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Outcomes of Endoscopic Totally Extraperitoneal (TEP) repair of clinically occult inguinal hernia diagnosed with ultrasonography

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Kebabci E., Ozturk S., Unver M.
Polish Journal of Surgery
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2021
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vol. 93
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issue 4
11-14
EN
Inguinal hernias generally present with groin lump and pain. Although inguinal hernias can be diagnosed clinically in most cases, patients without a groin lump pose a considerable diagnostic challenge. The first-line diagnostic imaging tool in these cases is ultrasound (US) and the recommended surgical procedure is laparoscopic-endoscopic repair. This retrospective study aims at evaluating postoperative results and complication rates of TEP technique in patients with occult contralateral hernias diagnosed with US in comparison to patients with clinically diagnosed hernias. A retrospective study was conducted to evaluate the outcomes of TEP procedure in patients with radiologically diagnosed occult contralateral hernias in comparison to patients with clinically diagnosed hernias. All hernias included in this study were repaired by TEP technique and secured with an extraperitoneal mesh. Demographic data, patient characteristics and perioperative information were obtained by reviewing medical records. A total number of 109 patients were enrolled in the study. The majority of patients were male and the mean age was 48.9 ± 14.6 years. In 56 cases, hernias were repaired unilaterally, while the remaining 53 were repaired bilaterally. Right-sided hernias were more common than left-sided hernias. The morbidity rate was 7.1% in unilateral repairs and 3.8% in bilateral repairs. The recurrence rate was 3.6% for unilateral repairs and 5.7% for bilateral repair. Some studies report that the incidence of clinical contralateral inguinal hernias identified after primary unilateral surgery is approximately 10%. If these contralateral hernias were diagnosed prior to the primary surgery, the risk of performing another operation could be avoided. Laparoscopic surgery enables bilateral hernia repair without any additional incisions, presenting similar morbidity rates when compared to unilateral repair. There was no significant difference between unilateral and bilateral TEP repair in terms of intraoperative and postoperative surgical complications. These results suggest that laparoscopic inguinal hernia repair is a safe and effective surgical technique for both unilateral and bilateral procedures. In order to prevent second operation, all patients with suspected inguinal hernia should undergo an US examination before surgery.
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How safe is the use of prosthetic materials in the repair of abdominal-wall defects in malnourished subjects?

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Karahan M., Kulacoglu H., Seker D., Ergul Z., Kiziltay A., Yilmazer D., Captug O., Yavuz A., Serbetci K., Bilgili H., Hasirci N.
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EN
Incisional hernias and abdominal-wall defects consume large amounts of healthcare resources. Use of mesh is effective in treatment of these disorders and can decrease the rate of recurrence. This experimental study focused on the safety of mesh use in the setting of malnutrition, a condition that impairs wound healing. Rats were divided into two groups: normally fed and food-restricted. An abdominal-wall defect, 2 by 2 cm, was covered with polypropylene mesh, 2.5 by 2.5 cm. After sacrifice of the rats at the 21st and 60th days, tissue samples were sent for tensiometric and histopathological studies. No significant difference in infectious complications was observed between the two groups. Tensiometry revealed no significant differences between the groups. On histopathological examination, the only difference noted was in the vascularization scores of normally fed rats. For malnourished subjects that survived after surgery, the use of polypropylene mesh appeared safe in the closure of abdominal-wall defects, with no increase in infection rate and satisfactory wound healing.
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