Laparoscopic transabdominal preperitoneal hernia repair (TAPP): stapling the mesh is not mandatory.
BACKGROUND
This report reviews our experience with 104 transabdominal preperitoneal (TAPP) hernia repairs, using a selective staple-free technique, over the period April 2003 to July 2007 (50 months).


METHODS
Ninety-one patients underwent TAPP repair (13 bilateral). Eighty-one were males and 10 females. Mean age was 61 years. There have been 58 right inguinal hernias and 46 left. We had 47 indirect, 42 direct, 6 pantaloon, 4 supravesicular, 3 inguinal-scrotal, 2 sliding, and 1 femoral hernia. Twenty-three of the hernias we repaired were recurrences. We used a modified staple-free technique with the placement of a 15 x 10 cm polypropylene mesh in the preperitoneal space with sutured peritoneal closure. The mesh was stapled selectively only in very large defects (nine repairs; 9%). We used nondisposable instruments and trocars.


RESULTS
We had no conversions. Mean operative time was 47 min/repair with a mean hospitalization of 1.2 nights. We had 1 recurrence (mean follow-up, 34 months). Postoperative complications were: preperitoneal hematoma 1, urinary retention 1, and inguinal seromas/hematomas 11. Mean return to normal activities was 7 days.


CONCLUSIONS
TAPP repair is a technically demanding laparoscopic technique, but once mastered, is safe and effective with a high degree of patient satisfaction. Stapling the mesh is not necessary in most cases, thus resulting in a remarkably low cost. The rapid rehabilitation typically associated with laparoscopic surgery was seen in all our patients. The low recurrence rate (1% in our series) compares favorably to other tension-free techniques.
Kapiris
Stylianos
S
Third Surgical Department and Laparoscopic Unit, "Evangelismos" Hospital, Athens, Greece. stkapiris@hotmail.com
Mavromatis
Theodoros
T
Andrikopoulos
Spyridon
S
Georgiades
Christakis
C
Floros
Demetrios
D
Diamantopoulos
Georgios
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000706:statistics & numerical data*; D016896:Treatment Outcome