ReviewTotally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: A meta-analysis of outcomes of our current knowledge
Introduction
Inguinal hernia repair is one of the most common surgical operations in general surgery. Since Lichtenstein1 described his tension-free hernioplasty in 1989, tension-free hernia repair was quickly accepted by most surgeons as the effective and safe method of hernia repair for its lower recurrence rate, less postoperative pain and easy to learn, various surgical methods were described and invented from that time on. In tension-free hernioplasty, a prosthesic mesh can be placed subaponeurotically or extraperitoneally, either through an open approach or laparoscopically.2 With improved understanding of the groin anatomical structure, especially the Fruchauds myopectineal orifice, reinforcing the extraperitoneal space and completely covering the orifice seem to be the most effective and reasonable method for hernia repair currently.3
Many open techniques that combined the benefit of tension-free with the advantages of the extraperitoneal approach have been in use for decades. For instances, Stoppa4 developed his technique through a lower midline incision putting a giant prosthesis in the extraperitoneal space with good results. The Kugel and Modified Kugel methods both place the polypropylene mesh in the extraperitoneal space the posterior and anterior approaches respectively.5 In addition, the transinguinal preperitoneal technique (TIPP) and the Prolene hernia system (PHS) both are commonly used technique that proved to be successful.6
Laparoscopic repairs combine the advantages of minimal access surgery with the open extraperitoneal approach. The transabdominal preperitoneal repair (TAPP) and the totally extraperitoneal repair(TEP) are the two most frequently-used methods. More surgeons prefer the latter for its not entering into the peritoneum.7 Many researches have shown that laparoscopic hernia repair may offer less postoperative pain and early return to normal activities compared with open method. However, its potential intraoperative complications, need for general anesthesia and long learning curve have restricted its use to some extent.8
To date, clinical comparisons between TEP and open extraperitoneal herniorrhaphy are not very abundant. There is no meta-analysis directly comparing the outcomes of laparoscopic extraperitoneal herniorrhaphy and open extraperitoneal mesh repair. In the present article, different types of open extraperitoneal repairs with prosthetic meshes are combined as they all achieve similar clinical goals.6
Section snippets
Literature search
All randomized controlled trials and prospective case control studies that compared TEP and the open extraperitoneal procedures for the repair of groin hernias were identified intensively in the electronic databases Pubmed, Embase, Web of Science, Medline, and the Cochrane Library from January 1992 to March 2013. The search strategies used the following major medical terms: “inguinal hernia”, “extraperitoneal”, “laparoscopic”, “OPM”, “Stoppa”, “Kugel”, “PHS”, and “repair/hernioplasty”. The
Results
The flowchart of literature selecting is presented in Fig. 1. Eventually, the meta-analysis included two well-designed comparative studies and 10 randomized controlled trials containing a total of 1157 patients (1377 hernias) older than 18 years of age.3, 4, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 The 2 comparative studies20, 21 had a large sample size, enough information and comparable baseline characteristics. Though one of them21 was written in French, the abstract and useful needed contents
Discussion
There is still an ongoing debate on the first line treatment for inguinal hernia. So far, there is no consensus about the best method for surgical repair.26 Currently, the reinforcement of the Fruchauds myopectineal orifice in the extraperitoneal space seems to be the most logical and effective method of herniorraphy. The meshes are all placed in the extraperitoneal space and completely cover the Fruchauds orifice either through an open approach or a laparoscopic way. The open extraperitoneal
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2018, Current Problems in SurgeryCitation Excerpt :Both transabdominal totally extraperitoneal (TAPP) or TEP laparoscopic techniques have been used to address inguinal hernias beginning in the 1990s.137,138 Although patients have benefited from diminished pain and faster recovery compared to the open approach,139,140 22.5% of patients still develop chronic pain after laparoscopic inguinal hernia repair.141 Pain may be neurogenic secondary to nerve impingement or non-neurogenic from periosteal injury, both caused by the fixation device.
Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences
2018, International Journal of SurgeryCitation Excerpt :Mean AMSTAR score of these papers was 6.9. Values were extracted from the 13 highest scoring studies [51–56,58–60,63–65,67,69]. Table 8 shows the characteristics of selected studies.
Totally extraperitoneal laparoscopic inguinal hernia repair using a self-expanding nitinol framed hernia repair device: A prospective case series
2017, International Journal of SurgeryCitation Excerpt :After three months, 2 (3.7%) patients experienced mild pain (VAS ≤ 2) and none of the patients reported pain after six months. Other advantages of the TEP procedure compared to open extraperitoneal mesh repair are shorter hospital stay and quicker return to normal activities or work [7]. In our study, the majority of the patients left the hospital on the day of surgery.