Transabdominal pre-peritoneal repair procedure (TAPP) versus open hernia repair (OHR) in the treatment of inguinal hernia

Inguinal hernia is a common condition, with about 30% of men and 6% of women developing this condition throughout their lifetime. Laparoscopic hernia repair procedures have become more and more important lately, due to the advantages of a fast recovery and reduced postoperative pain. The paper presents our clinical experience involving the TAPP repair procedure, compared to open hernia repair (OHR). We retrospectively compared our first 50 cases comprising patients who underwent the TAPP hernia repair procedure between January 2018 and June 2020, with 50 cases who underwent the OHR procedure in the same period. The total operation duration was 102.5 minutes in the TAPP group and 78.4 minutes in the OHR group. The average hospital stay in the TAPP group was 1.5 days with six patients requiring reinterventions for postoperative bleeding and who were discharged seven to nine days later. There is still no consensus regarding the use of tacks and/or the surgical glue, the surgeon\u27s experience and the intraoperative findings representing a cornerstone in choosing the best repair method for each case. Laparoscopic hernia repair has some advantages over the open technique, but it can be followed by complications that can further raise parameters

When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy

The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms ”difficult cholecystectomy”, ”bile duct injuries”, ”safe cholecystectomy”, and ”laparoscopy in acute cholecystitis”. The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies