Totally extraperitoneal versus transabdominal preperitoneal laparoscopic techniques for hernia inguinal repair using glue for mesh and peritoneal closure

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Radenko Koprivica Sanjanin Perišić Jelko Čopi Jernej Šadl

Abstract

Background: Totally extraperitoneal (TEP) and transabdominal preperitoneal repair (TAPP) are standard techniques of laparoscopic approach of groin hernia repair. Many studies compare clinical efficacy between TEP and TAPP technique. Which is the best approach?  The choice of technique of hernia inguinal repair is still controversial.


Aim: To compare our result in last three years in laparoscopic hernia inguinal repair.


Material and methods: This study is retrospective-prospective analysis of patients database with TEP and TAPP hernia inguinal repair between January 2021 to September 2023. Patients demografic profile, hernia characteristic and clinical outcomes included in database. We performed two groups patients: TEP groups and TAPP groups. The primary endpoint included: mesh and peritoneum fixation, operative time, intra and postoperative complication, hospital stay and conversion rate. The secondary outcomes were recurrence rates, acute and chronic pain. The follow-up time was 12 months. The results were processed by the methods of classical statistic analysis. The significance level was 0,05.


Results:  A total of 278 patients divide into two groups: TEP group had 128 patients and TAPP group had 150. There were 255 men and 23 women. The average age is 52.67 years. The American Society of Anesthesiologists Physical Status Classification System (ASA) had ASA I 157, ASA II 105 and ASA III 16 patients. There were 138 right and 140 left inguinal hernias. Bilateral hernias were 110, unilateral 168. There were 20,14% (56) recurrent hernias after Lichtenstein hernioplasty. The size of the hernia measured according to the criteria of the European Hernia Society (EHS) was L1/M1 106 or 38,1 %, L2/M2 114 or 41 % and L3/M3 58 or 20,9 %. There was no statistically significant difference by groups for age, ASA classification, hernia size, and location. We fixed the mesh in 87,3% (216) with glue, in 11% (30) we gave a self-fixing mesh and in 11,7% (32) cases we did not fix the mesh. We used lightweight titanium mesh in 89 % of cases and self gripping mesh in 11%. There was no statistically significant difference between TEP and TAPP groups in the method of mesh fixation and mesh type. In the TAPP group, we closed the peritoneum in 50,7% (76) cases with glue, in 38,7% (58) it was sutured and in 10,6% (16) suturing and gluing was done. Operative time of unilateral hernia surgery in the TEP group is 42 min, in the TAPP 60 min. In bilateral hernia, the operation time of TEP group is 74 min, TAPP group 105 min. The difference was statistically significant between the groups in both cases (p <0.05). The time of hospitalization is the same in both groups and is one day. Intraoperative complications were similarly distributed in both groups, without statistical significance (hemorrhage TEP 4, TAPP group 4, peritoneal lacerations TEP 12, TAPP 10). There was two conversion (0,72%) to another type of operation in both groups (TEP 1, TAPP 1). Postoperatively, we had groin seroma  in 3,6 % (10) of cases (TEP group 5, TAPP 5), testicular hematoma in 3,6% (10) of patients (TEP 4, TAPP 6).  There were two ( 0,72%) reinterventions, the first after the TAPP procedure due to postoperative ileus, and the second after TEP procedure due to iatrogenic perforation of the urinary bladder. Acute pain up to 30 days after surgery in 3,24% (9) patients (TEP 4, TAPP 5). There was no statistically significant difference in the occurrence of these postoperative complications (p> 0.05). Chronic pain was present in TEP group 3 and in TAPP group 4 patients, a total of 7 or 2,52 %, with no statistically significant difference. Hernia recurrence was present in 5 patients or 1,8 %, without statistical difference by groups (TEP 2, TAPP 3) .


Conclusions: Both laparoscopic techniques have similar complication, acute and chronic pain and recurrence rates. Thery are in exelent technique of laparoscopic inguinal hernia repair with acceptable complications. TEP has the advantage that the peritoneal cavity is not breached. However is more difficult to master when compared with TAPP. In conclusion, the choice of the technique should be based on the surgeon”s skills, hospital practice, education and experience.

Keywords: Laparoscopic hernia inguinal repair, TEP, total extraperitoneal repair, TAPP, transabdominal preperitoneal repair, recurrent inguinal hernia, chronic pain

Article Details

How to Cite
KOPRIVICA, Radenko et al. Totally extraperitoneal versus transabdominal preperitoneal laparoscopic techniques for hernia inguinal repair using glue for mesh and peritoneal closure. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5248>. Date accessed: 27 may 2024. doi: https://doi.org/10.18103/mra.v12i4.5248.
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Research Articles

References

1. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open versus non mesh for repair of femoral and inguinal hernia. Cochrane Database Syst rev. 2002;(4): CD002197.

2. Sains PS, Tilney HS, Purkayastha S, Darzi AW, Athanasiou T, Tekkis PP, et all. Outcomes following laparoscopic versus open repair of incisional hernia. World J Surg. 2006; 30(11): 2056-64.

3. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, et all. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004; 350 (18): 1819-27. Epub 2004 apr 25.

4. McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using totally extraperitoneal prosthetic approach. Surg Endosc. 1993, 7(1): 26-28.

5. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J et all. European hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009, 13 (4): 343-403. Doi:10.1007/s1 0029-009-0529-7. Epub 2009 Jul 28.

6. Lal P, Philips P, Saxena KN, Kajla RK, Chander j, Ramteke VK. Laparoscopic total extraperitoneal (TEP) inguinal hernia repair under epidural anesthesia: a detailed evaluation. Surg Endosc. 2007; 21 (49:595-601. Epub 2006 Dec 16.

7. Kockerling F, Bittner R, Jacob DA, Seidelmann L, Killer T, Adolf D, Kroft A, Kulle A. TEP versus TAPP: comparasion of the perioperative outcame in 17587 patients with a primary unilateral inguinal hernia. Surg Endosc. 2015; 29: 3750-3760.

8. Wilson P, Hickey L. Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (Liquiband Fix 8) for mesh fixation and peritoneal closure: learning experience during introduction into clinical practice. Hernia. 2019; 23:601-613

9. Ortenzi M, Williams S. at all. Laparoscopic repair of inguinal hernia: retrospective comparison of TEP and TAPP procedures in a tertiary referral center; Minerva Chir. 2020 okt;75(5):279-285

10. Bracale U, Melillo P, Pignata G, Di Salvo at all. Wich is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? Systematic review of the literature with a network meta-analysis. Surg Ednosc. 2012 dec; 26(12): 355-366.

11. Koprivica R, Perišić S, Kuhar Makoter M. Adchesive techniques for mesh and peritoneum fixation in laparoscopic inguinal hernia repair. Surgery and Surgical Endoscopy. 2020 oct; vol 2, No 2: 11-16.

12. Krishna A, Bansal VK at all. Totally extraperitoneal reapir in inguinal hernia: more than decades experience at a tertiary care hospital. Surg Laparosc Endosc Percut Tech. 2019 avg; 29(4): 247-251

13. Varcus F, Duta C at all. Laparoscopic repair of inguinal hernia TEP versus TAPP. Chirurgia 2016.111;308-312

14. Liew W, Wai YY, Kosai NR, Gendeh HS. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers. Hernia. 2017; 21(4): 549-554.

15. Mittermair R, Jenic G, Kolenik R, Sorre C. TAPP surgery with mesh fixation and peritoneal closure using n-butyl-2-cyanoacrylate (LiquiBand§FIX8tm )-initial experience. Eur Surg.2016; 49(1): 27-31.

16. Dauser B, Szyszkowitz A, Seitinger G, Fortelny RH, Herbst F. A novel glue device for fixation of mesh an peritoneal closure during laparoscopic inguinal hernia repair: short and medium term results. Eur Surg. 2017; 49(1): 27-31.

17. Kukleta JF, Freytag C, Weber M, et al. Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl.cyanoacrilate: long-term biocompatibility in over 1300 mesh fixation. Herni. 2012; 16: 153-62.

18. Katkhouda N, Mavor E, Friedlander MH, et al. Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg. 2001¸233: 18-25.

19. Niebuhr H, Wegner F, Hukauf M,et al. What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20004 patients fron the herniamed regurstry. Surg Endosc. 2018; 32: 1971-1983.

20. Nan H, Hong X, Deng-Chao W, Yue-Hua L, et al. Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A meta-analysis of randomized controlled trials. Asian Jornal of Surgery. 2023; 46: 3417-3425.

21. Vidovic D, Kirac I, Glavan E, Filipovic-Cugara J, Ledinsky M, bekavac-Beslin M. Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. J Laparoendosc Adv Surg Tech A. 2007; 17(5): 585-90.

22. Ramshaw B, Shuler FW, Jones HB, Duncan TD, White J, Wilson R,et al. Laparoscopic inguinal hernia repair: lessons learned after 1224 consecutive cases. Surg Endosc. 2001, 15(1): 50-4.