title: Needlescopic totally extraperitoneal hernioplasty for unilateral inguinal hernia in adult patients.
abstract: OBJECTIVE
  Totally extraperitoneal (TEP) inguinal hernioplasty for inguinal hernia is associated with less postoperative pain, shorter hospital stays, less chronic pain, and increased patient satisfaction when compared with the open Lichtenstein approach‥ However, only few studies to date have compared conventional with needlescopic TEP hernioplasty for treating unilateral inguinal hernias in adult patients. We report our prospective study that compared the postoperative outcomes of these two approaches over a 2-year period.
  
  
  METHODS
  From July 2007 to June 2009, a total of 32 patients underwent attempted unilateral needlescopic TEP hernioplasty. All data were prospectively collected and analysed, including demographic features, types of hernia, and postoperative outcome. The results were compared with those of an agematched cohort of 32 patients who underwent conventional TEP hernioplasty in the same period.
  
  
  RESULTS
  Needlescopic TEP hernioplasty was successfully performed in 24 patients. The other eight procedures were completed with conventional TEP approaches after changing one or two 5-mm ports. The most common hernia type was Nyhus type III (38/64, 59.3%). There was no significant difference in the mean operative time, hospital stay, and postoperative pain scores between the needlescopic and conventional approaches. There was no major complication detected on the first visit, except seroma formation (9 patients in the needlescopic group and 11 in the conventional group), all of which was resolved with conservative management. No recurrence of hernia was noted in either group during the mean follow-up period of 88.0 weeks.
  
  
  CONCLUSIONS
  Needlescopic TEP hernioplasty was a feasible technique in selected patients for inguinal hernia repair. Postoperative recovery following both approaches was similar. However, because this was a small cohort study, larger prospective, randomized controlled trials are required to establish the longterm benefit, safety and complications of needlescopic surgery.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR.
authors.forename: Wong-Hoi
authors.initials: WH
authors.lastname: She
authors.forename: Oswens Siu-Hung
authors.initials: OS
authors.lastname: Lo
authors.forename: Joe King-Man
authors.initials: JK
authors.lastname: Fan
authors.forename: Jensen Tung-Chung
authors.initials: JT
authors.lastname: Poon
authors.forename: Wai-Lun
authors.initials: WL
authors.lastname: Law
mesh_terms: D000328:Adult; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006723:Hong Kong; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D013996:Time and Motion Studies