C D Smith1, G Tiao, T Beebe. 1. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30365-2225, USA.
Abstract
BACKGROUND: Videoscopic preperitoneal mesh (VPM) inguinal herniorrhaphy avoids the entry into the abdominal cavity, which is necessary with other videoscopic techniques. Despite this advantage, surgeons have been slow to adopt this technique. We reviewed our experience with VPM inguinal herniorrhaphy, specifically investigating the technical aspects of this approach. METHODS: Data were collected prospectively. Operative notes were reviewed retrospectively detailing intraoperative events not "typical" with the VPM technique. RESULTS: One hundred consecutive patients undergoing VPM repair of 127 hernias were studied. The repair was completed in all but 2 patients. Mean operating time was 120 minutes (60 to 146). In 36 repairs there were 59 intraoperative "events" requiring specific maneuvers to correct. Events identified were the need for transection of the hernia sac, creation and repair of a peritoneal tear, and need to divide the inferior epigastric vessels. No complications related to these events occurred. When events occurred, operative times were significantly longer (146+/-45 versus 83+/-23 minutes; P <0.05). CONCLUSION: Intraoperative events are common with VPM herniorrhaphy. These events significantly prolong operating time. A surgeon's lack of familiarity with such events and how to deal with them may in part explain the reluctance to widely apply the VPM technique.
BACKGROUND: Videoscopic preperitoneal mesh (VPM) inguinal herniorrhaphy avoids the entry into the abdominal cavity, which is necessary with other videoscopic techniques. Despite this advantage, surgeons have been slow to adopt this technique. We reviewed our experience with VPM inguinal herniorrhaphy, specifically investigating the technical aspects of this approach. METHODS: Data were collected prospectively. Operative notes were reviewed retrospectively detailing intraoperative events not "typical" with the VPM technique. RESULTS: One hundred consecutive patients undergoing VPM repair of 127 hernias were studied. The repair was completed in all but 2 patients. Mean operating time was 120 minutes (60 to 146). In 36 repairs there were 59 intraoperative "events" requiring specific maneuvers to correct. Events identified were the need for transection of the hernia sac, creation and repair of a peritoneal tear, and need to divide the inferior epigastric vessels. No complications related to these events occurred. When events occurred, operative times were significantly longer (146+/-45 versus 83+/-23 minutes; P <0.05). CONCLUSION: Intraoperative events are common with VPM herniorrhaphy. These events significantly prolong operating time. A surgeon's lack of familiarity with such events and how to deal with them may in part explain the reluctance to widely apply the VPM technique.