Laparoscopic Totally Extraperitoneal Hernia Repair in Patients with Previous Lower Abdominal Surgery-Early Experience

Cho, Dae Hyun; Kim, Bum Soo; Choi, Sung Il; Joo, Sung Hyung; Lee, Sang Mok

Abstract

PURPOSE
Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has established itself as a safe and effective treatment for inguinal hernia. Nevertheless, there are difficulties in learning the technique. In particular, patients with a medical history of having undergone lower abdominal surgery are generally excluded from laparoscopic hernia repair due to the technical difficulty of the procedure. This study evaluated the early surgical outcome and examined the feasibility of techniques for laparoscopic TEP inguinal hernia repair in patients who had previously undergone lower abdominal surgery.
METHODS
Ten cases of laparoscopic TEP inguinal hernia repair in patients with a prior history of lower abdominal surgery between November 2006 and January 2010 were reviewed. All cases were treated by a single highly experienced laparoscopic surgeon.
RESULTS
Previous operations included 5 cases of radical prostatectomies for prostate cancer, 2 cases of open suprapubic prostatectomies for benign prostate hypertrophy, 2 cases of radical cystectomies for bladder cancer and 1 case of laparoscopic low anterior resection for rectal cancer. In all 10 cases, the patients were male with 9 cases involving an indirect hernia and 1 case involving a direct hernia. The mean operation time was 136.5+/-33.7 minutes, and in 1 case, the surgical method was converted to the transabdominal preperitoneal approach. Postoperatively, there were 3 cases of urinary retention, and the administration of analgesics were required 1.0+/-0.6 times on average. The mean length of hospitalization was 1.2+/-0.8 days. During the mean 18 month (1~36 months) follow-up period, there was no recurrence and chronic pain but 1 case of mesh infection was encountered 6 months after TEP repair.
CONCLUSION
Although the laparoscopic TEP inguinal hernia repair can be carried out safely on patients with previous lower abdominal surgery, it needs to be carried out by fully trained surgeons with sufficient experience in the TEP technique. Nevertheless, more extensive experience and a longer follow-up period will be needed to evaluate the feasibility and efficiency of the TEP approach.