Stab anterior preperitoneal hernioplasty in groin hernias: a new technique

With laparoscopic hernia repair still not qualifying as the ideal method, the search is still on for the optimal method of intervention combining the advantages of both open mesh repair and laparoscopic repair for groin hernias. Eighty-five patients with uncomplicated inguinal hernias classified as Nyhus type 2 or higher were operated on by the modified anterior preperitoneal (APP) repair. The peroperative parameters were studied and compared with those of totally extraperitoneal (TEP) repair to determine the efficacy of the modified approach. Eighty-eight anterior preperitoneal repairs were carried out on these 85 patients. Twenty-one patients were Nyhus type 2, 17 were type 3a (direct), 41 were type 3b (indirect), and nine were type 4 (recurrent). The results were compared with TEP parameters done by the same surgeon. The incision size was 2.8 cm (2.3-4.5 cm). The operating time was 15.7 min (11-26 min) compared with 31.2 min for the TEP repair. Discharge time was 2.3 days (range 2-4 days) compared with 2.2 days in TEP repair. Complications included seroma in eight patients, pain radiating to the scrotum even at 6 months in one patient, and superficial wound infection in one patient. Return to work in patients with stab APP was 12.6 days ( 7-15 days ), whereas it was 10.4 days in TEP repair. The overall recurrence rate was 1.66% at the end of 2 years. The results with stab APP repair were comparable with those with TEP repair. The stab APP in addition had the advantage of being easier to learn and can be done faster.