Laparoscopic inguinal hernia repair: is dual-approach better than classic transabdominal preperitoneal repair?

Saif, Sulaiman A.; Mohammed, Salah I.; Eltayeb, Almoutaz A.; Hamad, Mostafa A.

doi:10.4103/ejs.ejs_22_20

Laparoscopic inguinal hernia repair: is dual-approach better than classic transabdominal preperitoneal repair?

Authors

Abstract

Background
Transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (TEP) are the two major types of laparoscopic repair for inguinal hernia. Although TAPP is easier, there is still some difficulty in sac and peritoneal dissection. As a result of this, a new modification of TAPP, under the name of ‘dual approach’ (DA), was introduced by inflating the preperitoneal space with CO aiming to facilitate dissection and save time. The early reported results of this approach were encouraging.
Aim
The authors aimed to compare TAPP with the DA.
Patients and methods
In all, 40 consecutive patients with inguinal hernia were prospectively randomized into two equal groups; group I underwent TAPP and group II underwent DA. Preoperative, intraoperative, and postoperative data were collected and statistically analyzed.
Results
The mean age was 43±16 years and the mean BMI was 27.5±3.4. The mean operative time was 76.8±15.9 and 81.2±11.9 for TAPP and DA, respectively, with no significant difference. Within each group, the learning state of the operator affects the operative time significantly. Regarding the operative difficulty from the operator’s perspective, there was no significant difference considering both procedures as a whole. However, the lateral and medial preperitoneal dissection was significantly easier for the DA. On the other hand, the difficulty in sac dissection did not significantly improve with the DA. There was no significant difference between both groups regarding hospital stay, intraoperative and postoperative complications, number of analgesic doses, postoperative pain, or recurrence.
Conclusion
DA offers easier dissection of the lateral and medial pre-peritoneal pockets but not the sac. However, this new approach does not offer advantages over the classic TAPP regarding operative time, hospital stay, complications, postoperative pain, or recurrence.

Keywords