Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study

Shah, Mohammed Yunus; Raut, Pratik; Wilkinson, T. R. V.; Agrawal, Vijay K.

doi:10.1097/md.0000000000029746

Cited by 24 publications

(18 citation statements)

References 46 publications

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“…In our study, at the 10 days follow-up of the patients, the pain level was significantly higher in the laparoscopic TEP (in 6 cases) than in the Lichtenstein or TAPP procedure, with no correlation with the findings reported by Courtney et al [ 15 , 18 , 19 , 20 , 21 , 22 ]. This may be explained by the numerical difference between the groups with a significantly higher number of patients in the TEP group.…”

Section: Discussioncontrasting

confidence: 71%

“…The main intraoperative complication in laparoscopic TEP surgery described in the literature is the accidental creation of pneumoperitoneum, but in our study, we did not have this complication [ 15 ].…”

Section: Discussionmentioning

confidence: 88%

“…A higher level of pain has been reported in previous studies after open hernia repair, as well as in procedures such as Lichtenstein hernioplasty, compared to laparoscopic hernia repair (TEP or TAPP) [ 14 , 15 , 17 ].…”

Section: Discussionmentioning

confidence: 95%

“…Some studies have reported a similar operative time in open and laparoscopic hernia repair. The learning curve for laparoscopic hernia surgery is longer, as reported in the literature [ 3 , 14 , 15 , 16 ]. In our study, the average duration of the operation in the TEP group was shorter than in the other two groups.…”

Section: Discussionmentioning

confidence: 98%

“…The literature shows debatable reports regarding chronic pain. The metanalyses by Karthikesalimgam et al [ 23 ] and Dhankhar et al [ 24 , 25 ] reported no significant difference in chronic pain in laparoscopic and open mesh repair [ 15 , 16 , 18 , 22 , 23 , 24 , 26 ]. Several other studies have reported a higher incidence of chronic groin pain in open repair patients compared to laparoscopic repair patients [ 17 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?

Barta

Dumitraș

Bucur

et al. 2022

JCM

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Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed at analyzing the feasibility of the extraperitoneal approach, by routine for this team/ and answering the question of whether this type of approach can be considered a safe one. Although indications for an intra- or extraperitoneal approach largely overlap, it may also be a matter of surgeon preference in choosing one technique. Methods: The study was retrospective, conducted on a group of 493 patients operated on for inguinal hernia in the clinic, by a single operating team, between January 2012 and March 2022. Results: It was proven that out of the 493 surgeries for inguinal hernia, 95.1% (n = 469) were operated upon by laparoscopic TEP (total extra peritoneal patch plasty approach); 1.62% (n = 8) by laparoscopic TAPP (transabdominal intraperitoneal); and 3.24% (n = 16) by the open, anterior approach (Lichtenstein). There were no intraoperative complications recorded in any of the procedures, while postoperative complications were found in 10.23% of cases (n = 48) in the extraperitoneal approach, and recurrences after the TEP approach were recorded in 0.40% of cases (n = 2). Conclusions: For correctly selected cases, TEP hernia surgery can be considered a safe and reliable approach.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?

Barta

Dumitraș

Bucur

et al. 2022

JCM

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A novel laparoscopic inguinal hernia repair technique: single-port lateral non-abdominal pre-peritoneal approach

Avanaz

2023

Langenbecks Arch Surg

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Purpose: Open and endoscopic techniques have been described for the treatment of inguinal hernia, but the gold standard treatment method is yet to be de ned. Recurrence rates after inguinal hernia surgery vary between 10-15%, and chronic pain is seen in 10-12% of patients. This study aimed to introduce a new surgical technique called lateral non-abdominal pre-peritoneal repair for inguinal hernia surgery.Methods: We recorded the data of patients' age, gender, body mass index (BMI), prior hernia surgery, hernia side, type of hernia, postoperative complications, pain scores according to the numeric pain scale, and analgesic consumption.Results: Seventeen inguinal hernias were repaired with the new technique in 14 patients. Two of the patients were female. The median age was 59, and the mean BMI was 26.8. The median hospital stays and time passed since the surgery was 1 day, and 72 days, respectively. The mean operative time was 64 ±29 minutes. The median tramadol consumption was 100 mg, and the mean paracetamol consumption was 1143 mg. The median pain score on POD 1 and current pain score was 4 and 0, respectively. Conclusions: No signi cant complications occurred intraoperatively. We observed the pain scores were acceptable on POD 1, and excellent in postoperative follow-up. Low pain scores, low analgesic consumption, and the absence of recurrence in a newly developed procedure within the learning curve indicate that satisfactory results can be obtained.

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A novel high accuracy model for automatic surgical workflow recognition using artificial intelligence in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

Ortenzi,

Rapoport Ferman,

Antolin

et al. 2023

Surg Endosc

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Introduction Artificial intelligence and computer vision are revolutionizing the way we perceive video analysis in minimally invasive surgery. This emerging technology has increasingly been leveraged successfully for video segmentation, documentation, education, and formative assessment. New, sophisticated platforms allow pre-determined segments chosen by surgeons to be automatically presented without the need to review entire videos. This study aimed to validate and demonstrate the accuracy of the first reported AI-based computer vision algorithm that automatically recognizes surgical steps in videos of totally extraperitoneal (TEP) inguinal hernia repair. Methods Videos of TEP procedures were manually labeled by a team of annotators trained to identify and label surgical workflow according to six major steps. For bilateral hernias, an additional change of focus step was also included. The videos were then used to train a computer vision AI algorithm. Performance accuracy was assessed in comparison to the manual annotations. Results A total of 619 full-length TEP videos were analyzed: 371 were used to train the model, 93 for internal validation, and the remaining 155 as a test set to evaluate algorithm accuracy. The overall accuracy for the complete procedure was 88.8%. Per-step accuracy reached the highest value for the hernia sac reduction step (94.3%) and the lowest for the preperitoneal dissection step (72.2%). Conclusions These results indicate that the novel AI model was able to provide fully automated video analysis with a high accuracy level. High-accuracy models leveraging AI to enable automation of surgical video analysis allow us to identify and monitor surgical performance, providing mathematical metrics that can be stored, evaluated, and compared. As such, the proposed model is capable of enabling data-driven insights to improve surgical quality and demonstrate best practices in TEP procedures. Graphical abstract

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Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study

Cited by 24 publications

References 46 publications

Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?

Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution?

A novel laparoscopic inguinal hernia repair technique: single-port lateral non-abdominal pre-peritoneal approach

A novel high accuracy model for automatic surgical workflow recognition using artificial intelligence in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

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