Is laparoscopic total extraperitoneal mesh repair gold standard approach to inguinal hernia? A large case series with operative complications, post-operative outcome and recurrence rate after laparoscopic TEP mesh repair for inguinal hernias.

Abstract

<h4>Introduction</h4>Laparoscopic extraperitoneal mesh hernia repair is better approach for inguinal hernia with its low complication rate, early recovery and negligible recurrence rate. The aim of this case series is to study intraoperative complications, post-operative outcome and recurrence rate after laparoscopic total extraperitoneal mesh repair for inguinal hernias.<h4>Patients and methods</h4>This is a retrospective observational data. We have performed laparoscopic total extra peritoneal repair (TEP) for 152 consecutive patients presented with inguinal hernia at Surgical Outpatient Department, Command Hospital (Eastern Command), Kolkata, using 10-mm infraumbilical midline port and two 5-mm working lateral ports inserted lateral to the inferior epigastric artery. None of them required eTEP. All the hernias are repaired with flat, light-weight, macroporous polypropylene mesh 15 cm × 15 cm for unilateral hernias and 30 cm × 15 cm mesh for bilateral hernia covering myopectineal orifice and anchored with single absorbable tacker to lacunar ligament to each side. All patients were assessed for intraoperative complications such as bleeding, peritoneal breach, injury to vessels, vas deferens and bowel, total operative time and post-operative complications such as chronic pain, seroma, surgical site infection (SSI) and recurrence. Follow-up was done after 10 days, 1 month and 6 months.<h4>Results</h4>There were one hundred and fifty-two patients with a mean age of 47.8 years, oldest 78 and youngest 20 years; among them, 141 were males and 11 were females; 125 had unilateral and 27 had bilateral hernia. Four had minor intraoperative bleeding, 5 had intraoperative peritoneal breach and required accessor intra-abdominal port and required peritoneal repair. None of them had any chronic pain. Seven had seroma which is managed with serial aspirations. Seven patients developed SSI, of which 4 underwent mesh explanation and 3 resolved with ultrasonography-guided aspiration and pre-peritoneal amikacin infiltration. None of the patients had recurrence even after mesh explanation.<h4>Conclusions</h4>The laparoscopic total extraperitoneal mesh repair for inguinal hernia is minimal invasive approach. With same port placement, bilateral inguinal hernias can be repaired with ease. Laparoscopic TEP repairs inguinal hernia with less post-operative complications, no pain and nil recurrence, less hospital stay and patients can get back to their routine activities since the next day. It can be considered as gold standard laparoscopic approach for inguinal hernia.