Laparoscopic transabdominal preperitoneal hernia repair. Early experience of 37 patients

Introduction: Inguinal hernia repair is one of the most frequently performed procedures in surgery and many different techniques have been suggested. This report reviews our experience with 39 transabdominal preperitoneal (TAPP) hernia repairs in 37 patients. Methods: Thirty-seven patients have been admitted for inguinal hernia repair in Benghazi Medical Center and in Aljala hospital, Benghazi-Libya. Laparoscopic TAPP repair was considered for all reducible inguinal hernias aged (18–70 years). Data was prospectively collected from January 2009 to December 2013,including age, sex, BMI, hernia characteristics, complications, mean operative time and mean hospital stay. Patients with irreducible, obstructed or scrotal hernias, previous lower abdominal surgery, BMI more than thirty fiveand an American Society of Anesthesiologists (ASA) grade higher than II were excluded. Results: There were 34 males and 3 females, with a mean age of 33.4 ± 13.0 years and BMI of 24.6 ± 1.9. Mean operative time was 75 ± 18.6 minutes .The mean hospital stay was one day ± 0.27. There was no conversion, mesh infection, bladder or vascular injury, death or recurrence after a median follow up for six months. Four minor complications occurred with two seroma formation, one wound bruising and one chronic groin pain due to tackers treated conservatively. Median return to normal activities was 10 days. One fourth of patients required no postoperative analgesia. Conclusion: Laparoscopic inguinal hernia repair was found in our study to be feasible, safe, with less postoperative pain, shorter hospital stay, and early return to normal activities

Laparoscopic transabdominal preperitoneal hernia repair. Early experience of 37 patients

Introduction: Inguinal hernia repair is one of the most frequently performed procedures in surgery and many different techniques have been suggested. This report reviews our experience with 39 transabdominal preperitoneal (TAPP) hernia repairs in 37 patients. Methods: Thirty-seven patients have been admitted for inguinal hernia repair in Benghazi Medical Center and in Aljala hospital, Benghazi-Libya. Laparoscopic TAPP repair was considered for all reducible inguinal hernias aged (18–70 years). Data was prospectively collected from January 2009 to December 2013,including age, sex, BMI, hernia characteristics, complications, mean operative time and mean hospital stay. Patients with irreducible, obstructed or scrotal hernias, previous lower abdominal surgery, BMI more than thirty fiveand an American Society of Anesthesiologists (ASA) grade higher than II were excluded. Results: There were 34 males and 3 females, with a mean age of 33.4 ± 13.0 years and BMI of 24.6± 1.9. Mean operative time was 75 ±18.6 minutes .The mean hospital stay was one day ± 0.27. There was no conversion, mesh infection, bladder or vascular injury, death or recurrence after a median follow up for six months. Four minor complications occurred with two seroma formation, one wound bruising and one chronic groin pain due to tackers treated conservatively. Median return to normal activities was 10 days. One fourth of patients required no postoperative analgesia. Conclusion: Laparoscopic inguinal hernia repair was found in our study to be feasible, safe, with less postoperative pain, shorter hospital stay, and early return to normal activities

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies