Methods Observations and Results of Laparoscopic Surgery for Groin Hernia

 

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Methods

This is a retrospective, Uni-Centric, cross-sectional study of 93 patients operated on by surgeons from the surgical department for laparoscopic hernia of the groin. These patients were collected over a period of 8 years from January 2006 to December 2013.This study included all patients aged 18 and over without upper age limit with uncomplicated groin hernias. We excluded patients with contraindications to laparoscopy or general anesthesia.

For minimally invasive surgery technique many of them have not received practical training with simulators resembling Lap Trainer Box.

The primary endpoint was the recurrence rate. The secondary endpoints were intraoperative and postoperative morbidity and chronic postoperative pain. Senior surgeons with expertise in laparoscopic surgery operated all patients. Repair techniques are standard in our service.

TAPP technique:

The patient positioned in the supine position with both arms at their sides, lower limbs together, with a slight Trendelenburg. The worker positions on the side opposite the hernia. The crioscopy column placed at the patient's feet. Three trocars used: A 10 mm trocar at the upper edge of the umbilicus for the optics and for the subsequent introduction of the prosthesis.

Two 5 mm trocars at the level of the right and left flanks, at equivalent distances, on a straight line which passes through the umbilicus and which is oriented towards the side of the hernia. The hernia cure goes through 4 essential stages: Opening of the pre-peritoneal space, dissection of the hernial sac, introduction and positioning of the prosthesis and finally peritonization.

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Patient set-up and trocar arrangement

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Placement of the plate and closure of the peritoneum

PET technique:

After creation of the pneumo-Retzius, we proceed to the placement of the trocars, dissection of the Bogros space, dissection of the hernia and finally the introduction and positioning of the prosthesis. During this work, statistical analysis performed using SPSS version 17.0 software. We considered entire frequencies and comparative frequencies (percentages) for the qualitative variables. We calculated means, medians and standard deviations and determined the extreme values for the quantitative variables. In all statistical trials, the significance level was set at 0.05.

Observations

We collected 104 hernias in 92 patients meeting the inclusion criteria of our study. The average age of our patients was 48 years with extremes ranging from 19 to 83 years. A clear male predominance observed. Seventy of our patients had a job before the operation, ie 76%, of which 16 patients were doing hard work. Five patients practiced sports on a regular basis; which represents 5% of patients. Surgically, two laparoscopic techniques are in use: TAPP and PET. The TAPP approach was the most widely used: 94 cases (90%) TAPP versus 10 PET cases.

The prosthetic material used was polypropylene in nine cases, mersylene in 4 cases, an influenza plaque in 10 patients and a 3D prosthesis in 19 cases. The type of prosthesis used does was not specified in the other cases. Twenty-seven plates are attach to the wire. Thirty-Seven (37) are in use with nonabsorbable staples. The prosthesis is not fix in 30 cases.

No intraoperative complications are in report and no conversions observed. We perform drainage in six cases, removed in all cases on the first postoperative day. Sixty interventions (64%) did not exceed 60 minutes. The operative mortality of our series was zero. The mean hospital stay was 1.2 days (1-4 days). Ninety-four percent of patients had not spent more than 2 days postoperative stay. Postoperative morbidity was 5% (5 patients).

It had a hematoma type in 3 cases and serum in 2 cases. No medical complications are in report. The time to return to normal activity was 21 days. The mean follow-up of our series was 2 years. Eight patients were lost to follow-up after the first follow-up visit. Only two (2) patients had presented a recurrence. One patient operated on by TAPP and who is relapse after 7 months (reopened by inguinal route). The second patient operated on by PET who had presented a recurrence after 10 months (reopened by TAPP).

In addition, we observe chronic postoperative pain in three patients. Two of them are operate using the TAPP technique (plaque fixation performed by non-absorbable staples) and one patient operated using the PET technique. Eight patients were lost to follow-up after the first follow-up visit. Only 2 patients had presented a recurrence. One patient operated on by TAPP and relapse after 7 months (reopened by inguinal route). The second patient operated on by PET present a recurrence after 10 months (reopened by TAPP).

In addition, chronic postoperative pain noted in three patients. Two of them operated using the TAPP technique (plaque fixation performed by non-absorbable staples) and one patient operated using the PET technique. A patient operated on by TAPP and who had recurrence after 7 months (reoperated by inguinal route) and a second patient operated on by PET who had presented a recurrence after 10 months (reopened by TAPP).

In addition, chronic postoperative pain observed in three patients. Two of them operated using the TAPP technique (plaque fixation performed by non-absorbable staples) and one patient operated using the PET technique. A patient operated on by TAPP and who had recurrence after 7 months (reoperated by inguinal route) and a second patient operated on by PET who had presented a recurrence after 10 months (reopened by TAPP). In addition, chronic postoperative pain noted in three patients: two of them operated using the TAPP technique (plaque fixation performed by non-absorbable staples) and one patient operated using the PET technique.

Result

Our review has shown that laparoscopic crotch hernia therapy has carried impressive solace to our patients as to difficult peculiarities, length of hospitalization and wiped out leave. The outcomes acquired in this series are great and in accordance with the outcomes previously distributed in the writing. This urges us to keep utilizing these strategies and to screen our results in the more extended term. Crotch by laparoscopy has carried significant solace to our patients with respect to difficult peculiarities, length of hospitalization and debilitated leave.

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