TEP for elective primary unilateral inguinal hernia repair in men: what do we know?

Abstract

Introduction Based on the new international guidelines for groin hernia management, there is no one surgical technique that is suited to all patient characteristics and diagnostic findings. Therefore, a tailored approach should be used. Here, a distinction must be made between primary unilateral inguinal hernia in men and in women, bilateral inguinal hernia, scrotal inguinal hernia, inguinal hernia following pelvic and lower abdominal procedures, patients with severe cardiopulmonary complications, recurrent inguinal hernias and incarcerated inguinal and femoral hernias. This paper now explores the relevant studies on TEP for elective primary unilateral inguinal hernia in men, which constitutes the most common indication for repair. Material A systematic search of the available literature was performed in February 2019 using Medline, PubMed, Scopus, Embase, Springer Link and the Cochrane Library. Only meta-analyses, systematic reviews, RCTs and comparative registry studies were considered. 117 publications were identified as relevant. Results RCTs and comparative registry analyses demonstrated the advantages of TEP with regard to postoperative complications, complication-related reoperations, and postoperative and chronic pain compared with Lichtenstein repair for elective primary unilateral inguinal hernia repair in men. No relevant differences were found compared with TAPP. Mesh fixation is not needed in TEP, but heavyweight meshes result in a lower recurrence rate. Extraperitoneal bupivacaine analgesia vs placebo does not demonstrate any advantages, but drainage is advantageous for seroma prophylaxis. The risk of chronic pain is negatively influenced by small defects, younger patient age, preoperative pain, higher BMI, postoperative complications, higher ASA score and risk factors. Conclusion For the subgroup of elective primary unilateral inguinal hernia in men, accounting for a proportion of less than 50% of the total collective, advantages were identified for TEP compared with open Lichtenstein repair but not versus TAPP.

Long-Term Follow-Up of Lichtenstein Repair of Inguinal Hernia in the Morbid Patients With Self-Gripping Mesh (ProgripTM)

“…In addition, the higher ASA classification in this group also contributed to the lower incidence of postoperative pain. It seems that the young and active groups of the patients experience more postoperative acute and chronic pain than older patients (33), the possible explanation of this phenomenon could be the higher level of daily activities in younger and healthy patients and therefore a higher demand for postsurgical tissue. Another possible explanation can be sought in the decrease in elasticity of the tissue in older patients possibly leading to less tension in the surgical area.…”

Abordaje TAPP versus TEP en hernia inguinal unilateral. Experiencia de un Centro de Tercer Nivel

“…Es por eso que se deben idear tratamientos personalizados con base en: sexo del paciente, localización y tipo de hernia, antecedente de procedimientos abdominales y pélvicos, comorbilidades cardiopulmonares mayores y recurrencia. 7 Las técnicas laparoscópicas han demostrado ser superiores a las técnicas abiertas, disminuyen el dolor posoperatorio, inguinodinia a largo plazo, tiempo de hospitalización más corto, menor índice de recurrencias, menor formación de seromas, hematomas, e infección de la herida quirúrgica, resultando en una pronta recuperación con incorporación temprana a las actividades diarias; seguimiento en cinco años de la técnica Lichtenstein vs. TEP, durante el que se observó dolor crónico de 18.8 vs. 9.4%; y Lichtenstein vs. TAPP con seguimiento a 53 meses, con dolor leve de 23.7 vs. 14.8%, dolor moderado de 5.3 vs. 1.2%, dolor severo de 3.9 vs. 0%. 8 Es por ello que al encontrarnos en un centro de referencia de tercer nivel, es de vital importancia incorporar dentro de lo posible dichas ventajas a los procedimientos que ofrecemos a la población.…”

“…5 Las guías más recientes del Hernia Surge Group únicamente recomiendan las técnicas laparoendoscópica de TEP y TAPP, el abordaje anterior de Lichtenstein y en casos seleccionados, la técnica de Shouldice. 7 En nuestro centro, un hospital de referencia de tercer nivel, se ha implementado el uso de ambas técnicas de reparación laparoendoscópica. Describimos nuestra experiencia inicial a continuación.…”

Results at 3-year follow-up of totally extraperitoneal (TEP) hernia surgery with long-term resorbable mesh

“…However, there are two aspects that may play a greater role. On one hand, TEP per se has a lower risk of CPP than Lichtenstein according to several studies [15,16,42,43]. On the other hand, resorbable meshes do not produce chronic foreign body inflammation once the mesh has been degraded [21,26].…”

“…A pilot study using such an implant, the TIGR Matrix Surgical Mesh, in the Lichtenstein technique showed good results on chronic pain and recurrences in patients with LIH at a 3-year follow-up but a high rate of recurrences in patients with MIH [14]. Since various studies indicate that the Totally Extra Peritoneal (TEP) technique has less risk of CPP than the Lichtenstein hernia repair [15,16], our research group has recently tested the same long-term resorbable mesh in patients with LIH using the TEP technique. The trial showed promising results on chronic post-operative pain and low recurrences at 1-year follow-up [17].…”