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Modified TAPP is the standard procedure for complex inguinal and femoral hernias: late results and patient satisfaction

A retrospective single-center long-term follow-up study

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Summary

Purpose

Can the routine use of a modified endoscopic laparoscopic hernioplasty (TAPP) in the treatment of complex inguinal and femoral hernias achieve similar low complication rates and patient satisfaction as with primary hernias?

Materials and methods

93.9% of all 7010 inguinal and femoral hernias operated from 1993 to 2009 were treated with a modified TAPP. 4 subgroups of patients with 1492 hernias, operated 1994, 1999, 2004 and 2009 and with structural equality to all hernias, were enrolled in a retrospective follow-up study of 17 years, including femoral hernias, scrotal hernias, hernias after radical open prostatectomy, incarcerated hernias, hernia recurrences after anterior repair and recurrences after failed TAPP/TEP (Laparoscopic transabdominal preperitoneal hernia repair/Endoscopic totally extraperitoneal inguinal hernia repair) procedure. Intra- and postoperative complications were analyzed and 856 living patients with 1123 hernias were asked with a comprehensive questionnaire for late complications and satisfaction with their operation. The follow-up was 94%.

Results

99.1% of all patients had no early and 97.2% no late postoperative complications. Hernia recurrences (1.5%), hydrocele formation (0.3%) and trocar hernias (0.3%) were the most common complications without significant differences between complex and primary hernias. Postoperative pain longer than 3 weeks was reported by 7.8% of the patients. Only 2 patients with femoral hernias and 2 patients with incarcerated phernias were not satisfied with the result of TAPP hernioplasty because of chronic pain or trocar hernia.

Conclusion

Experienced endoscopic laparoscopic hernia surgeons have the same or lower complication rates in TAPP therapy in complex inguinal and femoral hernias as in primary hernias with a high patient satifaction with the outcome of TAPP hernioplasty.

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References

  1. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63. https://doi.org/10.1007/s10029-014-1236-6.

    Article  CAS  PubMed  Google Scholar 

  2. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guideline for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS). Surg Endosc. 2011;25:2773–843. https://doi.org/10.1007/s004664-011-1799-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Poelman MM, van der Heuvel B, Deelder JD, Abis GSA, Beudeker N, Bittner R, et al. EAES consensus development conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27:795–800. https://doi.org/10.1007/s00464-013-3001-9.

    Article  Google Scholar 

  4. Peitsch WKJ. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs. Surg Endosc. 2014;28:671–82. https://doi.org/10.1007/s004664-013-3208-9.

    Article  PubMed  Google Scholar 

  5. Knook MTT, Weidema WF, Stassen LPS, van Steensel JC. Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy. Surg Endosc. 1999;13:1145–7.

    Article  CAS  PubMed  Google Scholar 

  6. Van den Heuvel B, Dwars BJ. Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc. 2013;27:795–800.

    Article  PubMed  Google Scholar 

  7. Roos MM, van Hessen CV, Verleisdonk EJMM, Clevers GJ, Davids PHP, Voorbrood CEH, et al. An 11-year analysis of reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high-volume hernia center. Hernia. 2019;23:655–62.

    Article  CAS  PubMed  Google Scholar 

  8. Ramakrishnan P, Bansal S, Deuri B, Subbiah R, Palanisamy S, Palanivelu P, et al. A single center experience of laparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes. Surg Endosc. 2016;30:2308–14. https://doi.org/10.1007/s004664-015-4387-3.

    Article  PubMed  Google Scholar 

  9. Lamb ADG, Robson AJ, Nixon SJ. Recurrence after totally extraperitoneal laparoscopic repair: implications for operative technique and surgical training. Surgeon. 2006;4:299–307.

    Article  CAS  PubMed  Google Scholar 

  10. Burcharth J, Andresen K, Pommergaard H‑C, Bisgaard T, Rosenberg J. Recurrence patterns of direct and indirect inguinal hernias in a nationwide population in Denmark. Surgery. 2014;155:173–7.

    Article  PubMed  Google Scholar 

  11. Philips EH, Rosenthal R, Fallas M, Carroll B, Arregui M, Corbitt J, et al. Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc. 1995;9:140–5.

    Google Scholar 

  12. Chowbey PK, Bandyopadhyay SK, Sharma A, Khullar R, Soni V, Baijal M. Recurrent hernia following endoscopic total extraperitoneal repair. J Laparoendosc Adv Surg Tech A. 2003;13:21–5.

    Article  PubMed  Google Scholar 

  13. Lowham AS, Filipi CJ, Fitzgibbons RJ, Stoppa R, Wantz E, Felix EL, et al. Mechanisms of hernia recurrence after preperitoneal mesh repair. traditional and laparoscopic. Ann Surg. 1997;225:422–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Roos MM, Bakker WJ, Schouten N, et al. Higher recurrence rate after endoscopic totally extraperitoneal (TEP) inguinal hernia repair with ultrapro lightweight mesh. Ann Surg. 2018;268:241–6.

    Article  PubMed  Google Scholar 

  15. Schouten N, Simmermacher RK, van Dalen T, et al. Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc. 2013;27:789–94.

    Article  CAS  PubMed  Google Scholar 

  16. Kukleta JF. Causes of recurrence in laparoscopic inguinal hernia repair. J Minim Access Surg. 2006;2:187–91.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mancini R, Pattaro G, Spaziani E. Laparoscopic trans-abdominal pre-peritoneal (TAPP) surgery for incarcerated inguinal hernia repair. Hernia. 2019;23:261–6. https://doi.org/10.1007/s10029-018-1828-7.

    Article  CAS  PubMed  Google Scholar 

  18. Leibl B, Schmedt CG, Kraft K, Bittner R. Laparoscopic transperitoneal hernia repair of incarcerated hernias: is it feasible? Results of a prospective study. Surg Endosc. 2001;15:1179–83.

    Article  CAS  PubMed  Google Scholar 

  19. Legnani GL, Rasini M, Pastori S, Sarli D. Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases. Hernia. 2008;12:185–8. https://doi.org/10.1007/s10029-007-0305-5.

    Article  CAS  PubMed  Google Scholar 

  20. Yang S, Zhang G, Jin C, Cao J, Zhu Y, Shen Y, et al. Transabdominal laparoscopic approach for incarcerated inguinal hernia repair. a report of 73 cases. Medicine. 2016;95:e5686. https://doi.org/10.1097/MD.0000000000005686.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Misra MC, Bhowate PD, Bansal VK, Kumar S. Massive scrotal hernias: problems and solutions. J Laparoendosc Adv Surg Tech A. 2009;19:19–22.

    Article  PubMed  Google Scholar 

  22. Mayer F, Niebuhr H, Lechner M, Dinnewitzer A, Köhler G, Hukauf M, et al. When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases. Surg Endosc. 2016;30:4363–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Köckerling F, Bittner R, Adolf D, Fortelny R, Niebuhr H, Mayer F, et al. Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures. Surg Endosc. 2018;32:2222–31. https://doi.org/10.1007/s004664-017-5912-3.

    Article  PubMed  Google Scholar 

  24. Berney CR. The endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach. Hernia. 2012;16:301–5. https://doi.org/10.1007/s10029-011-0892-z.

    Article  CAS  PubMed  Google Scholar 

  25. Fujinaka R, Urade T, Fukuoka E, Murata K, Mii Y, Sawa H, et al. Laparoscopic transabdominal preperitoneal approach for giant inguinal hernias. Asian J Surg. 2019;42:414–9. https://doi.org/10.1016/j.asjsur.2017.12.004.

    Article  PubMed  Google Scholar 

  26. Leibl BJ, Schmedt C‑G, Kraft K, Ulrich M, Bittner R. Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair. Surg Endosc. 2000;14:289–92.

    Article  CAS  PubMed  Google Scholar 

  27. Agresta F, Mazzarolo G, Balbi P, Bedin N. Inguinal-scrotal hernias in young patients: is laparoscopic repair a possible answer? Preliminary results of a single-institution experience with a transabdominal preperitoneal approach. Hernia. 2010;14:471–5. https://doi.org/10.1007/s10029-010-0677-9.

    Article  CAS  PubMed  Google Scholar 

  28. Peitsch WKJ. Laparoscopic transperitoneal inguinal hernioplasty (TAPP) after radical open retropubic prostatectomy: special features and clinical outcomes. Hernia. 2019;23:281–6. https://doi.org/10.1007/s10029-018-1846-5.

    Article  CAS  PubMed  Google Scholar 

  29. Köckerling F, Jakob D, Wiegank W, Hukauf M, Schug-Pass C, Kuthe A, et al. Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome? Surg Endosc. 2016;30:1146–55. https://doi.org/10.1007/s004664-015-4318-3.

    Article  PubMed  Google Scholar 

  30. The HerniaSurge Group. International guideline for groin hernia management. Hernia. 2018;22:1–165. https://doi.org/10.1007/s10029-017-1688-x.

    Article  Google Scholar 

  31. Ruze R, Wu Q, Zhan H, Zhang G. Correlation between laparoscopic transection of an inguinal hernia sac and postoperative seroma formation: a prospective randomized controlled study. Surg Endosc. 2019;33:1147–54. https://doi.org/10.1007/s004664-018-6374-y.

    Article  PubMed  Google Scholar 

  32. Aravind B, Cook A. Intra-abdominal giant infected seroma following laparoscopic inguinal hernia repair. Hernia. 2015;19:795–7.

    Article  CAS  PubMed  Google Scholar 

  33. Fenger AQ, Helvind NM, Pommergaard H‑C, Burcharth J, Rosenberg J. Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence. Surg Endosc. 2016;30:986–92. https://doi.org/10.1007/s004664-015-4280-0.

    Article  PubMed  Google Scholar 

  34. Andresen K, Fenger AQ, Burcharth J, Pommergaard H‑C, Rosenberg J. Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery: a comparison between fibrin sealant and tacks. Surg Endosc. 2017;31:4077–84. https://doi.org/10.1007/s004664-017-5454-8.

    Article  PubMed  Google Scholar 

  35. Niebuhr H, Wegner F, Hukauf M, Lechner M, Fortelny R, Bittner R, et al. What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20,004 patients from the Herniamed Registry. Surg Endosc. 2018;32:1971–83. https://doi.org/10.1007/s004664-017-5893-2.

    Article  CAS  PubMed  Google Scholar 

  36. Lederhuber H, Stiede F, Axer S, Dahlstrand U. Mesh fixation in endoscopic inguinal hernia repair. evaluation of methodology based on systematic review of randomized clinical trials. Surg Endosc. 2017;31:4370–81. https://doi.org/10.1007/s004664-017-5509-x.

    Article  PubMed  Google Scholar 

  37. Fortelny RH, Petter-Puchner AH, May C, Jaksch W, Benesch T, Khakpour Z, et al. The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of prospective randomized controlled study. Surg Endosc. 2012;26:249–54. https://doi.org/10.1007/s004664-011-1862-3.

    Article  CAS  PubMed  Google Scholar 

  38. Chan MS, Melissa CS, Teoh AYB, Bun TAY, Chan KW, Wing CK, et al. Randomized double-blinded prospective trial of fibrin sealant spray versus mechanical stapling in laparoscopic total extraperitoneal hernioplasty. Ann Surg. 2014;259:432–7. https://doi.org/10.1097/SLA.0b013e3182a6c513.

    Article  PubMed  Google Scholar 

  39. Köckerling F, Bittner R, Kraft B, Hukauf M, Kuthe A, Schug-Pass C. Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair? Surg Endosc. 2017;31:573–85. https://doi.org/10.1007/s004664-016-5001-z.

    Article  PubMed  Google Scholar 

  40. Ferrarese A, Marola S, Surace A, Borello A, Bindi M, Cumbo J, et al. Fibrin glue versus stapler fixation in laparoscopic transabdominal inguinal hernia repair: A single center 5‑year experience and analysis of the results in the elderly. Int J Surg. 2014;12(Suppl):94–8. https://doi.org/10.1016/j.ijsu.2014.08.371.

    Article  Google Scholar 

  41. Muschalla F, Schwarz J, Bittner R. Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result. Surg Endosc. 2016;30:4985–94. https://doi.org/10.1007/s004664-016-4843-8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. St. Josef Krankenhaus Werden, Department of General‑, Visceral- and Vascular Surgery, University Medicine Essen, Propsteistr. 2, 45239, Essen, Germany

    Werner K. J. Peitsch

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  1. Werner K. J. Peitsch
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Contributions

Werner K. J. Peitsch: project development, data collection, and manuscript writing. The manuscript has not been submitted to more than one journal for simultaneous consideration. This manuscript has not been published previously. Only the overall recurrence rate of a group of hernias with TAPP procedure, operated 1994, 1999, 2004, and 2009, has been published before [4].

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Correspondence to Werner K. J. Peitsch.

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W.K. J. Peitsch declares that he has no competing interests.

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All procedures performed in the study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The retrospective clinical study was reviewed and approved by the Ethics Committee of the Faculty of Medicine at the University of Göttingen, Germany. Informed consent was obtained from all individual participants included in the study.

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Peitsch, W.K.J. Modified TAPP is the standard procedure for complex inguinal and femoral hernias: late results and patient satisfaction. Eur Surg 52, 74–87 (2020). https://doi.org/10.1007/s10353-019-00624-0

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