Skip to main content
SpringerLink
Log in

Combined open and laparoscopic technique for extraperitoneal mesh repair of large sac inguinal hernias

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic total extraperitoneal (TEP) hernia repair has been confirmed as an effective procedure in several studies but is considered technically demanding. Separating the hernial sac and spermatic cord is difficult when a large sac inguinal hernia is encountered. This study aimed to investigate the feasibility and effectiveness of a combined open and laparoscopic TEP repair of large sac inguinal hernias.

Methods

From June 2012 to May 2015, laparoscopic TEP (112 cases) and combined open and laparoscopic TEP (COL-TEP) (44 cases) were performed in patients with large sac hernia. There was no clear definition of large sac inguinal hernia; therefore, we defined a large sac as one with the sac base cranial to or over outer ring that could not be easily resected laparoscopically. Using this definition, the laparoscopic TEP group was divided into a small sac TEP (SS-TEP) group (68 cases) and a large sac TEP (LS-TEP) group (44 cases). Direct hernias were included in the SS-TEP group because the hernial sac was easily dissected laparoscopically. The patient demographics, perioperative parameters, complications, and recurrence were compared between the three groups.

Results

No significant differences were found between the groups in mean age, gender, body mass index, comorbidities, number of previous laparotomies, or recurrence rate. Compared with the LS-TEP group, both the SS-TEP and COL-TEP groups had a significantly lower surgical duration (51.4 ± 10.9 vs. 32.8 ± 13.1 and 36.2 ± 11.2 min, respectively), conversion rate (13.6 vs. 0 and 0 %, respectively), and total complication rate (27.3 vs. 13.2 and 11.3 %, respectively).

Conclusion

The combined technique was safe and effective for repair of large sac inguinal hernias. The combined technique was associated with decreased technical difficulty, surgical duration, and conversion and total complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ferzli GS, Massad A, Albert P (1992) Extraperitoneal endoscopic inguinal hernia repair. J Laparoendosc Surg 2(6):281–286

    Article  CAS  PubMed  Google Scholar 

  2. Dulucq JL, Wintringer P, Mahajna A (2009) Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc 23:482–486

    Article  PubMed  Google Scholar 

  3. Kim MJ, Hur KY (2013) Laparoscopic totally extraperitoneal inguinal hernia repair: 10-year experience of a single surgeon. Surg Laparosc Endosc Percutan Tech 23:51–54

    Article  CAS  PubMed  Google Scholar 

  4. Daes J (2014) Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation. Hernia 18:119–122

    Article  CAS  PubMed  Google Scholar 

  5. Palanivelu C, Rangarajan M, John SJ (2007) Modified technique of laparoscopic intraperitoneal hernioplasty for irreducible scrotal hernias (omentoceles): how to remove the hernial contents. World J Surg 31(9):1889–1891

    Article  PubMed  Google Scholar 

  6. Ferzli GS, Rim S, Edwards ED (2013) Combined laparoscopic and open extraperitoneal approach to scrotal hernias. Hernia 17:223–228

    Article  CAS  PubMed  Google Scholar 

  7. Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649

    Article  PubMed  Google Scholar 

  8. Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Osterberg J (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 93:1060–1068

    Article  CAS  PubMed  Google Scholar 

  9. Lau H, Patil NG, Yuen WK (2006) Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males: a randomized trial. Surg Endosc 20:76–81

    Article  CAS  PubMed  Google Scholar 

  10. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikinnen 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 

  11. Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382

    Article  PubMed  Google Scholar 

  12. Sgourakis G, Dedemadi G, Gockel I, Schmidtmann I, Lanitis S, Zaphiriadou P, Papatheodorou A, Karaliotas C (2013) Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits. Surg Endosc 27:2526–2541

    Article  PubMed  Google Scholar 

  13. Schouten N, Simmermacher RK, van Dalen T, Smakman N, Clevers GJ, Davids PH, Verleisdonk EJ, Burgmans JP (2013) Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc 27(3):789–794

    Article  CAS  PubMed  Google Scholar 

  14. Schouten N, Elshof JW, Simmermacher RK, van Dalen T, de Meer SG, Clevers GJ, Davids PH, Verleisdonk EJ, Westers P, Burgmans JP (2013) Selecting patients during the “learning curve” of endoscopic Totally Extraperitoneal (TEP) hernia repair. Hernia 17:737–743

    Article  CAS  PubMed  Google Scholar 

  15. Putnis S, Berney CR (2012) Totally extraperitoneal repair of inguinal hernia: techniques and pitfalls of a challenging procedure. Langenbecks Arch Surg 97:1343–1351

    Article  Google Scholar 

  16. Wantz GE (1984) Complications of inguinal hernia repair. Surg Clin North Am 64:287–298

    CAS  PubMed  Google Scholar 

  17. Bittner R, Arregui ME, Bisgaard T, Dudai MG, Ferzli G, Fitzgibbons RJ, Fortelny H, Klinge U, Kockerling F, 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. Misra MC, Bhowate PD, Bansal VK, Kumar S (2009) Massive scrotal hernias: problems and solutions. J Laparoendosc Adv Surg Tech 19:19–22

    Article  Google Scholar 

  19. Koning GG, Wetterslev J, van Laarhoven CJHM, Keus F (2013) The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One 8(1):e52599

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sajid MS, Craciunas L, Singh KK, Sains P, Baig MK (2013) Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep (Oxf) 1:127–137

    Article  Google Scholar 

  21. Antoniou SA, Antoniou GA, Bartsch DK, Fendrich V, Koch OO, Pointner R, Granderath FA (2013) Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies. Am J Surg 206:245–252

    Article  PubMed  Google Scholar 

  22. Meyer A, Blanc P, Balique JG, Kitamura M, Juan RT, Delacoste F, Atger J (2013) Laparoscopic totally extraperitoneal inguinal hernia repair. Twenty-seven severe complications after 4565 consecutive operations. Rev Col Bras Cir 40(1):32–36

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Jinhui Zhu, Kai Yu, Yun Ji, Chen Yan, and Yuedong Wang have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China

    Jinhui Zhu, Kai Yu, Yun Ji, Yan Chen & Yuedong Wang

Authors
  1. Jinhui Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yun Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuedong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuedong Wang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, J., Yu, K., Ji, Y. et al. Combined open and laparoscopic technique for extraperitoneal mesh repair of large sac inguinal hernias. Surg Endosc 30, 3461–3466 (2016). https://doi.org/10.1007/s00464-015-4630-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4630-y

Keywords

Search

Navigation