Liming Wang*, Taku Maejima, Shoji Kasai and Shingo Kitagawa
Department of Surgery, Sin Sapporo Houwakai Hospital, JapanFulltext PDF
Background: Laparoscopic Transabdominal Preperitoneal Patch (TAPP) technique is a clinically accepted method for inguinal hernia repair that is clearly advantageous in repairing Bilateral Inguinal Hernias (BIH). Shorter operative time, less postoperative pain, and earlier return to work are achieved via TAPP, albeit at higher cost. Although guidelines of the International Endohernia Society (IEHS) strongly support TAPP in managing BIH, subsequent reoperation rates exceed those of open hernia repair. Expansive mesh patching is a controversial means of reducing hernia recurrence, prompting us to examine long-term outcomes of this approach using large one-piece mesh cutouts shaped as butterfly wings for repair of BIH. Materials and Methods: In this single-center retrospective review, we assessed all 12 patients undergoing TAPP repair of BIH by the same surgeon between January 2013 and February 2016. One-piece polypropylene mesh cut by scissors in the shape of out spread butterfly wings served to cover both lesions at once. Results: Among the 50 consecutive patients undergoing TAPP procedures during the study period, there were 12 BIH repairs involving butterfly-wing mesh. Four of the latter (33.3%) were identified preoperatively, and 8 (66.7%) were intraoperative discoveries. In the other 38 patients, Unilateral Inguinal Hernia (UIH) repairs took place. The follow-up period ranged from 47-67 months (median, 56 months). Members of BIH group were comparatively older (75.2 ± 0.85 vs. 62.1 ± 0.99; p<0.05), and operative time was longer (99.2 ± 18.2 vs. 80.2 ± 7.3 min; p<0.05). Mesh patches in UIH and BIH groups averaged 15 cm × 10 cm and 28 cm × 12 cm, respectively. Only one recurrence was recorded in the UIH group. There were no significant differences in duration of non-steroidal antiinflammatory drug use, chronic pain, reoperation rate, or postoperative days until discharge. Conclusion: TAPP repair of BIH is feasible, easy, and safe (even in older patients) using large, onepiece mesh cutouts shaped as butterfly wings.
Wang L, Maejima T, Kasai S, Kitagawa S. Laparoscopic Transabdominal Preperitoneal Patch Technique Using Large Butterfly-Wing Mesh Cutouts for One-Piece Bilateral Inguinal Hernia Repairs. Clin Surg. 2019; 4: 2646..