Top

Published in:

01-03-2021 | Inguinal Hernia

A prospective randomised control trial to compare the perioperative outcomes and ergonomic challenges between triangular versus midline port placement in total extra-peritoneal repair of uncomplicated unilateral inguinal hernia

Authors: Sapna Singh, Akshay Anand, Awanish Kumar, Ajay K. Pal, Manish K. Agrawal, Sanjeev Kumar, Harvinder S. Pahwa, Abhinav A. Sonkar

Published in: Surgical Endoscopy | Issue 3/2021

Abstract

Background

Routine TEP technique requires three skin incisions for placement of three trocars in the midline. Otherwise, this can be done by three-port triangular technique or two-hand technique. This study reports a randomised trial of perioperative outcomes and ergonomics characteristics of this procedure using two different techniques of port insertion.

Methods

N = 28 patients were randomised into two groups for triangular three-port (TTEP) versus midline three-port TEP (MTEP) hernioplasty after informed written consent in Department of Surgery, King George’s Medical University UP between September 2016 and September 2017 after institutional ethical approval. Patient-related outcomes in terms of quality of life (QOL) and ergonomic evaluation of the technique were compared in double-blinded fashion.

Results

Postoperative pain score at 24 h post surgery (5.1 ± 0.6; 95% CI 4.9–5.3 vs. 4.8 ± 0.4; 95% CI 4.6–4.9) differed, while hospital stay, time to return to routine work, tolerance to oral feeds and intraoperative complications occurrence (OR 2.1; 95% CI 0.2–24.3) were comparable in both groups. Time to return to office work (5.5 ± 0.5; 95% CI 5.4–5.7 vs. 4.0 ± 0.8; 95% CI 3.7–4.3) and immediate postoperative sensation of mesh and pain score were significantly higher in MTEP compared to TTEP. Ergonomic parameters including visualization of landmark score, spreading of mesh score and total surgeon satisfaction score (TTEP 8.4 ± 0.7; 95% CI 8.1–8.6 vs. MTEP 7.0 ± 0.8; 95% CI 6.7–7.3), mental effort quotient (SMEQ score: TTEP 50.6 ± 12.7; 95% CI 45.9–55.3 vs. MTEP 70.8 ± 12.6: 95% CI 66.1–75.4) and physical effort quotient (LEDQ scores in wrist, hand, arm and shoulders) were also superior in triangular technique of port placement.

Conclusion

Triangular three-port TEP hernioplasty is ergonomically feasible and enables a surgeon to perform surgery safely using basic principles of laparoscopy.

Available only for authorised users

Schultz L, Graber J, Pietrafitta J, Hickok D (1990) Laser laparoscopic herniorraphy: a clinical trial preliminary results. J Laparoendosc Surg 1(1):41–45. https://doi.org/10.1089/lps.1990.1.41CrossRefPubMed

Blamey SL, Wale RJ (1991) Laparoscopic repair of inguinal hernia. Med J Aust 155(10):718PubMed

Lichtenstein IL, Shulman AG, Amid PK (1991) Laparoscopic hernioplasty. Arch Surg 126(12):1449. https://doi.org/10.1001/archsurg.1991.01410360019002CrossRefPubMed

Kumar A, Agrahari A, Pahwa HS, Anand A, Singh S, Kushwaha JK, Sonkar AA (2017) A prospective non randomized study of comparison of perioperative and quality of life outcomes of endoscopic versus open inguinal hernia repair: data from a developing country. J Laparoendosc Adv Surg Tech A 27(3):264–267. https://doi.org/10.1089/lap.2016.0491CrossRefPubMed

Cho BJ, Jeong WJ, Lee IK, Lee SC (2016) Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial. Hernia 20(6):789–795. https://doi.org/10.1007/s10029-016-1499-1CrossRef

Rajapandian S, Senthilnathan P, Gupta A, Gupta PD, Praveenraj P, Vaitheeswaran V, Palanivelu C (2010) Laparoscopic totally extraperitoneal repair of inguinal hernia using two-hand approach—a gold standard alternative to open repair. J Indian Med Assoc 108(10):652–654PubMed

Chung SD, Huang CY, Wang SM, Hung SF, Tsai YC, Chueh SC, Yu HJ (2011) Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 25(11):3579–3583. https://doi.org/10.1007/s00464-011-1761-7CrossRefPubMed

Van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP, Broeders IA (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc. 23(6):1365–1371. https://doi.org/10.1007/s00464-008-0184-6CrossRefPubMed

Hasbahceci M, Basak F, Acar A, Alimoglu O (2014) A new proposal for learning curve of TEP inguinal hernia repair: ability to complete operation endoscopically as a first phase of learning curve. Minim Invasive Surg 2014:528517. https://doi.org/10.1155/2014/528517CrossRefPubMedPubMedCentral

10.

Choi YY, Kim Z, Hur KY (2012) Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia. Can J Surg 55(1):33–36. https://doi.org/10.1503/cjs.019610CrossRefPubMedPubMedCentral

11.

Köckerling F, Bittner R, Kuthe A, Hukauf M, Mayer F, Fortelny R, Schug-Pass C (2017) TEP or TAPP for recurrent inguinal hernia repair-register-based comparison of the outcome. Surg Endosc 31(10):3872–3882. https://doi.org/10.1007/s00464-017-5416-1CrossRefPubMedPubMedCentral

12.

Kumar A, Pal AK, Choudhary A, Anand A, Sonkar AA, Pahwa HS (2019) Transfascial suture versus tack fixation of mesh in totally extraperitoneal repair of inguinal hernia: a prospective comparative study. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_192_18CrossRefPubMedPubMedCentral

13.

Koch CA, Greenlee SM, Larson DR, Harrington JR, Farley DR (2006) Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. JSLS 10(4):457–460PubMedPubMedCentral

14.

Reiner MA, Bresnahan ER (2016) Laparoscopic total extraperitoneal hernia repair outcomes. JSLS 20(3):e2016.00043. https://doi.org/10.4293/JSLS.2016.00043CrossRefPubMedPubMedCentral

15.

Zhu X, Liu Z, Shen J, Tang R (2019) Triangle trocar configuration in laparoscopic totally extraperitoneal inguinal hernia repair: a prospective randomized controlled study. J Surg Res 239:149–155. https://doi.org/10.1016/j.jss.2019.01.067CrossRefPubMed

16.

Kushwaha JK, Enny LE, Anand A, Sonkar AA, Kumar A, Pahwa HS (2017) A prospective randomized controlled trial comparing quality of life following endoscopic totally extraperitoneal (TEP) versus open stoppa inguinal hernioplasty. Surg Laparosc Endosc Percutan Tech 27(4):257–261. https://doi.org/10.1097/SLE.0000000000000450CrossRefPubMed

17.

Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206(4):638–644. https://doi.org/10.1016/j.jamcollsurg.2007.11.025CrossRefPubMed

18.

Christoffersen MW, Rosenberg J, Jorgensen LN, Bytzer P, Bisgaard T (2014) Health-related quality of life scores changes significantly within the first three months after hernia mesh repair. World J Surg 38(7):1852–1859. https://doi.org/10.1007/s00268-013-2411-0CrossRefPubMed

19.

Lau H, Patil NG, Yuen WK, Lee F (2002) Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 16(12):1724–1728. https://doi.org/10.1007/s00464-001-8298-0CrossRefPubMed

20.

Schouten N, Simmermacher RK, Van Dalen T, Smakman N, Clevers GJ, Davids PH, Verleisdonk EJ, Burgmans JP (2013) Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc 27(3):789–794. https://doi.org/10.1007/s00464-012-2512-0CrossRefPubMed

21.

Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 25(1):CD004703. https://doi.org/10.1002/14651858.CD004703.pub2CrossRef

Title: A prospective randomised control trial to compare the perioperative outcomes and ergonomic challenges between triangular versus midline port placement in total extra-peritoneal repair of uncomplicated unilateral inguinal hernia
Authors: Sapna Singh
Akshay Anand
Awanish Kumar
Ajay K. Pal
Manish K. Agrawal
Sanjeev Kumar
Harvinder S. Pahwa
Abhinav A. Sonkar
Publication date: 01-03-2021
Publisher: Springer US
Keyword: Inguinal Hernia
Published in: Surgical Endoscopy / Issue 3/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07525-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A prospective randomised control trial to compare the perioperative outcomes and ergonomic challenges between triangular versus midline port placement in total extra-peritoneal repair of uncomplicated unilateral inguinal hernia

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2021

Intragastric satiety-inducing device reduces food intake and suppresses body weight gain in a rodent model

The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia

Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy

Effect of dynamic position changes during colonoscope withdrawal: a meta-analysis of randomized controlled trials

Minimally invasive strategy for type I choledochal cyst in adult: combination of laparoscopy and choledochoscopy

Cost-effectiveness and quality of life analysis of laparoscopic and robotic distal pancreatectomy: a propensity score-matched study