Laparoscopic transabdominal preperitoneal repair (umbilical TAPP) versus open ventral patch repair for medium size umbilical hernias in overweight and obese patients.

INTRODUCTION: Despite high prevalence of umbilical hernias an open anterior approach is still frequently performed. Mesh use, although necessary in recurrence prevention, may lead to more frequent surgical site infections, especially in obese patients. Intraperitoneal onlay mesh (IPOM) may promote intraperitoneal adhesions. Some of these limitations may be reconciled by transabdominal-preperitoneal repair (TAPP). AIM: To compare the feasibility, safety and efficacy of umbilical TAPP (u-TAPP) with ventral patch repair technique (VPR). MATERIAL AND METHODS: The analysis included overweight/obese patients undergoing elective surgery for primary umbilical hernia (22 in VPR, 21 in u-TAPP). RESULTS: There were no differences between groups regarding size of the hernia defect. The mean width of the defect was 26 mm in VPR and 30 mm in u-TAPP (p = 0.185). The operation time was significantly shorter (p < 0.001) in VPR (43.1 ±11.6 min) than in u-TAPP (93.2 ±22.3 min). However, in VPR it was possible to place a much smaller area of synthetic mesh than in u-TAPP (34.3 vs. 164.2 cm2; p < 0.001). After 30 days of follow-up, there was no recurrence in any of the groups. No significant differences were observed between the two groups regarding post-operative pain. CONCLUSIONS: TAPP technique in umbilical hernia repair allows for placement of a much larger mesh than an anterior approach surgery, and is closer to current recommendations, especially for patients with additional risk factors, such as obesity or coexistence of diastasis recti. TAPP allows a mesh to be introduced into the preperitoneal space, allowing one to avoid direct contact between the mesh and the intestines. Laparoscopic umbilical TAPP is feasible and safe, but the operation time is longer compared to open methods.

Laparoscopic enhanced-view totally extraperitoneal Rives-Stoppa repair (eTEP-RS) for ventral and incisional hernias - early operative outcomes and technical remarks on a novel retromuscular approach.

INTRODUCTION: Incisional hernias can complicate up to one in four laparotomy procedures, and successful repair remains a significant clinical challenge for surgeons. Recently, the surgical technique of ventral hernia repair (eTEP-RS) has been introduced. AIM: To present early results in treating patients with ventral hernia using the eTEP-RS technique and to discuss key technical aspects affecting the safety and efficiency of repair. MATERIAL AND METHODS: A prospective study of early outcomes was conducted for all ventral hernia patients (hernia orifice between 4 and 8 cm) who underwent eTEP-RS between March 2019 and July 2020. RESULTS: As of July 2020, we performed a total of 11 eTEP-RS procedures. The mean duration of the surgery was 204 min (158 to 295). The average size of the treated defect in the transverse dimension was 5.8 cm, and the defect area was 38.5 cm2. The average size of the mesh used was 486 cm2 (280 to 590). After an average follow-up of 7 months (1-17) there was no recurrence or major complication. Based on our initial experiences we present a detailed description of the main aspects of the surgical technique itself, as well as the essential nuances, to enable evaluation of the technique and future popularization. CONCLUSIONS: The eTEP-RS technique is a safe alternative to open ventral hernia repair and allows for the placement of a large piece of mesh in accordance with current recommendations. Excellent knowledge of the detailed anatomy of the abdominal wall is essential for safe and effective hernia repair.

The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon's experience.

BACKGROUND: Although inguinal hernia is one of the most common conditions requiring surgical treatment, no reliable information is available on the quality of life of patients with inguinal hernias before surgery. Additionally, patients with intense inguinal pain prior to surgery are more susceptible to postoperative chronic pain. In such cases, less invasive laparoscopic techniques can be used, allowing atraumatic mesh fixation to reduce postoperative pain. The aim of the study was to determine, whether these treatments for patients with preoperative pain would minimize upsetting experiences after surgery. MATERIALS AND METHODS: Data were gathered prospectively from the National Hernia Repair Register for 146 patients who underwent TAPP repairs in the general surgery department (2013-2016). The demographic data were recorded, the pain intensity was determined and patients described the occurrence of pain during ten everyday activities. RESULTS: The average surgery time was 56.4 min. The follow-up was 23.4 months. The pain before surgery was 4.28 and 12 months after surgery 0.38 (p < 0.001). Pain intensity before surgery was scored as 4.1, 4.3, and 4.9 among patients who had a hernia < 12 months, > 1 year, and > 5 years, respectively (p = 0.028). Twelve months after surgery, the pain was 0.26, 0.34, and 0.40 (p = 0.037), respectively. Patients < 40 years experienced pain before the surgery more often. The intensity of pre-/postoperative pain was significantly higher < 40 years (4.9/0.63) than > 60 years (3.8/0.29). CONCLUSIONS: TAPP inguinal hernia repair with glue fixation significantly decreased the frequency and intensity of the pain compared to that experienced preoperatively. After TAPP repair, the influence of pain on basic everyday activities is substantially lower. Patients under 40 years of age experience frequent and intense pre- and postoperative pain. A longer hernia duration prior to surgery causes increased pre- and postoperative pain.