Laparoscopic hernia: umbilical-pubis length versus technical difficulty.
Laparoscopic hernia repair is more difficult than open hernia repair. The totally extraperitoneal procedure with 3 trocars on the midline is more comfortable for the surgeon. We studied the impact of the length between the umbilicus and the pubis on the totally extraperitoneal procedure (95 hernias operated on in 70 patients). This length did not influence the totally extraperitoneal procedure in this study.


BACKGROUND
The laparoscopic repair of hernias is considered to be difficult especially for the totally extra-peritoneal technique (TEP) due to a limited working space and different appreciation of the usual anatomical landmarks seen through an anterior approach. The aim of our study has been to answer a question: does the umbilical-pubic distance, which influences the size of the mesh, affect the TEP technique used in the treatment of inguinal hernias?


METHODS
From January 2001 to May 2011, the umbilical-pubic (UP) distance was measured with a sterile ruler graduated in centimeters in all patients who underwent a symptomatic inguinal hernia by the TEP technique in two hernia surgery centers. The sex, age, BMI, hernia type, UP distance, operation time, hospital stay and complications were prospectively examined based on the medical records.


RESULTS
Seventy patients underwent 95 inguinal hernia repairs by the TEP technique. The umbilical-pubic distance average was 14 cm (10 to 22) and a 25 kg/m2 (16-30) average concerning the body mass index (BMI). Seventy percent of patients were treated on an outpatient basis. The postoperative course was very simple. There was no recurrence of hernia within this early postoperative period.


CONCLUSIONS
The umbilical-pubic distance had no influence on the production of TEP with 3 trocars on the midline in this study.
Department of Surgery, Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil.
Alberto
A
Meyer
Clinique Chirurgicale Mutualiste de Saint Etienne, Saint Etienne, France.
Pierre
P
Blanc
Department of Digestive Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
Radwan
R
Kassir
Service de Chirurgie Générale & Digestive, CHICAS, Gap, France.
Jérôme
J
Atger
D000293:Adolescent; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011630:Pubic Bone / Q000033:anatomy & histology*; D012008:Recurrence; D014472:Umbilicus / Q000033:anatomy & histology*; D014945:Wound Healing; D055815:Young Adult
Herniorrhaphy; Inguinal hernia; Laparoscopy