The Feasibility of Laparoscopic Total Extraperitoneal (TEP) Herniorrhaphy after Previous Lower Abdominal Surgery

Abstract

Purpose:We retrospectively reviewed the medical records to estimate the feasibility and surgical outcome of laparoscopic herniorrhaphies in patients with previous lower abdominal surgery. Methods: Between December 2000 and December 2008, a total of 1,101 cases of laparoscopic herniorrhaphies were performed in 974 patients, among them 47 cases (4.27%) of laparoscopic herniorrhaphy in 40 patients who had undergone previous lower abdominal surgery were enrolled to this study. Results: Most patients (23 of 24) who had a history of appendectomy successfully underwent laparoscopic totally extraperitoneal (TEP) repair. Six patients who had history of a prostatectomy and 2 patients with a Pfannenstiel incision underwent an intraperitoneal only mesh (IPOM) repair after a failed TEP repair. Five patients had lower midline incisions due to panperitonitis, among them TEP repairs were performed in 3 patients and IPOM was performed after failed TEP repairs in 2 patients who had undergone surgery due to trauma-induced rupture of the bladder. Conclusion: Laparoscopic TEP hernia repair could be possible and reasonable in patients after an appendectomy; however, it is difficult in patients with previous pelvic surgeries. Additional studies are needed to determine whether or not laparoscopic TEP repair for inguinal hernias is feasible in patients who have undergone other general surgical procedures. (J Korean Surg Soc 2010;78:405-409)

Laparoscopic Totally Extraperitoneal Hernia Repair after Radical Prostatectomy or Lower Abdominal Surgery Except for Appendectomy – Experience of 35 Cases

“…Relatively long operation times were reported by most studies (Table 4). 6,[10][11][12][13] In our study, the mean operation time was 111 min, which is longer than other studies. However, this could be due to different operational settings and patient variance among studies.…”

“…Numerous conversion cases have been reported in other reports (Table 4). 6,[10][11][12][13] Mainly reasons are severe adhesion on operation field or peritoneal injury. Conversion rate shown in our study is higher than other reports.…”

“…[7][8][9] This is because there may be severe tissue adhesion after previous operations, which increases the risk of organ injury and bleeding during dissection. 10,11 Several studies have reported the results of laparoscopic TEP hernia repair in selective patients with a previous history of various lower abdominal surgery. 6,[10][11][12][13] Although most studies have reported favorable results, no clear conclusion has yet been reached, and the suitability is still a matter of debate.…”

“…10,11 Several studies have reported the results of laparoscopic TEP hernia repair in selective patients with a previous history of various lower abdominal surgery. 6,[10][11][12][13] Although most studies have reported favorable results, no clear conclusion has yet been reached, and the suitability is still a matter of debate. We have published our early experience of laparoscopic TEP repair in these patients in 2011 that the procedure is quite challengeable under operation by skilled surgeon, although longer operation time should be overcome.…”

Meta-analysis of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery

“…Previous lower abdominal surgery is often considered a relative contraindication to TEP repair, as access to the preperitoneal space may be challenging when scar tissue from previous interventions is encountered. Nonetheless, the feasibility and safety of TEP repair in patients with a history of lower abdominal surgery remains inconclusive. The aim of this study was to perform a meta‐analysis of trials comparing the feasibility and safety of TEP inguinal hernia repair in patients with (PS, previous surgery group) and without (NS, no previous surgery group) a history of lower abdominal surgery.…”