Totally Extraperitoneal Endoscopic Inguinal Hernia Repair Using Mini Instruments: Pushing the Boundaries of Minimally Invasive Hernia Surgery

Background: Inguinal hernia is the most prevalent surgical disease in clinical practice. Endoscopic inguinal hernia repair has been shown to be slightly superior to open approaches. Recent modifications in the minilaparoscopic technique may improve the totally extraperitoneal repair (TEP) results. Objectives: We have performed a prospective study to analyze the feasibility of laparoscopic inguinal hernia repair using mini instruments. Main measured outcomes included postoperative pain, return to work activities and aesthetics. Technical aspects, including operative time and intraoperative and postoperative complications were also analyzed. Patients and Methods: From October, 2009 to May, 2011 consecutive patients undergoing TEP inguinal hernia repair using miniinstruments were included in the study protocol. Exclusion criteria was the same as for standard laparoscopic hernia repair. In all cases, a standardized laparoscopic technique using mini instruments was performed. A study protocol was applied prospectively for data collection, including operative time, hospital stay, need for pain medication, return to work and, patient’s aesthetic evaluation of the scars. Results were expressed in Mean ± SD. Results: Sixty consecutive patients diagnosed with inguinal hernia underwent TEP inguinal hernia repair using mini instruments. Of these, 53 were men and seven were women. The mean age was 50 ± 32 years. In eight cases, the hernias were recurrent and ten were bilateral. A total of 70 hernias were treated. The average operative time was ± 35 min. The mean hospital stay was 18 ± 6 hours. Analgesia was necessary for more than 2 days in 8 patients (13.3 %). There was one conversion to open surgery. Sixteen of the male workers (37 %) had to take 1 week off work. In total, 58 (96 %) of the patients considered the aesthetic outcome to be excellent. Patients were followed for 30 days. No recurrences were noted in this period. Conclusions: Totally extraperitoneal endoscopic inguinal hernia repair using mini instruments is feasible, and applicable to routine surgical practice with good short-term clinical and aesthetic results. Further comparative studies with standard laparoscopic extraperitoneal and open hernia repair are needed to access its long term results.