Single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP): Lessons learned from 102 procedures and initial experience

Abstract

Background: The abdominal wall in groin area is conventionally considered that it was comprised by 9 layers. Single incision laparoscopy totally extraperitoneal hernioplasty (SIL-TEP) reported before were operated through the front of the posterior rectus sheath. Method: 102 SIL-TPP were conducted from October 2018 to October 2020 at The Affiliated Hospital of Medical School of Ningbo University using a self-made single-port device and standard laparoscopic instruments. Clinical data, demographic and intraoperative findings, and short-term postoperative outcomes were analyzed. Results: Of the 102 hernias treated, 46 were right inguinal hernias, 33 were left inguinal hernias and 23 were double-side inguinal hernias. All patients received the SIL-TPP and no conversion happened. The mean left-side and right-side hernia operative time was almost same. The left-side and right-side operative time were 75.48 ± 26.95 and 76.24 ± 26.09 minutes, respectively. The mean operative time was 75.92 ± 26.45 (range, 29–170 minutes) in unilateral inguinal hernia. Mean operative time was 104.17 ± 28.58 minutes (range, 67–180 minutes) in double-side inguinal hernia. The intraoperative complications rate was 21.57 (22/102) and all the complications were Peritoneum or sac tearing. Postoperative complications occurred in 3 cases (1 case wound seroma, 1 case urinary retension and 1 case upper respiratory infection) and were successfully treated conservatively. The mean hospital stay was 2.8646 ± 1.38 days. The 24 hours Visual analogue scale score was 2.28 ± 0.77. During follow-up to June 2022, no recurrence case occurred. Conclusion: SIL-TPP is safe and feasible. SIL-TPP has its unique skills and advantages to treat inguinal hernia. Large-scale randomized controlled trials comparing SIL-TPP inguinal hernia repair with conventional single port and conventional three port laparoscopic totally extraperitoneal hernioplasty with short-term outcome and long-term recurrence rate are needed to confirm these results.

TPP (totally preperitoneal) making single incision laparoscopic inguinal hernia repair more feasible: a comparison with single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP)

“…Most complications in our study were peritoneum or sac tearing and minor bleeding which did not conduce postoperative morbidity. As we have report before, peritoneum or sac tearing didn’t cause obvious difficulty to operation for its favorable factors in SIL-TPP [ 6 ] (Fig. 7 ).…”

“…Consideration the characteristics of PPS, we introduced the TPP concept and succeed to repair the inguinal hernia totally through preperitoneal space. Remarkable, our results showed the SIL-TPP is a safe and feasible procedure with acceptable short-term outcomes for inguinal hernia repairation [ 6 ]. In current study, the perioperative, short-term, and mid-term outcomes of SIL-TEP and SIL-TPP were compared.…”

“…In procedure, patient was placed in a Trendelenburg position and the hernia opposite side was tilted down. In SIL-TPP group, the procedure including setting single incision were conducted as our previous study [ 6 ]. Setting a 2 cm single preperitoneal incision and insert a single-port device.…”

“…For our operation was conducted through single incision parallel and distinguishing to the SIL-TEP, the procedure was named by SIL-TPP. Moreover, our results suggested SIL-TPP is a safe and feasible procedure with acceptable short-term outcomes [ 6 ]. Up to now, there was no randomized clinical trial comparing SIL-TPP and SIL-TEP inguinal hernia repair.…”

Lateral single incision laparoscopic totally extraperitoneal hernioplasty (L-SILTEP) after laparoscopic radical prostatectomy: A rare case report with literature review

“…[5,6] However, it also has some limitations such as a narrow operative field, limited instrument maneuverability, and high technical difficulty. [7,8] For patients with inguinal hernia after laparoscopic radical prostatectomy, it is difficult to perform SIL-TEP because the preperitoneal space in the traditional approach is the original surgical scar area, with serious adhesions and unclear boundaries. Lateral single incision laparoscopic totally extraperitoneal hernioplasty (L-SILTEP) is a modified technique that uses a lateral incision, instead of a central incision, to access the preperitoneal space.…”