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Feasibility of right-sided total extraperitoneal procedure for inguinal hernia repair after appendectomy: a prospective cohort study.

Elshof JW, Keus F, Burgmans JP, Clevers GJ, Davids PH, van Dalen T - Surg Endosc (2008)

Bottom Line: The conversion rate was significantly higher in group 2: four patients (10%) were converted to open Lichtenstein repair versus five (1%) in group 1 (p = 0.005).However, we found no significant differences in complication rate, operative time, and return to daily activities.A right-sided (or bilateral) TEP procedure may be performed safely in patients after previous appendectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582, KE, Utrecht, The Netherlands. jelshof@diakhuis.nl

ABSTRACT

Background: Totally extraperitoneal (TEP) endoscopic hernia surgery is increasingly popular since it is associated with little postoperative pain and with early return to work. Previous appendectomy may preclude preperitoneal dissection in patients with right-sided hernias. The feasibility of TEP surgery in these patients was the subject of the present study.

Methods: Between January 2005 and February 2007 all consecutive patients undergoing TEP surgery were included in a prospective cohort study. The study group consisted of patients with right-sided and bilateral hernias. Operative times, conversions, complication rates, and return to daily activities were recorded. Patients were divided into two groups according to previous appendectomy.

Results: A total of 462 patients with right-sided hernias underwent TEP surgery: 421 patients without previous abdominal surgery (group 1) and 41 patients with previous appendectomy (group 2). The conversion rate was significantly higher in group 2: four patients (10%) were converted to open Lichtenstein repair versus five (1%) in group 1 (p = 0.005). However, we found no significant differences in complication rate, operative time, and return to daily activities.

Conclusions: A right-sided (or bilateral) TEP procedure may be performed safely in patients after previous appendectomy. Despite a higher conversion rate, the vast majority of patients can be operated endoscopically.

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Related in: MedlinePlus

Flow chart of patient inclusion
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Fig1: Flow chart of patient inclusion

Mentions: The main advantages of endoscopic inguinal hernia repair are less postoperative pain and quicker convalescence when compared with conventional open hernia repair. Both transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are technically demanding operative procedures necessitating adequate “surgical volume” to ensure recurrence rates comparable to the Lichtenstein procedure (Fig. 1) [1–4].Fig. 1


Feasibility of right-sided total extraperitoneal procedure for inguinal hernia repair after appendectomy: a prospective cohort study.

Elshof JW, Keus F, Burgmans JP, Clevers GJ, Davids PH, van Dalen T - Surg Endosc (2008)

Flow chart of patient inclusion
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710495&req=5

Fig1: Flow chart of patient inclusion
Mentions: The main advantages of endoscopic inguinal hernia repair are less postoperative pain and quicker convalescence when compared with conventional open hernia repair. Both transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are technically demanding operative procedures necessitating adequate “surgical volume” to ensure recurrence rates comparable to the Lichtenstein procedure (Fig. 1) [1–4].Fig. 1

Bottom Line: The conversion rate was significantly higher in group 2: four patients (10%) were converted to open Lichtenstein repair versus five (1%) in group 1 (p = 0.005).However, we found no significant differences in complication rate, operative time, and return to daily activities.A right-sided (or bilateral) TEP procedure may be performed safely in patients after previous appendectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582, KE, Utrecht, The Netherlands. jelshof@diakhuis.nl

ABSTRACT

Background: Totally extraperitoneal (TEP) endoscopic hernia surgery is increasingly popular since it is associated with little postoperative pain and with early return to work. Previous appendectomy may preclude preperitoneal dissection in patients with right-sided hernias. The feasibility of TEP surgery in these patients was the subject of the present study.

Methods: Between January 2005 and February 2007 all consecutive patients undergoing TEP surgery were included in a prospective cohort study. The study group consisted of patients with right-sided and bilateral hernias. Operative times, conversions, complication rates, and return to daily activities were recorded. Patients were divided into two groups according to previous appendectomy.

Results: A total of 462 patients with right-sided hernias underwent TEP surgery: 421 patients without previous abdominal surgery (group 1) and 41 patients with previous appendectomy (group 2). The conversion rate was significantly higher in group 2: four patients (10%) were converted to open Lichtenstein repair versus five (1%) in group 1 (p = 0.005). However, we found no significant differences in complication rate, operative time, and return to daily activities.

Conclusions: A right-sided (or bilateral) TEP procedure may be performed safely in patients after previous appendectomy. Despite a higher conversion rate, the vast majority of patients can be operated endoscopically.

Show MeSH
Related in: MedlinePlus