General Surgery Department, Faculty of Medicine, Zagazig University, Egypt and National Hospital, Riyadh, Saudi Arabia.
Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.
A. Lasheen, A. Tolba, H. Mohamed, H. Mohammed and N. Smaeil, "Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2," Surgical Science, Vol. 4 No. 12, 2013, pp. 554-557. doi: 10.4236/ss.2013.412107.
[1] L. J. Grunwaldt, S. D. Schwaitzberg, D. W. Rattner and D. B. Jones, “Is Laparoscopic Inguinal Hernia Repair an Operation of the Past?” Journal of the American College of Surgeons, Vol. 200, No. 4, 2005, pp. 616-620. http://dx.doi.org/10.1016/j.jamcollsurg.2004.10.033
[2] R. Bittner, C. G. Schmedt, J. Schwarz, K. Kraft and B. J. Leibl, “Laparoscopic Transperitoneal Procedure for Routine Repair of Groin Hernia,” British Journal of Surgery, Vol. 89, No. 8, 2002, pp. 1062-1066. http://dx.doi.org/10.1046/j.1365-2168.2002.02178.x
[3] S. Bringman, S. Ramel, T. J. Heikkinen, T. Englud, B. Westman and B. Anderberg, “Tension-Free Inguinal Hernia Repair: TEP versus Mesh-Plug versus Lichtenstien: A Prospective Randomized Controlled Trial,” Annals of Surgery, Vol. 237, No. 1, 2003, pp. 142-147. http://dx.doi.org/10.1097/ 00000658-200301000-00020
[4] E. A. O’Reilly, J. P. Burke and P. R. O’Connell, “A Meta-Analysis of Surgical Morbidity and Recurrence after Laparoscopic and Open Repair of Primary Unilateral Inguinal Hernia,” Annals of Surgery, Vol. 255, No. 5, 2012, pp. 846-853. http://dx.doi.org/10.1097/SLA.0b013e31824e96cf
[5] E. J. Schoenmaeckers, E. B. Wassenaar, J. T. Raymakers and S. Rakic, “Bulging of the Mesh after Laparoscopic Repair of Ventral and Incisional Hernias,” Journal of the Society of Laparoendscopic Surgeons, Vol. 14, No. 4, 2012, pp. 541-546. http://dx.doi.org/10.4293/108680810X129244660 08240
[6] S. Yakan, A. Coskun, A. Senlikci, M. A. Ustuner, M. Yildirim and N. Erkan, “Mesh Migration into the Lumen of the Small Bowel. A Late Complication of Incisional Hernia Repair,” Surgical Chronicles, Vol. 2, 2013, pp. 102-103.
[7] M. S. Kavic, “Laparoscopic Hernia Repair,” Surgical Endoscopy, Vol. 9, No. 1, 1995, pp. 12-15. http://dx.doi.org/10.1007/BF00187877
[8] N. Kosai, P. A. Sutton, J. Evans and J. Varghese, “Laparoscopic Preperitoneal Mesh Repair Using a Novel Self-Adhesive Mesh,” Journal of Minimal Access Surgery, Vol. 7, No. 3, 2011, pp. 192-194.
[9] R. Fitzgibbons, J. Camps, D. Comet, N. Nguyen, B. Litke, R. Annibali and G. Salerno, “Laparoscopic Inguinal Herniorrhaphy Results of a Multicenter Trial,” Annals of Surgery, Vol. 221, No. 1, 1995, pp. 3-113. http://dx.doi.org/10.1097/00000658-199501000-00002
[10] J. Payne, “Complications of Laparoscopic Inguinal Herniorrhaphy,” Seminars in Laparoscopic Surgery, Vol. 4, 1997, pp. 166-181.
[11] P. Miguel, M. Reusch, A. daRosa and J. Carlos, “Laparoscopic Hernia Repair-Complications,” Journal of the Society of Laparoendscopic Surgeons, Vol. 2, No. 1, 1998, pp. 35-40.
[12] R. Annibali and R. J. Fitzgibbons, “Surgical Anatomy of the Inguinal Region and Lower Abdominal Wall: The Laparoscopic Perspective,” 80th Annual Clinical Congress, American College of Surgeons, Chicago, 1994, pp. 72-85.
[13] A. Hakeem and V. Shanmugam, “Effectiveness of Multiple Neurectomies to Prevent Chronic Groin Pain after Tension-Free Hernia Repair,” International Surgery, Vol. 96, No. 2, 2011, pp. 162-163. http://dx.doi.org/10.9738/1359.1