Totally extraperitoneal laparoscopic hernioplasty : feasibility and safety in large sliding inguinal hernias

الملخص EN

Background / Aim : the totally extra peritoneal (TEP) hernioplasty is currently the most widely used laparoscopic technique in inguinal hernia repair.

It combines the low recurrence rate with the advantages of minimally invasive surgery.

Although well studied in common groin hernias, its use (with any needed modifications) in the sliding inguinal hernias has been rarely described in the literature.

The aim of this study was to evaluate the safety, feasibility and needed modifications of the TEP technique in the repair of large sliding inguinal hernias.

Patients & methods : out of 110 primary laparoscopic TEP procedures performed in our center in the period between October 2000 and October 2004, twelve patients suffered from large sliding inguinal hernias.

All twelve patients were males, with a median age of 52 (range 38-62) years.

Of these, 9 had left sided hernias (with sliding sigmoid colon) and 3 were right sided (with sliding caecum + / - appendix).

Technique modifications for operative reduction and repair as well as analysis of this group's operative, early and late postoperative outcomes are reported in this study.

Results : the median operative time was 60 (range 45-120) minutes.

Only minor complications were met intraoperative, including; injury to the inferior epigastria vessels (16.7 %), minor peritoneal tears (33.3%) and neuromuscular tear in the sigmoid (8.3%).

No conversion to laparoscopic trans abdominal (TAP) or open technique was needed.

Minor postoperative complications occurred in 50 % of patients.

The median hospital stay was 1.5 (range 1-5) days.

The median follow-up was 20 (range 6-56) months.

No recurrence of the hernias was recorded during the period of follow up.

Conclusion : laparoscopic total extra peritoneal repair of large sliding hernias is feasible and safe with a comparable morbidity profile to that of non-sliding hernias.

Minor technique modification proved useful.

Longer follow up is needed to fully evaluate the technique.