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Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy: results of 509 repairs
P J Quilici1, E M Greaney, J Quilici
1Department of Surgery, TransMed Surgical Services, Providence Saint Joseph Medical Center, Burbank, California, USA.
Insights
Transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair offers improved recovery for patients. While technically demanding, this minimally invasive approach shows promising results with minimal pain and rapid return to activity.
Area of Science:
- Minimally Invasive Surgery
- Surgical Techniques
- Hernia Repair
Background:
- Inguinal hernias are common surgical conditions.
- Traditional open hernia repair can involve significant recovery time.
- Laparoscopic techniques offer potential advantages in recovery and pain management.
Purpose of the Study:
- To present a follow-up series of 509 transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs.
- To evaluate the outcomes, recovery, and complications of this specific TAPP technique.
- To assess the feasibility and patient tolerance of the procedure.
Main Methods:
- A series of 509 transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs were performed.
- An original TAPP approach using SurgiPro Mesh with two technical variations was utilized.
- Patients were included without age restrictions if cleared for general anesthesia.
Main Results:
- Average operating time for unilateral repairs was 48 minutes.
- 93% of patients reported minimal pain within 72 hours.
- 89% resumed activities within 5 days, with 97% resuming within 10 days.
- Low morbidity and mortality reported, with two postoperative neuropathies and 19 seromas.
- One recurrence reported, but long-term data is needed for accurate rate.
Conclusions:
- Transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair demonstrates significantly improved patient recovery rates.
- The procedure is well-tolerated with minimal pain and rapid return to daily activities.
- Further long-term follow-up is required to definitively establish recurrence rates and compare outcomes with open repair.
Abstract:
A follow-up series of 509 transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs is presented. The technique used was an original TAPP approach using a SurgiPro Mesh with two technical variations. Age restrictions were removed after the first few cases; thereafter, all patients cleared for general anesthesia were entered into this study without restrictions. Our average operating time was 48 minutes for unilateral hernia repairs. All procedures were outpatient procedures with the exception of 11 overnight admissions for urinary retention. The procedure was well tolerated. Ninety-three per cent of all patients reported minimal pain or discomfort within 72 hours. All patients were instructed to resume unrestricted physical activities within 24 to 48 hours after the procedure; 89 per cent were able to resume activities within 5 days, 94 per cent within 7 days, and 97 per cent within 10 days. No significant morbidity nor mortality were reported, with the exception of two postoperative neuropathies. Nineteen patients developed postoperative seromas that were successfully aspirated. One recurrence has been reported to date. Due to the lack of long term follow-up, these results remain inadequate to establish an accurate recurrence rate. This procedure remains technically difficult and is subject to a learning curve, but the rate of recovery for these patients is significantly improved. In conclusion, the superiority of this procedure in comparison to its open counterpart cannot be proven until long term follow-up becomes available.