Single‐incision totally extraperitoneal inguinal hernia repair is feasible and safe in patients on antithrombotic therapy: A single‐center experience of 92 procedures

Asian J Endoscop Surgery

et al. 2018

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Introduction: The learning curve for totally extraperitoneal repair (TEP) is longer and steeper than that for transabdominal preperitoneal repair (TAPP) due to the preperitoneal view to which the surgeon is not accustomed and the limited working space. The aim of this study was to clarify the learning curve for SILS-TEP.Methods: A retrospective analysis of 80 consecutive patients with unilateral inguinal hernia was performed. All patients underwent elective SILS-TEP performed by a single learning surgeon with a teaching assistant between July 2016 and March 2018 at Kinki Central Hospital.Results: The operative time decreased gradually after 20 cases and stabilized after 40 cases. The first 40 cases were categorized as the learning period group, and the remaining 40 cases were categorized as the experienced period group. More patients received antithrombotic therapy in the experienced period than in the learning period (P < 0.05). The median operative time was 107 and 60 min in the learning period and the experienced period, respectively (P < 0.05). There were no significant differences in blood loss peritoneal injury, conversion to a different procedure, postoperative hospital stay, complications, and recurrence between the two groups. No major complications or hernia recurrence were noted during follow-up. Conclusions:The learning curve for SILS-TEP might take 40 cases to reduce the operative time. SILS-TEP can be performed safely by a learning surgeon with a teaching assistant.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair

Asian J Endoscop Surgery

et al. 2018

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“…Although TAPP repair has been more commonly used for reducing and evaluating hernia content, TEP with laparoscopic exploration and hernia reduction has the potential benefit of being an easy and familiar repair. Currently, SILS offers better cosmetic outcomes than conventional laparoscopic surgery for inguinal hernia repair . However, there has been no report on the feasibility and safety of SILS for TEP (SILS‐TEP) for irreducible or incarcerated inguinal hernias.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single‐incision laparoscopic totally extraperitoneal repair for irreducible or incarcerated inguinal hernia

Asian J Endoscop Surgery

et al. 2018

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“…Recently, laparoscopic preperitoneal mesh repair that could combine the advantages of the minimally invasive surgery approach with the standard open Rives-Stoppa technique has been gradually reported [ [2] , [3] , [4] , [5] ]. In addition, single-incision laparoscopic surgery (SILS) is considered to achieve better cosmetic outcomes than conventional multi-port laparoscopic surgery [ 6 , 7 ]. In this report, a case of a supra-pubic incisional hernia that was successfully repaired by single-incision laparoscopic preperitoneal mesh repair that offered a good cosmetic result is presented.…”

Section: Introductionmentioning

confidence: 99%

Single-incision laparoscopic preperitoneal mesh repair of supra-pubic incisional hernia: A case report

Annals of Medicine and Surgery

et al. 2018

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IntroductionRepair of supra-pubic incisional hernia is still challenging because of the highest pressure at the lower abdominal wall in the erect position. Recently, laparoscopic preperitoneal mesh repair has been gradually reported.Case presentationA 77-year-old woman underwent single-incision laparoscopic preperitoneal mesh repair under a diagnosis of a supra-pubic incisional hernia, measuring 7 × 4 cm. A single, 2.5-cm, intraumbilical incision was made, followed by creation of the preperitoneal space. Then, the posterior rectus sheath and peritoneum were opened, and laparoscopic exploration was performed. After dissection of the supra-pubic hernia content, the tube for degassing the abdominal cavity was inserted into the abdominal cavity, and the peritoneum and the posterior sheath were closed. The preperitoneal space was dissected gradually, and circular dissection of the hernia sac was performed. The proximal sac (peritoneum) was sutured continuously. A 15 × 10 cm mesh was placed in the preperitoneal space and fixed securely with absorbable tacks at the pubic bone, Cooper's ligament, and the rectus abdominis muscle, respectively. After degassing the preperitoneal space, a second laparoscopic exploration was performed to confirm the secure suture of the peritoneum and no injury of the abdominal organs. At 4-month follow-up, the patient remained well with no signs of recurrence.DiscussionSingle-incision laparoscopic preperitoneal mesh repair could minimize the recurrence of supra-umbilical incisional hernia and perioperative complications.ConclusionSingle-incision laparoscopic preperitoneal mesh repair, offering good cosmetic results, might be useful for repair of supra-pubic incisional hernia.