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Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result

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Abstract

Introduction

The aim of the study was to investigate the effectiveness of laparoscopic inguinal hernia repair in daily clinical practice.

Patients and methods

All patients admitted to the hospital for surgery of an inguinal hernia during a 1-year period were prospectively documented and included in a follow-up study. The follow-up was performed at least 5 years after surgery and consisted of a clinical examination, ultrasound investigation and a questionnaire.

Results

From January 2000 to January 2001 a total of 1208 inguinal hernias in 952 patients were consecutively operated by a total of 11 general surgeons in daily clinical routine. Of the patients, 98.02 % were operated on laparoscopically with the transabdominal preperitoneal patch plasty technique (TAPP) and 1.98 % had an open repair. The frequency of intraoperative and early postoperative complications was 2.8 %. The complication rate in the patients presenting a complex hernia was not higher than in patients with uncomplicated unilateral hernias. Life-threatening complications were seen in four patients (bowel lesion—0.4 %), but all four patients presented extensive adhesions in the abdominal cavity after previous abdominal surgery. The follow-up rate after 5 years was 85.3 %. After 5 years the recurrence rate was 0.4 % and the rate of severe chronic pain 0.59 %. None of the patients took analgesics or had to change his occupation.

Conclusion

Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain. Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen.

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References

  1. Cavazzola LT, Rosen MJ (2013) Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 93(5):1269–1279 (Review)

    Article  PubMed  Google Scholar 

  2. Leibl B, Däubler P, Schwarz J, Ulrich M, Bittner R (1995) Standardized laparoscopic hernioplasty vs. Shouldice repair. Results of a randomized comparative study. Chirurg 66(9):895–898

    CAS  PubMed  Google Scholar 

  3. Bittner R, Leibl B, Kraft K, Däubler P, Schwarz J (1996) Laparoscopic hernioplasty (TAPP)—complications and recurrences in 900 operations. Zentralbl Chir 121(4):313–319

    CAS  PubMed  Google Scholar 

  4. Leibl B, Schwarz J, Däubler P, Kraft K, Bittner R (1996) Endoscopic hernia surgery (TAPP)—gold standard in management of recurrent hernias? Chirurg 67(12):1226–1230

    Article  CAS  PubMed  Google Scholar 

  5. Bittner R, Kraft K, Schmedt CG, Schwarz J, Leibl B (1998) Risks and benefits of laparoscopic hernia-plasty (TAPP). 5 years experiences with 3,400 hernia repairs. Chirurg 69(8):854–858

    Article  CAS  PubMed  Google Scholar 

  6. Leibl BJ, Schmedt CG, Schwarz J, Däubler P, Kraft K, Schlossnickel B, Bittner R (1998) A single institution’s experience with transperitoneal laparoscopic hernia repair. Am J Surg 175(6):446–451 (discussion 452)

    Article  CAS  PubMed  Google Scholar 

  7. Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ (2002) Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 89(8):1062–1066

    Article  CAS  PubMed  Google Scholar 

  8. Bittner R, Schmedt C-G, Leibl BJ (2003) Transabdominal pre-peritoneal approach. In: LeBlanc K (ed) Laparoscopic hernia surgery, 1st edn. Arnold, London, pp 53–64

    Chapter  Google Scholar 

  9. Bittner R, Schwarz J (2012) Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg 397(2):271–282 (Review)

    Article  CAS  PubMed  Google Scholar 

  10. McCarthy M Jr, Chang CH, Pickard AS, Giobbie-Hurder A, Price DD, Jonasson O, Gibbs J, Fitzgibbons R, Neumayer L (2005) Visual analog scales for assessing surgical pain. J Am Coll Surg 201(2):245–252

    Article  PubMed  Google Scholar 

  11. Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH (2004) Quantification of pain and satisfaction following laparoscopic and open hernia repair. Arch Surg 139:596–602

    Article  PubMed  Google Scholar 

  12. Bökeler U, Schwarz J, Bittner R, Zacheja S, Smaxwil C (2013) Teaching and training in laparoscopic inguinal hernia repair (TAPP): impact of the learning curve on patient outcome. Surg Endosc 27(8):2886–2893

    Article  PubMed  Google Scholar 

  13. Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF (1984) The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 64:269–285

    Article  CAS  PubMed  Google Scholar 

  14. Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W, Veterans Affairs Cooperative Studies Program 456 Investigators (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827

    Article  CAS  PubMed  Google Scholar 

  15. Strate T, Mann O, Izbicki JR (2004) Open mesh versus laparoscopic mesh hernia repair. N Engl J Med 351:1463–1465 author reply 1463–1465

    Article  PubMed  Google Scholar 

  16. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society [IEHS]). Surg Endosc 25:2773–2843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. McCormack K, Wake BL, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systemic review of effectiveness and economic evaluation. Health Technol Assess 9:1–203

    Article  CAS  PubMed  Google Scholar 

  19. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166

    Article  CAS  PubMed  Google Scholar 

  20. Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251:819–824

    Article  PubMed  Google Scholar 

  21. Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P (2015) International Endohernia Society. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29(2):289–321

    Article  CAS  PubMed  Google Scholar 

  22. Bittner R, Gmähle E, Gmähle B, Schwarz J, Aasvang E, Kehlet H (2010) Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP). Surg Endosc 24:2958–2964

    Article  PubMed  Google Scholar 

  23. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112:957–969

    Article  PubMed  Google Scholar 

  24. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19(1):48–54

    Article  PubMed  Google Scholar 

  25. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Swedish hernia data base the danish hernia data base. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10):1372–1376

    Article  CAS  PubMed  Google Scholar 

  26. Antoniou SA, Koehler G, Antoniou GA, Muysoms FE, Pointner R, Granderath F-A (2016) Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 211(1):239–249

    Article  PubMed  Google Scholar 

  27. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs. Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:188–199

    Article  CAS  PubMed  Google Scholar 

  28. Hasson HM (1984) Open laparoscopy. Biomed Bull 5(1):1–6

    CAS  PubMed  Google Scholar 

  29. Leibl BJ, Schmedt CG, Kraft K, Kraft B, Bittner R (2001) Laparoscopic transperitoneal hernia repair of incarcerated hernias: Is it feasible? Results of a prospective study. Surg Endosc 15:1179–1183

    Article  CAS  PubMed  Google Scholar 

  30. Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R (2000) Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair. Surg Endosc 14:289–292

    Article  CAS  PubMed  Google Scholar 

  31. Wauschkuhn CA, Schwarz J, Bittner R (2009) Laparoscopic transperitoneal inguinal hernia repair (TAPP) after radical prostatectomy: is it safe? Results of prospectively collected data of more than 200 cases. Surg Endosc 23:973–977

    Article  PubMed  Google Scholar 

  32. Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R (2000) Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of the reoperation. J Am Coll Surg 190:651–655

    Article  CAS  PubMed  Google Scholar 

  33. Kraft BM, Kolb H, Kuckuk B, Haaga S, Leibl BJ, Kraft K, Bittner R (2003) Diagnosis and classification of inguinal hernias. Surg Endosc 17(12):2021–2024

    Article  CAS  PubMed  Google Scholar 

  34. Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH (eds) (2001) Abdominal wall hernias: principles and management. Springer, New York

    Google Scholar 

  35. Fitzgibbons RJ Jr, Greenberg AG (2001) Nyhus and Condon’s hernia, 5th edn. Lippincott William & Wilkins, Philadelphia

    Google Scholar 

  36. Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R (2010) Laparoscopic inguinal hernia repair: Gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surg Endosc 24:3026–3030

    Article  PubMed  Google Scholar 

  37. Köckerling F, Schug-Pass C, Adolf D, Keller T, Kuthe A (2015) Bilateral and unilateral total extraperitoneal inguinal hernia repair (TEP) have equivalent early outcomes: analysis of 9395 cases. World J Surg 39(8):1887–1894

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wittenbecher F, Scheller-Kreinsen D, Röttger J, Busse R (2013) Comparison of hospital costs and length of stay associated with open-mesh, totally extraperitoneal inguinal hernia repair, and transabdominal preperitoneal inguinal hernia repair: an analysis of observational data using propensity score matching. Surg Endosc 27(4):1326–1333

    Article  PubMed  Google Scholar 

  39. Coronini-Cronberg S, Appleby J, Thompson J (2013) Application of patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery in England. J R Soc Med 106:278–287

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We are grateful for the kind assistance of Dr.G. Blumenstock, Institute for Medical Biometry, University of Tübingen, in statistical analysis of the data.

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Authors and Affiliations

  1. Surgical Clinic, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, Munich, Germany

    Florian Muschalla

  2. Hernia Center Rottenburg, Winghoferstr.42, 72108, Rottenburg a.N., Germany

    Jochen Schwarz & Reinhard Bittner

  3. Supperstr. 19, 70565, Stuttgart, Germany

    Reinhard Bittner

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  1. Florian Muschalla
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Correspondence to Reinhard Bittner.

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Florian Muschalla, Jochen Schwarz and Reinhard Bittner have no conflicts of interest or financial ties to disclose.

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Muschalla, F., Schwarz, J. & Bittner, R. Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result. Surg Endosc 30, 4985–4994 (2016). https://doi.org/10.1007/s00464-016-4843-8

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