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A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction

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Abstract

Objective

The management of the hernia sac is the core step of laparoscopic indirect inguinal hernioplasty. In this study, a randomized controlled trial was conducted to evaluate the clinical effect of laparoscopic total extraperitoneal inguinal herniorrhaphy (TEP) with hernia sac transection and complete sac reduction.

Method

From May 2017 to May 2018, 70 patients aged 18–75 with primary indirect inguinal hernia in our hospital were randomly divided into a transected sac group (TS) and a completely reduced sac group (RS). The primary outcomes compared between the two groups were the hernia sac treatment time, operation time, and the incidence of seroma formation after operation. Secondary outcomes included acute pain, chronic pain (pain which lasted for at least 3 months), hospital stay, recurrence rate, and other complications.

Result

There were no significant differences in baseline demographic characteristics including age, sex, hernia type, size of hernia defect, and follow-up time between the two groups. The times required for hernia sac separation and operation in the TS group were significantly shorter than in the control group (6.1 ± 2.3 vs. 25 ± 5.8 min for hernia sac separation, p < 0.01; and 35.10 ± 3.50 vs. 54.40 ± 4.20 min for operation, p < 0.01). There was no significant difference in hospitalization time, incidence of acute pain, seroma formation, or urinary retention between the two groups. During the 12-month follow-up period, chronic pain, early recurrence, and other complications were not found in either group.

Conclusion

Both the hernia sac transection technique and the complete sac reduction technique are safe and reliable. The hernia sac transection technique is a simple and effective hernia sac treatment method. It reduces the operation time and does not increase seroma or acute or chronic pain. It is valuable and likely to be popularly applied.

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Acknowledgements

The authors are thankful to the Second Affiliated Hospital of Kunming Medical University for the management of our inguinal hernia patient database. This work was supported by the Wu Jieping Medical Foundation of China (No. 320.6750.16211) and Yunnan health training project of high level talents (No. D2017037).

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Author notes

  1. Weiming Li and Yijun Li have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China

    Weiming Li, Yijun Li, Lili Ding, Qingwen Xu, Xiongzhi Chen, Shumin Li, Yueying Lin, Pengyuan Xu, Dali Sun & Yanbo Sun

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  1. Weiming Li
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  2. Yijun Li
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Correspondence to Dali Sun or Yanbo Sun.

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Drs. Weiming Li, Yijun Li, Lili Ding, Qingwen Xu, Xiongzhi Chen, Shumin Li, Yueying Lin, Pengyuan Xu, Dali Sun, and Yanbo Sun have no conflicts of interest or financial ties to disclose.

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Li, W., Li, Y., Ding, L. et al. A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction. Surg Endosc 34, 1882–1886 (2020). https://doi.org/10.1007/s00464-019-07303-x

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