TAPP or TEP? Population-Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair

Background: Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP. Methods: Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation. Results: Data on 4,552 patients undergoing TEP (n=3,457) and TAPP (n=1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9% vs. TAPP 0.9%, p=0.029) and surgical postoperative complications (TEP: 2.3% vs. TAPP: 0.8%, p=0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3days, p=0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0min, p<0.001) and the conversion rate was higher (TEP 1.0% vs. TAPP 0.2%, p=0.011). Conclusions: This study is one of the first population-based analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repai

Photodynamic inactivation of planktonic and biofilm growing bacteria mediated by a meso-substituted porphyrin bearing four basic amino groups

Biofilm-associated diseases account for 80% of all infections in humans. Due to the emergence of antibiotic resistances, alternative therapies such as Photodynamic Inactivation (PDI) of microorganisms have emerged. Porphyrins with intrinsic positive charges have been proposed as successful photosensitizers (PSs) against microorganisms. We have recently designed the new synthetic porphyrin 5,10,15,20-tetrakis[4-(3-N,N-dimethylammoniumpropoxy)phenyl]porphyrin (TAPP) containing four basic amine groups in the periphery of the tetrapyrrolic macrocycle, which can acquire positive charges at physiological pH, thus favouring the interaction with biomembranes. Illumination of planktonic cultures of Staphylococcus aureus at 180 J/cm2 in the presence of 2.5 μM TAPP induced complete bacteria eradication. For the TAPP-PDI treatment of S. aureus biofilms, higher light fluences and PS concentrations were needed. Employing 20 μM TAPP and 180 J/cm2, around 3-log CFU reduction were obtained. In order to determine the efficacy of TAPP-PDI on Gram-negative bacteria, we performed planktonic and biofilm assays employing Pseudomonas aeruginosa. Much higher TAPP doses as compared to S. aureus were needed to achieve planktonic bacteria photosensitization (3-log CFU reduction at 20 μM TAPP and 180 J/cm2). On the other hand, high concentrations of TAPP were nontoxic to P. aeruginosa growing on biofilms, and employing 30 μM TAPP and 180 J/cm2 we obtained 3-log CFU reduction. The main conclusion of the present work is that TAPP is a promising and efficient PS capable of promoting photodynamic killing of both Gram-negative and -positive in planktonic bacteria, though more effectively in the latter. In addition, TAPP-PDI induces similar photoinactivation rates in both bacteria types growing on biofilms, with lower dark toxicity in the Gram-negative one.Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicada

Principals\u27 Perceptions of Teacher Academy for Preparation and Pedagogy Teachers (Tapp) And Traditionally Certified Teachers

Georgia\u27s alternative certification program, Teacher Academy for Preparation and Pedagogy (TAPP), is producing approximately 20% of the teacher pool in Georgia although minimal research exists about the performance of TAPP teachers in Georgia classrooms compared to traditionally certified teachers. Principals that employ TAPP teachers and traditionally certified teachers are responsible for performance evaluations and; therefore, they are a valid source for providing comparisons between the two types of teacher preparation. In an effort to gain a better understanding of principals\u27 perceptions of TAPP teachers and traditionally certified teachers, the researcher used a previously validated formal survey constructed by Dr. Michael Nusbaum in 2002. The survey was sent electronically to 40 principals in an east Georgia RESA district that currently employ a first year TAPP teacher. The survey focused on three constructs of teaching: content knowledge, classroom management and instructional planning. A random group of principals from the RESA district were also interviewed to obtain further understanding of the survey results. The researcher\u27s findings confirmed that principals\u27 perceive TAPP teachers\u27 content knowledge to be equal to traditionally certified teachers. However, principals\u27 reported that traditionally certified teachers are more adept at classroom management than TAPP teachers. Principals also perceived that TAPP teachers initially struggle with instructional planning, but eventually learn the skill by collaborating with experienced teachers

Quality of life of patients after inguinal hernia repair

Introduction. Endoscopic procedures for inguinal hernia repair have become widespread. There are many methods of such treatment: transinguinal preperitoneal mesh-plasty (TIPP), TAPP, TEP, MINI (combination of TEP and TAPP). However, the most common among them are TAPP and TEP. Despite the fact that these procedures are now common in many hospitals, the choice of tactics and repair procedures for different types of inguinal hernias is still uncertain. First, it concerns the quality of life of patients. Aim. The aim of this study was to compare TAPP, TEP and Lichtenstein based on quality of life analysis using the EuraHS-QoL scale. Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. Lichtenstein's procedure was performed in 65 patients (Lichtenstein group), transabdominal preperitoneal (TAPP) inguinal hernia repair in 81 patients (TAPP group) and totally extraperitoneal (TEP) inguinal hernia repair in 65 patients (TEP group). We assessed quality of life using a special scale for hernias (EuraHS-QoL). The missing values were treated according to the instructions of the validation study. Results and discussion. As we expected, inguinal hernia repair improved EuraHS-QoL scores in all groups. In the Lichtenstein group, the total mean decreased from 51.2 to 11.8 (4.3 times) (r=-0.13), in the TAPP group – from 51.1 to 9.9 (5.2 times), in the TEP group – from 51.2 to 12.6 (4.1 times). Cosmetic discomfort was highest at the follow-up visit in patients in the Lichtenstein group (4.2). In the TAPP group, this indicator was probably (p&lt;0.05) the smallest (3.0). Low-traumatic methods of operations in modern surgery are priorities today. The Lichtenstein procedure, despite its simplicity, is a traumatic operation compared to TAPP and TEP. Conclusions. Different options for inguinal hernia repair, which are based on the tension-free principle of inguinal canal correction, can be useful. However, when we analyzed the quality of life according to the EuraHS-QoL scale, we decided that transabdominal preperitoneal (TAPP) inguinal hernia repair is the most optimal in terms of various indicators

Transabdominal pre-peritoneal mesh in inguinal hernia repair in elderly: end point of our experience

BACKGROUND: Aim of this study is to present our standardized laparoscopic transabdominal preperitoneal hernia repair (TAPP) technique, and to study our experience in the elderly as far as concerns preoperative and postoperative variables. METHODS: We described our standardized TAPP technique according with Stuttgart technique [1], and we evalutated our team's experience in TAPP inguinal hernia repair in elderly (> 65 yrs) and in young patients (< 65 yrs). RESULTS: We retrospectively reviewed our Surgery Division's experience about TAPP; we included in our study 185 patients. The sample was subdivided in two groups: TAPP Group (< 65 years patients) and TAPPe Group (> 65 years patients). TAPP Group was composed by 154 patients and TAPPe Group of 31 patients. According with literature, in this subgroup recurrence rate (3,2%), early and delayed complications and mean operative time (86 min). There were no major vascular or intestinal complications. At the moment follow-up is 31 months. There were no incisional hernias on umbilical trocar. Mean satisfaction rate was excellent also in elderly patients. CONCLUSIONS: According with literature, in our experience TAPP technique is a safe and feasible procedure, even in elderly patients