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Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results

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Abstract

Background

This prospective study of a new titanium-coated low-weight polypropylene (PP) mesh (16 g PP/m2) was designed to investigate the clinical efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP).

Methods

In this study, 400 patients (average age, 53.5 years; range, 19 – 80 years) with a total of 588 inguinal hernias underwent surgery with the TEP technique between September 2002 and October 2003. Of these patients, 12.4% had experienced recurrent hernias after open suture herniotomy. In 92% of the cases (368 patients with 540 hernias), a lightweight (16 g PP/m2) titanium-coated polypropylene mesh was implanted without fixation, and in 8% (32 patients with 48 hernias) an identical medium-weight (35 g PP/m2) mesh was implanted. The first follow-up examination was scheduled for postoperative week 6.

Results

In the lightweight mesh group, the mean group, operating time per patient was 61 min, corresponding to a calculated time per hernia of 41 min. Two intraoperative major complications occurred: an injury to the cecum and an injury to the bladder. In 12 cases (2%), bleeding from epigastric, testicular, or pubic bone vessels was observed. No injuries to pelvic vessels were seen. One patient was underwent an endoscopic revision to deal with an anticoagulation-related bleed. The mortality rate was 0%. In 12 patients, postoperative hematomas developed. One preperitoneal lipoma had to be extirpated. No infections of the mesh occurred.

The median follow-up period for 371 patients (92.3%) was 7.2 weeks (range, 4–14 weeks). These 343 patients (with 504 hernias) had been provided with a lightweight titanium-coated polypropylene mesh (16 g PP/m2) (follow-up rate, 93.2%). Of these patients, 3.5% reported persistent ingunial pain, 1.7% described a sensation of rigidity in the region of the groin, and 3.2% reported dysesthesia. The early recurrence rate was 0.2%.

Conclusions

The TEP procedure can be performed safely and effectively with the appreciably material-reduced and titanium-coated polypropylene mesh without the need for fixation of the implant. The low early recurrence rate of 0.2% is evidence that the posterior wall of the inguinal canal is adequately augmented. The question whether the material reduction and the titanium coating of the mesh may bring about a reduction in postoperative chronic pain and the sensation of rigidity in the inguinal area via an improvement in biocompatibility must await the results of the scheduled follow-up examination 1 year after the surgical procedure.

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References

  1. P Aeberhard C Klaiber A Meyerberg A Osterwalder J Tschudi (1999) ArticleTitleProspective audit of laparoscopic totally extraperitoneal inguinal hernia repair Surg Endosc 13 1115–1120 Occurrence Handle10.1007/s004649901185 Occurrence Handle10556450

    Article  PubMed  Google Scholar 

  2. PK Amid (1997) ArticleTitleClassification of biomaterials and their related complications in abdominal wall hernia surgery Hernia 1 15–21

    Google Scholar 

  3. B Andersson M Hallén P Leveau A Bergenfelz J Westerdahl (2003) ArticleTitleLaparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial Surgery. 133 464–472 Occurrence Handle10.1067/msy.2003.98 Occurrence Handle12773973

    Article  PubMed  Google Scholar 

  4. M Bay-Nielsen FM Perkins H Kehlet (2001) ArticleTitlePain and functional impairment 1 year after inuinal herniorrhaphy: a nationwide questionnaire study Ann Surg 233 1–7 Occurrence Handle10.1097/00000658-200101000-00001 Occurrence Handle11141218

    Article  PubMed  Google Scholar 

  5. R Bittner V Schumpelick (2000) ArticleTitleDiscussion und Briefe an die: Herausgeber Klosterhalfen B et al: Pathologie traditioneller chirurgischer Netze zur Hernienreparation nach Langzeitimplantation im Menschen (Chirurg 2000, 71:43) Kommentar Chirurg 71 589–591 Occurrence Handle10.1007/s001040051109

    Article  Google Scholar 

  6. M Bodenbach T Bschleipfer M Stoschek R Beckert C Sparwasser (2002) ArticleTitleIntravesikale Migration eines Polypropylennetzes 3 Jahre nach laparoskopischer transperitonealer Hernioplastik Urologe 41 366–368 Occurrence Handle10.1007/s00120-001-0148-0 Occurrence Handle12214456

    Article  PubMed  Google Scholar 

  7. S Bringmann S Ramel T Heikkinen T Englund B Westman B Anderberg (2003) ArticleTitleTension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial Ann Surg 237 142–147 Occurrence Handle10.1097/00000658-200301000-00020 Occurrence Handle12496542

    Article  PubMed  Google Scholar 

  8. T Callesen K Bech H Kehlet (1999) ArticleTitleProspective study of chronic pain after groin hernia repair Br J Surg 86 1528–1531 Occurrence Handle10.1046/j.1365-2168.1999.01320.x Occurrence Handle10594500

    Article  PubMed  Google Scholar 

  9. R Chiafalo F Holzinger Klaiber Ch (2001) ArticleTitleTotal endoskopische präperitoneale Netzplastik bei primären und Rezidivleistenhernien Chirurg 72 1485–1491 Occurrence Handle10.1007/s001040170015 Occurrence Handle11824036

    Article  PubMed  Google Scholar 

  10. J Cunningham WJ Temple P Mitchell JA Nixon RM Preshaw NA Hagen (1996) ArticleTitleCooperative hernia study: pain in the postrepair patient Ann Surg 224 598–602 Occurrence Handle10.1097/00000658-199611000-00003 Occurrence Handle8916874

    Article  PubMed  Google Scholar 

  11. InstitutionalAuthorNameEU Hernia Trialists Collaboration (2002) ArticleTitleRepair of groin hernia with synthetic mesh: meta analysis of randomized controlled trials Ann Surg 235 322–332

    Google Scholar 

  12. X Feliu-Pala M Martin-Gomez S Morales-Conde E Fernandez-Sallent (2001) ArticleTitleThe impact of the surgeon’s experience on the results of laparoscopic hernia repair Surg Endosc 15 1467–1470 Occurrence Handle11965467

    PubMed  Google Scholar 

  13. E Felix S Scott B Crafton P Geis T Duncan R Sewell B McKernan (1998) ArticleTitleCauses of recurrence after laparoscopic hernioplasty: a multicenter study Surg Endosc 12 226–231 Occurrence Handle10.1007/s004649900640 Occurrence Handle9502701

    Article  PubMed  Google Scholar 

  14. EL Felix N Harbertson S Vartanian (1999) ArticleTitleLaparoscopic hernioplasty: significant complications Surg Endosc 13 328–331 Occurrence Handle10.1007/s004649900982 Occurrence Handle10094740

    Article  PubMed  Google Scholar 

  15. MB Ghadimi C Langer H Becker (2002) ArticleTitleZum kanzerogenen Potenzial von Biomaterialien in der Hernienchirurgie Chirurg 73 833–838 Occurrence Handle10.1007/s00104-002-0488-3 Occurrence Handle12425161

    Article  PubMed  Google Scholar 

  16. HS Goldstein (1999) ArticleTitleSelecting the right mesh Hernia 3 23–26 Occurrence Handle10.1007/BF01576737

    Article  Google Scholar 

  17. TJ Heikkinen K Haukipuro P Koivukangas A Hulkko (1998) ArticleTitleA prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients Surg Laparosc Endosc 8 338–344 Occurrence Handle10.1097/00019509-199810000-00003 Occurrence Handle9799140

    Article  PubMed  Google Scholar 

  18. T Hernandez-Richter G Meyer HM Schardey HG Rau FW Schildberg (1999) ArticleTitleErfahrungen mit der laparoskopischen transabdominellen präperitonealen (TAPP) Technik bei Versorgung von “Rezidiv-Leisten-Hernien.” Chirurg 70 1020–1024 Occurrence Handle10.1007/s001040050760 Occurrence Handle10501667

    Article  PubMed  Google Scholar 

  19. RH Hume J Bour (1996) ArticleTitleMesh migration following laparoscopic inguinal hernia Repair J. Laparoendosc Surg 6 333ff

    Google Scholar 

  20. B Klosterhalfen U Klinge B Hermanns V Schumpelick (2000) ArticleTitlePathologie traditioneller chirurgischer Netze zur Hernienreparation nach Langzeitimplantion im Menschen Chirurg 71 43–51 Occurrence Handle10663001

    PubMed  Google Scholar 

  21. S Kumar RG Wilson SJ Nixon IMC Macintyre (2002) ArticleTitleChronic pain after laparoscopic and open mesh repair of groin hernia Br J Surg 89 1476–1479 Occurrence Handle10.1046/j.1365-2168.2002.02260.x Occurrence Handle12390395

    Article  PubMed  Google Scholar 

  22. P Lal R K Kajla J Chander R Saha VK Ramteke (2003) ArticleTitleRandomized controlled study of laparoscopic total extraperitoneal vs open Lichtenstein inguinal hernia repair Surg Endosc 17 850–856 Occurrence Handle10.1007/s00464-002-8575-6 Occurrence Handle12658428

    Article  PubMed  Google Scholar 

  23. MSL Liem Y Graaf Particlevan der CJ Steensel Particlevan RU Boelhouwer GJ Clevers WS Meijer LPS Stassen JP Vente WF Weidema AJP Schrijvers TJMV Vroonhoven Particlevan (1997) ArticleTitleComparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair N Engl J Med 336 1541–1547 Occurrence Handle10.1056/NEJM199705293362201 Occurrence Handle9164809

    Article  PubMed  Google Scholar 

  24. K Miller W Junger (1997) ArticleTitlelleocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair Surg Endosc 11 772–773 Occurrence Handle10.1007/s004649900448 Occurrence Handle9214331

    Article  PubMed  Google Scholar 

  25. H Scheidbach C Tamme A Tannapfel H Lippert F Köckerling (2004) ArticleTitle In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal patchplasty (TEP): an experimental study in pigs Surg Endosc 18 211–220 Occurrence Handle10.1007/s00464-003-8113-1 Occurrence Handle14691711

    Article  PubMed  Google Scholar 

  26. C-G Schmedt R Bittner S Sauerland GG Meyer H Keller C Peiper T Manger D Birk KH Bauer (2003) ArticleTitleCAMIC-Konsensuskonferenz “Leistenhernie” Thema: Endoskopische Verfahren (TAPP/TEP) vs Offene Verfahren mit und ohne Netzimplantation Ergebnisse–einer systematischen Literaturübersicht und Metaanalyse Zentralbl Chin 128: 593–601

    Google Scholar 

  27. V Schumpelick U Klinge G Welty B Klosterhalfen (1999) ArticleTitleMeshes in der Bauchwand Chirurg 70 876–887 Occurrence Handle10.1007/s001040050737 Occurrence Handle10460281

    Article  PubMed  Google Scholar 

  28. V Schumpelick B Klosterhalfen M Müller U Klinge (1999) ArticleTitleMinimierte Polypropylen-Netze zur präperitonealen Netzplastik (PNP) der Narbenhernie Eine prospektive randomisierte klinische Studie Chirurg 70 422–430 Occurrence Handle10.1007/s001040050666 Occurrence Handle10354839

    Article  PubMed  Google Scholar 

  29. JR Schwab DA Beaird BJ Ramshaw JS Franclin TD Duncan RA Wilson J Miller EM Mason (2002) ArticleTitleAfter 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair? Surg Endosc 16 1201–1206 Occurrence Handle10.1007/s00464-001-8341-1 Occurrence Handle11984685

    Article  PubMed  Google Scholar 

  30. N Stylopoulos GS Gazelle DW Rattner (2002) ArticleTitleA cost utility analysis of treatment options for inguinal hernia in 1,512,008 adult patients Surg Endosc 17 180–189 Occurrence Handle10.1007/s00464-002-8849-z Occurrence Handle12415334

    Article  PubMed  Google Scholar 

  31. C Tamme H Scheidbach C Hampe C Schneider F Köckerling (2003) ArticleTitleTotally extraperitoneal endoscopic inguinal hernia repair (TEP): results of 5,203 hernia repairs Surg Endosc 17 190–195 Occurrence Handle10.1007/s00464-002-8905-8 Occurrence Handle12457220

    Article  PubMed  Google Scholar 

  32. C Tamme C Hampe C Schneider I v.Heimburg R Wunder F Köckerling (2003) Total extraperitoneale Hernioplastik (TEP) – Ergebnisse von 5,957 Operationen F Köckerling R Bittner I Gastinger H Lippert (Eds) Minimal Invasive Chirurgie Science Med Hanover 107–112

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Center for Minimally Invasive Surgery, Hanover, Hospital, Roesebeckstrasse 15 (Siloah), 30449, Hanover, Germany

    C. Tamme, N. Garde, C. Hampe, R. Wunder & F. Köckerling

  2. Department of Theoretical Surgery, University of Innsbruck, Schoepstrasse 41, 6020 , Innsbruck, Austria

    A. Klingler

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  1. C. Tamme
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  2. N. Garde
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  3. A. Klingler
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  4. C. Hampe
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  5. R. Wunder
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  6. F. Köckerling
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Correspondence to C. Tamme.

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Tamme, C., Garde, N., Klingler, A. et al. Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results. Surg Endosc 19, 1125–1129 (2005). https://doi.org/10.1007/s00464-004-8219-0

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