Laparoscopic transabdominal preperitoneal technique versus open surgery with the ULTRAPRO Hernia System for the repair of female primary femoral hernias—an observational retrospective study

Abstract

Femoral hernias (FHs), predominantly seen in females, require surgery for cure. To date, surgical repair of primary FHs in female patients with either open surgery or laparoscopic operation has been poorly documented. We retrospectively investigated the treatment of female primary FHs with open surgery using the ULTRAPRO Hernia System (UHS procedure) or the laparoscopic procedure, namely, the transabdominal preperitoneal (TAPP) technique. A total of 41 female patients with primary FHs who had undergone UHS or TAPP were included in this study. The procedural parameters, post-surgical complications, treatment expense, and follow-up results were analyzed. The vast majority of patients (39/41) underwent elective operations: 15 received UHS (including 2 emergency cases) and 26 had TAPP (P = .08). The UHS group had a greater average age, due to the fact that FHs occur often in people with advanced age who tend to have systemic disease, limiting the use of general anesthesia required for TAPP. Compared with UHS, TAPP took a significantly shorter time to complete and patients undergoing TAPP had a dramatically shorter hospital stay. While no recurrence was observed in both groups, post-procedure pain and foreign body sensation were reported by significantly more patients in UHS group. The cost was greater with TAPP. Taken together, we concluded that both UHS and TAPP are effective in the management of female FHs. In view of the advantages and disadvantages between the open and the laparoscopic operation, surgeons can select a procedure according to their skills and patients’ situation.

Resection of mesothelial cyst of uterine round ligament by laparoscopic transabdominal preperitoneal procedure alone or combined with open surgery

“…Endoscopic procedures have been shown to be safe and effective for the repair of inguinal and femoral hernias. 18,[22][23][24] Additionally, clinical studies comparing endoscopic procedures versus open surgery for groin hernia repair have revealed that endoscopic procedures, namely, TAPP repair and total extraperitoneal techniques, result in a lower wound infection rate, faster recovery and return to normal activities/work, and a lower incidence of chronic pain. [25][26][27][28] However, no studies to date have investigated the anatomical localization of MCURLs relative to the inguinal canal.…”

“…A space between the inner ring of the inguinal canal and the triangle of doom was created by dissection, and a 10- × 15-cm polypropylene hernia patch covering the entire myopectineal orifice was placed and fixed in this space as described elsewhere. 18 When the distal end of the cyst extended beyond the inner ring and was difficult to resect with the TAPP procedure, the residual lesion was further excised by open surgery as described previously. 2 Briefly, an incision starting from the external ring and extending toward the inner ring of the inguinal canal was made to open the skin, subcutaneous tissue, and external oblique aponeurosis.…”

Safety and Efficiency of Laparoscopic Femoral Hernia Repair with Preserved Uterine Round Ligament

“…In addition, TAPP is associated with reduced postoperative pain and early restoration of normal activities. 5,6 Therefore, TAPP seems an appealing technique for female with femoral hernia.…”

The fascial connections of the pectineal ligament

“…In contrast, little is known about the role of most ligaments and other soft tissues of the anterior pelvic ring, in spite of these structures gaining recent attention in the literature, particularly in relation to abdominal and gynecological surgery (Becker et al, 2010). With respect to the anterior pelvic ring, the soft tissues of the superior pubic ramus including the thick periosteum and fascial structures serve as anchor points in hernia repair as well as in urinary antiincontinence operations and neovaginal reconstruction (Burch, 1961;McVay, 1974;Perdu et al, 1998;Chen et al, 2018). Such thickened connective tissue was originally described by Cooper as "a ligamentous expansion, which forms a remarkably strong ridge above the iliopectineal line" (Cooper, 1804).…”