Retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic totally extraperitoneal repair for groin hernias: 10 years of experience.

Abstract

Objectives: The aim of this study was to investigate the feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space in laparoscopic total extraperitoneal repair (TEP) for groin hernias.

Methods: A retrospective analysis of the clinical data of 1388 patients who underwent TEP surgery for a groin hernia at the General Hospital of Northern Theater Command of the Chinese People's Liberation Army (hereinafter referred to as the General Hospital of Northern Theater Command) from August 2013 to August 2023 was conducted. The feasibility and safety of retrograde puncture for trocar placement for the establishment of the preperitoneal space were examined.

Results: All 1388 operations were successful, with no conversion to open surgery. The mean time for unilateral placement of the Trocars was 6.36 ± 2.32 min. The mean time for unilateral hernia surgery was 42.73 ± 10.33 min, and the mean time for bilateral hernia surgery was 73.11 ± 20.31 min. Peritoneal injuries were observed in 8 patients (0.58%), but there were no abdominal organ injuries. Two patients (0.14%) had inferior epigastric vascular injuries, and 16 patients (1.15%) experienced muscle hemorrhage during retrograde puncture. Twenty-five patients (1.80%) had postoperative local hematomas of the abdominal wall, and 37 patients (2.67%) had subcutaneous emphysema. Sixty-four patients (4.61%) experienced seroma retention, and 13 patients (0.94%) experienced urinary retention. The postoperative follow-up period ranged from 3 to 124 months, with a median follow-up time of 66 months. None of the patients experienced recurrence, persistent pain, localized foreign body sensation, mesh infection, or incision infection.

Conclusions: The retrograde puncture method for placing trocars to establish the preperitoneal space in laparoscopic TEP surgery for groin hernias is feasible and safe.