Mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal bilateral inguinal hernia repair without mesh fixation

IF 3.5 3区医学 Q1 SURGERY

Asian Journal of Surgery Pub Date : 2025-04-01 DOI:10.1016/j.asjsur.2024.12.127

Abdullah Hilmi Yilmaz , Mehmet Esref Ulutas , Saim Turkoglu

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引用次数: 0

Abstract

Purpose

International guidelines recommend laparoscopic surgical repair for bilateral inguinal hernia. One of the laparoscopic procedures with rapid recovery, less chronic pain and less chance of infection is enhanced totally extraperitoneal (eTEP).

The eTEP technique is useful in bilateral hernias, large inguinal-scrotal hernias, incarcerated hernias, obese patients and patients with a short distance between the umbilicus and pubic tubercle. However, eTEP inherently involves extensive extraperitoneal dissection. Both bilateral hernia repair and the use of the eTEP technique reveal that the extraperitoneal space is even larger. This can be considered as a factor for mesh displacement. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in bilateral laparoscopic inguinal hernia repair.

Methods

Form January 2023 to June 2023, 40 consecutive patients with bilateral inguinal hernia were randomized into two groups; eTEP group (n = 20) and TEP group (n = 20) without mesh fixation.

Study was registered at http://Clinicaltrials.gov (NCT06070207). The meshes were marked with three radiopague clips. Pelvic radiographs was performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP technique in terms of mesh displacement without fixation in laparoscopic bilateral inguinal hernia.

Results

There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, operation time, length of hospital stay, accidental pneumoperitoneum, hematoma, seroma formation and surgical site infection.

Conclusion

There was no more mesh displacement in the eTEP group in which more extraperitoneal space was created. Both bilaterality and without mesh fixation did not cause any difference in mesh displacement in both groups. Despite both bilaterality and larger extraperitoneal space dissection, the absence of mesh fixation in the bilateral eTEP technique is safe. Mesh displacement in laparoscopic bilateral inguinal hernia repair is minimal and similar in the TEP and eTEP technique.

Trial registration clinicaltrials number

NCT06070207.

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增强视角完全腹膜外与完全腹膜外双侧腹股沟疝修补术中的网片移位（无网片固定术

目的国际指南建议采用腹腔镜手术修补双侧腹股沟疝。eTEP技术适用于双侧腹股沟疝、巨大腹股沟-阴囊疝、嵌顿疝、肥胖患者以及脐部与耻骨结节之间距离较短的患者。不过，eTEP 本身涉及广泛的腹膜外剥离。双侧疝修补术和 eTEP 技术的使用都显示腹膜外空间更大。这可能是导致网片移位的一个因素。方法2023年1月至2023年6月，40名连续的双侧腹股沟疝患者被随机分为两组：eTEP组（n = 20）和无网片固定的TEP组（n = 20）。该研究已在http://Clinicaltrials.gov（NCT06070207）上注册。网片用三个放射线夹标记。骨盆X光片用于评估网片的移位情况。这项研究的主要结果是网片移位。结果两组在网片移位、复发、术后 VAS 评分、手术时间、住院时间、意外腹腔积气、血肿、血清肿形成和手术部位感染等方面均无显著差异。两侧固定和无网片固定对两组的网片移位均无影响。尽管两侧腹腔镜手术和腹膜外间隙剥离都较大，但在双侧eTEP技术中不使用网片固定是安全的。腹腔镜双侧腹股沟疝修补术中的网片移位很小，TEP和eTEP技术的网片移位情况相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Journal of Surgery 医学-外科

CiteScore

3.60

自引率

31.40%

发文量

1589

审稿时长

33 days

期刊介绍： Asian Journal of Surgery, launched in 1978, is the official peer-reviewed open access journal of the Asian Surgical Association, the Taiwan Robotic Surgery Association, and the Taiwan Society of Coloproctology. The Journal is published monthly by Elsevier and is indexed in SCIE, Medline, ScienceDirect, Scopus, Embase, Current Contents, PubMed, Current Abstracts, BioEngineering Abstracts, SIIC Data Bases, CAB Abstracts, and CAB Health. ASJSUR has a growing reputation as an important medium for the dissemination of cutting-edge developments in surgery and its related disciplines in the Asia-Pacific region and beyond. Studies on state-of-the-art surgical innovations across the entire spectrum of clinical and experimental surgery are particularly welcome. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance.