Reconstruction of the Uterine Round Ligament During Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

To evaluate the safety and feasibility of a new technique for preserving the uterine round ligament (RL) during laparoscopic totally extraperitoneal (TEP) repair in female patients with inguinal hernias.

Observational study. Place and Duration of the Study: Department of General Surgery, Baoji People's Hospital, Baoji, China, from January 2019 to January 2023.

A total of 27 female patients with a primary inguinal hernia who underwent laparoscopic TEP were included in the study. During the surgical procedure, the technique of RL reconstruction following to its division was adopted. Clinical data of the enrolled patients were retrieved through medical record review, surgical video analysis, and telephone or outpatient follow-up. The Shapiro-Wilk test was used to assess the distribution of sample data. Measurement data with normal distribution were expressed as mean ± standard deviation (SD), non-normal distribution data as median (interquartile range, IQR), and categorical data as frequencies and percentages.

All the participants underwent the operation successfully, without the need for conversion. Peritoneal rupture occurred in 11.1% of cases (3/27). The mean operation times were 53.5 ± 9.2 minutes for unilateral and 85.8 ± 7.3 minutes for bilateral. Each RL took 2-6 minutes for suture reconstruction, and the intraoperative blood loss ranged from 0 to 4 millilitres. The visual analogue scale (VAS) score was 1-3 at 24 hours after surgery. Postoperative follow-up lasted for at least 12 months. Seroma was detected in five (18.5%) patients. One case (3.7%) of chronic inguinal pain, inguinal nerve paraesthesia, and labia majora oedema was observed for each condition. No instances of urinary retention, pelvic pain, dyspareunia, uterovaginal prolapse, infection, and recurrence were documented.

The RL reconstruction technique applied during laparoscopic TEP in female patients with inguinal hernias is safe and feasible. However, further investigation should be carried out.

Uterine round ligament, Reconstruction, Laparoscopic totally extraperitoneal, Female, Inguinal hernia.