Surgeons' Approach to Intraoperative Complications in Total Extraperitoneal (TEP) Hernia Repair.

Background and Objectives: This study aimed to determine the frequency of laparoscopic inguinal hernia repair (LIHR) and how surgeons managed complications such as intraoperative bleeding, organ damage, and peritoneal injury that may develop during this procedure. Methods: The data for the study were collected through an electronic survey created using Google Forms and sent using WhatsApp in May 2024. Results: The study included 220 of 250 surgeons (88%) working in 25 healthcare centers located in different regions where the survey was distributed. Fourteen respondents with missing data were excluded from the study. The mean age of the remaining 206 participants was 39.6 (27-69) years. The rate of surgeons using laparoscopic techniques in inguinal hernia surgery was 89.3%. The method most preferred by the surgeons performing LIHR was total extraperitoneal (TEP) repair (60.9%), followed by transabdominal preperitoneal (TAPP) repair (39.1%). The surgeons preferred open procedures in patients with a history of lower abdominal surgery, those with scrotal hernia, and elderly patients. Additionally, in cases of intraoperative complications that developed at different stages of TEP, it was observed that participants mostly convert to the TAPP technique (43.5-46%), and in some cases, almost all participants continued the procedure with the same technique, i.e., TEP repair (94.6%). Conclusion: This study revealed that surgeons preferred open procedures in some specific patient groups, but they mostly preferred LIHR in the remaining cases. Young surgeons, in particular, seem more inclined to employ laparoscopic methods. In cases of intraoperative complications, most surgeons chose to continue with laparoscopic techniques.

Prospective randomized study comparing mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair without mesh fixation.

PURPOSE: In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence. METHODS: Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia. RESULTS: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant. CONCLUSION: Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs. TRIAL REGISTRATION: ClinicalTrials number: NCT06070142.

An innovative procedure: Laparoscopic sterilisation of liver hydatid cyst cavities with Foley catheter method.

Sterilisation of the liver hydatid cyst cavities is a significant step in the surgical treatment of these cysts. We previously performed a study addressing the Foley catheter method in sterilisation of the cyst cavities with open surgery. Recently, we have been laparoscopically using Foley catheters for sterilisation of the cyst cavities. We tried laparoscopically in five cases with six cysts. A Foley catheter can be used in the sterilisation of hydatid cysts cavity both in laparoscopic and open interventions. We think that this procedure can reach cysts at all locations of liver and be applied to multiple liver cysts, too. From laparoscopic point of view, the method we presented is innovative procedure. To date, we have not seen any morbidity including recurrence and mortality in cases we applied this procedure.

The management of xanthogranulomatous cholecystitis.

OBJECTIVES: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages. MATERIAL AND METHODS: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients' demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy. RESULTS: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p <0.05). Total complication rate in XGC cases was 3.9%. CONCLUSION: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.

Withdrawn: An innovative procedure: Laparoscopic sterilization of liver cyst cavities with foley catheter method.

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