires less dissection of the spermatic cord and vessels, which may reduce the dissection time, dissection toward the front of the ventral side may increase the effort required. There was no significant difference between the two methods in terms of peritoneal dissection and suture techniques.…”

“…Three 8 mm cannulas were placed 8 cm apart; monopolar scissors or Maryland bipolar forceps were mainly used for the right hand and fenestrated or Force Bipolar forceps were used for the left hand with a rigid scope placed in the center cannula, which was created from or above the umbilicus. The peritoneal flap was created using a cephalad linear incision 3–4 cm from the internal ring in a medial‐lateral direction, similar to the global standard 13 or a circular incision near the hernia orifice, which is a common method in Japan 14 . Following adequate space exposure with or without hernial sac reduction, a mesh was placed to cover the entire myopectineal orifice 15,16 .…”

“…The peritoneal flap was created using a cephalad linear incision 3-4 cm from the internal ring in a medial-lateral direction, similar to the global standard 13 or a circular incision near the hernia orifice, which is a common method in Japan. 14 Following adequate space exposure with or without hernial sac reduction, a mesh was placed to cover the entire myopectineal orifice. 15,16 Closure of the direct inguinal defect hernia was performed in some medial hernia cases.…”

Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP

“… 4 Transabdominal preperitoneal Patch Plasty (TAPP) is a very commonly used surgical method for inguinal hernia repair. 5 …”