M Ismail1, P Garg. 1. Department of General and Laparoscopic Surgery, Moulana Hospital, Perintalmanna, Kerala 679322, India.
Abstract
BACKGROUND: The need for general anesthesia and the cost and pain due to metal staples required for fixing the mesh are the major reported disadvantages of laparoscopic total extraperitoneal (TEP) hernia repair. We studied the feasibility and results of TEP done under spinal anesthesia with non-fixation of the mesh (SA-NF). This group was compared to TEP done under general anesthesia with non-fixation of the mesh (GA-NF) and repairs done under SA with fixation of the mesh (SA-F). METHODS: A retrospective analysis was carried out in 675 patients (1,289 hernias) in whom TEP was performed. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days to resume normal activities, seroma formation, and urinary retention rates were noted. RESULTS: A total of 1,289 TEP repairs (675 patients) were analyzed, with 636 patients (1,220 hernias) in the SA-NF group, 16 patients (27 hernias) in the GA-NF group, and 23 patients (42 hernias) in the SA-F group. Follow up ranged from 13 to 45 months. The recurrence rates, conversion rates, and complications were similar in all three groups. The mean hospital stay, days to resume normal activities, and pain scores were significantly higher in the mesh fixation (SA-F) group. CONCLUSIONS: TEP, done under SA and without fixation of the mesh, is safe, feasible, and associated with low recurrence rates. Since this procedure does not have the disadvantages usually attributed to TEP, it can be possibly recommended as a first-line procedure, even for unilateral inguinal hernias. Further studies are needed to substantiate this.
BACKGROUND: The need for general anesthesia and the cost and pain due to metal staples required for fixing the mesh are the major reported disadvantages of laparoscopic total extraperitoneal (TEP) hernia repair. We studied the feasibility and results of TEP done under spinal anesthesia with non-fixation of the mesh (SA-NF). This group was compared to TEP done under general anesthesia with non-fixation of the mesh (GA-NF) and repairs done under SA with fixation of the mesh (SA-F). METHODS: A retrospective analysis was carried out in 675 patients (1,289 hernias) in whom TEP was performed. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days to resume normal activities, seroma formation, and urinary retention rates were noted. RESULTS: A total of 1,289 TEP repairs (675 patients) were analyzed, with 636 patients (1,220 hernias) in the SA-NF group, 16 patients (27 hernias) in the GA-NF group, and 23 patients (42 hernias) in the SA-F group. Follow up ranged from 13 to 45 months. The recurrence rates, conversion rates, and complications were similar in all three groups. The mean hospital stay, days to resume normal activities, and pain scores were significantly higher in the mesh fixation (SA-F) group. CONCLUSIONS:TEP, done under SA and without fixation of the mesh, is safe, feasible, and associated with low recurrence rates. Since this procedure does not have the disadvantages usually attributed to TEP, it can be possibly recommended as a first-line procedure, even for unilateral inguinal hernias. Further studies are needed to substantiate this.
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