Transection of the hernia sac during laparoscopic totally extraperitoneal inguinal hernioplasty: is it safe and feasible?
BACKGROUND
Complete reduction of an indirect inguinal hernia sac during laparoscopic totally extraperitoneal (TEP) repair is not always possible when the sac extends to the scrotum or adheres to adjacent tissues. Laparoscopic TEP repair would be much easier to perform in such cases by transecting the hernia sac. Therefore, the purpose of this study was to determine the safety and efficacy of transection of the hernia sac during laparoscopic TEP.


METHODS
Five hundred twenty laparoscopic TEP repairs were performed on 498 patients by a single surgeon from July 2003 to December 2008. The patients were classified into two groups: the transected sac (TS) group with 269 patients (275 cases) and the completely reduced sac (RS) group with 230 patients (245 cases).


RESULTS
Statistical analysis between the TS and RS groups showed no significant differences in postoperative pain, length of hospital stay, and recurrence, except for postoperative seromas, which were more frequent in the TS group (24 of 275) than the RS group (6 of 245; P = .002). And the mean operative time was longer in the TS group (23.62 ± 10.25 minutes) than the RS group (21.49 ± 8.17 minutes; P = .010).


CONCLUSIONS
Although transection of the hernia sac during laparoscopic TEP repair may cause seromas, our study demonstrated that transection of the hernia sac did not cause significant postoperative complications, including recurrence. Transection of the hernia sac is an alternative technique for laparoscopic TEP repair in cases with difficult hernia sac reduction.
Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.
Yoon Young
YY
Choi
Zisun
Z
Kim
Kyung Yul
KY
Hur
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult