title: Feasibility of a new approach for creating a preperitoneal space in transabdominal preperitoneal repair inguinal hernia repair: using a sandwich approach.
abstract: OBJECTIVE
  In Japan, transabdominal preperitoneal (TAPP) inguinal hernia repair is performed by firmly pulling the peritoneum inwards to lift it from the underlying deep layer of subperitoneal fascia. It decreases the postoperative pain and discomfort in the inguinal area. The aim of this study was to evaluate the feasibility of the sandwich approach, which is a new technique for creating a preperitoneal space.
  
  
  METHODS
  The operation was performed via the sandwich approach. We made sure to protect the preperitoneal fascia areolar layer when making the preperitoneal space.
  
  
  RESULTS
  We performed TAPP in 745 patients (876 hernias) treated between October 2006 and April 2015 at Himeji Medical Center and Kurashiki Central Hospital. Before October 2010, we did not use the sandwich approach, and recurrence was observed in three patients. From October 2010, we always used the sandwich approach and never experienced any cases of recurrence. Clavien-Dindo classification Grade 3 or higher postoperative complications occurred in 6 patients (0.8%) between October 2006 and April 2015. Mesh-related ileus was the most frequently observed morbidity. There were no cases of vas differentia or spermatic vessel injury, postoperative chronic pain, or urinary retention.
  
  
  CONCLUSIONS
  The sandwich approach is feasible as another standard dissective procedure for TAPP.
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan. nagahisa440@yahoo.co.jp.
authors: Yoshio
authors: Y
authors: Nagahisa
authors: Himeji Medical Center, Honmachi 64, Himeji City, Hyogo, 670-8520, Japan.
authors: Shusaku
authors: S
authors: Homma
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Kai
authors: K
authors: Chen
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Reo
authors: R
authors: Sakurai
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Nobuaki
authors: N
authors: Hattori
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Yusuke
authors: Y
authors: Kawamoto
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Kazuki
authors: K
authors: Hashida
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Michio
authors: M
authors: Okabe
authors: Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan.
authors: Tadashi
authors: T
authors: Itou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D010537:Peritoneum / Q000601:surgery*; D016896:Treatment Outcome
keywords: Inguinal hernia; Preperitoneal repair; Sandwich approach; TAPP