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Introduction: Endoscopic repair was introduced for use with inguinal hernia therapy more than 10 years ago. The technique as well as the indications for this method are debated, however. As a borderline inguinal hernia situation, the scrotal hernia in particular evokes vehement objections to an endoscopic procedure because of the anticipated problems and complications in dissecting the extended hernia sac. The efficiency of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of scrotal hernia therefore is discussed in this article. methods: Laparoscopic hernia repair (TAPP) has been performed in our department since 1993. Data are collected by a prospective documentation of operative and follow-up results. For evaluation, a comparison of scrotal and normal hernia repair was performed. Results: Between April 1993 and June 1998 the TAPP technique was used to treat 191 scrotal hernias, 42 (22%) of which were recurrent hernias. The median operating time for a nomal inguinal hernia repair was 45 min, whereas scrotal hernias required a median of 65 min and irreducible scrotral hernias a median of 68.5 min. Major complications were observed in 1.6% of scrotal and 0.6% of normal inguinal hernia repairs. The most frequent scrotal hernia repair problem was the formation of a seroma, 10.5% of which had to be avacuated. During a follow-up period of 30 months, we found a total of two recurrences (1.05%). Conclusion: In scrotal hernia repair, TAPP is not associated with higher complication rates and can be performed with efficiency comparable with that in normal inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background: Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos., Methods: Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data., Results: Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%., Conclusion: This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Seroma/hematoma formation is the most common postoperative complication after laparoscopic inguinal hernia repair. The occurrence of seroma/hematoma remains unclear. The aim of this study was to determine the risk factors for seroma/hematoma formation after transabdominal preperitoneal patch plasty (TAPP)., Methods: The study enrolled 359 groin hernia patients treated by TAPP at Kumamoto Medical Center between 2014 and 2019. The primary outcome was risk factors for postoperative seroma/hematoma formation after TAPP. The secondary outcomes included recurrence of hernia, postoperative complications, and hospital stay., Results: Among the 359 patients, the incidence rate of seroma/hematoma was 16% (n = 69 patients), and the recurrence rate was 0.3% (n = 1 patient, both sides). In total, there were 452 lesions. Japan Hernia Society (JHS) type II was present in 23% (n = 106) of the total cases but was significantly more common in the postoperative seroma/hematoma group (40%; P = 0.0082). Meanwhile, JHS type I-3 comprised 27% of the total JHS type I group but was significantly higher in the postoperative seroma/hematoma JHS type I group (40%; P = 0.016). Compared with JHS type I, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS type II was 2.77 (95% CI 1.54-4.95). Compared with JHS grade 1/2, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS grade 3 was 2.27 (95% CI 1.28-4.03)., Conclusions: Internal inguinal hernia and hernia size ≥ 3 cm were considered risk factors for postoperative seroma/hematoma formation after TAPP., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aim: Minimally invasive inguinal hernia repair has become increasingly accepted, demonstrating superior outcomes over open procedures in postoperative complications. However, certain postoperative complications, such as seroma, remain a dilemma, with many attributing it to the management of the hernia sac. We aimed to perform a systematic review and meta-analysis comparing the reduction versus abandonment of the hernia sac during laparoscopic inguinal hernia repair., Material and Methods: Cochrane, Scopus, SciELO, and PubMed were searched for studies comparing reduction and abandonment of the hernia sac. Our primary outcome was seroma. Secondary outcomes were overall complications, postoperative pain, surgical site infection, recurrence, hospital length of stay (LOS), and operative time. We performed a subgroup analysis of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Statistical analysis was performed with R Studio., Results: 2388 studies were screened, and seven studies were included, comprising 3153 patients, of which 916 (29%) were in the abandonment group. We found higher seroma rates for the abandonment group (RR 1.52; 95% CI 1.22 to 1.89; P < 0.001). No differences were found in overall complications (RR 0.88; 95% CI 0.55 to 1.42; P = 0.61), postoperative pain (RR 1.15; 95% CI 0.46 to 2.87; P = 0.76), recurrence (RR 2.67; 95% CI 0.51 to 14.05; P = 0.25), operative time (MD - 4.45 min; 95% CI - 12.77 to 3.86; P = 0.29), and LOS (MD -0.06 days; 95% CI - 0.14 to 0.02; P = 0.14) between both groups. Subgroup analysis of seroma showed no differences between the groups when analyzing TAPP (19.3% vs. 13%; RR 1.65; 95% CI 0.91 to 2.99; P = 0.1) and TEP (9% vs. 4.3%; RR 1.69; 95% CI 0.62 to 4.6; P = 0.3) procedures., Conclusion: Our systematic review and meta-analysis support that hernia sac abandonment may be associated with increased early seroma rates following laparoscopic inguinal hernia repair, but limited data are available for technique-specific analyses., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice., Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I 2 statistics, with p values inferior to 0.10 and I 2  > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing)., Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I 2  = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I 2  = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I 2  = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates., Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Inguinoscrotal hernias (ISH) pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence rates. The aim of this study is to report our initial experience and early results with a new technique for inguinoscrotal hernia repair., Methods: A review of a prospectively maintained multi-center database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias from March 2021 to July 2022. Demographics and outcomes were analyzed. Univariate analysis and multivariate logistic regression were performed., Results: A total of 76 minimally invasive inguinal hernia repairs were performed. In 70 patients (92%) C-PAS was used as the technique to abandon the sac while in the remaining 6 patients, "pirate-eye-patch" technique was used. Median hernia ring was 3 (IQR 2.5-3.5) cm and median hernia sac was 9.5 (8-10.8) cm. Median operative time was 70 min (IQR 56-96). Seroma was present in 22 (28.9%) patients 7 days after surgery. Most had seroma only in the inguinal area (n = 19; 25%). Thirty days after surgery, 12 (15.8%) patients still had seroma in the inguinal area and 6 (7.9%) in the inguinoscrotal area. Ninety days after surgery, four (5.3%) patients had inguinal seroma, 2 (2.6%) scrotal seromas and 3 (3.9%) inguinoscrotal seromas. The size of the hernia sac was not associated with seroma formation 7 days after surgery (OR 1.06; 95% CI 0.89-1.2; P = 0.461) in the multivariate logistic regression. BMI was also not associated with seroma formation (OR 0.8; 95% CI 0.74-1.06; P = 0.2)., Conclusions: Planned abandon of the hernia sac is an interesting alternative and is associated with a low rate of complications and acceptable seroma formation rates., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240., Methods: We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018., Results: Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13 min (SD ± 15.54; range 30-105 min) for the first third (Q1) vs 54.61 min (SD ± 15.38; range 30-100 min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59 min (SD ± 21.89; range 50-160 min) for Q1 vs 84.48 min (SD ± 20.52; range 30-130 min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time., Conclusion: In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: An articulated laparoscope comprises a rigid shaft with an articulated distal end to change the viewing direction. The articulation provides improved navigation of the operating field in confined spaces. Furthermore, incorporation of an actuation system tends to enhance the control of an articulated laparoscope., Methods: A preliminary prototype of a scope actuation system to maneuver an off-the-shelf articulated laparoscope (EndoCAMaleon by Karl Storz, Germany) was developed. A user study was conducted to evaluate this prototype for the surgical paradigm of video-assisted thoracic surgery. In the study, the subjects maneuvered an articulated scope under two modes of operation: (a) actuated mode where an operating surgeon maneuvers the scope using the developed prototype and (b) manual mode where a surgical assistant directly maneuvers the scope. The actuated mode was further assessed for multiple configurations based on the orientation of the articulated scope at the incision., Results: The data show the actuated mode scored better than the manual mode on all the measured performance parameters including (a) total duration to visualize a marked region, (a) duration for which scope focus shifts outside a predefined visualization region, and (c) number of times for which scope focus shifts outside a predefined visualization region. Among the different configurations tested using the actuated mode, no significant difference was observed., Conclusions: The proposed articulated scope actuation system facilitates better navigation of an operative field as compared to a human assistant. Secondly, irrespective of the orientation in which an articulated scope's shaft is inserted through an incision, the proposed actuation system can navigate and visualize the operative field., (© 2023. The Author(s).)

Background: Incarcerated and strangulated hernias are a common clinical presentation encompassing several challenges in acute care surgery. The role of laparoscopy is still controversial and the data is scarce. Laparoscopy enables better evaluation of the incarcerated organ and its viability. The use of mesh repair in these emergent operations is also a major concern. In this series we aimed to evaluate the safety and efficacy of laparoscopic emergent repairs of acutely incarcerated and strangulated hernias, and their long-term results, in comparison to the conventional open repairs., Methods: Retrospective review of prospectively collected data of all adult patients, between the ages of 18 and 89, who underwent emergent operation due to an incarcerated and strangulated hernia between November 2017 and December 2020., Results: During the study period, 89 patients underwent emergent operation due to incarcerated hernias-63 laparoscopic repair and 26 underwent an open repair. In the laparoscopic group (LG) 38 patients had a groin hernia and 25 had a ventral hernia, while in the open group (OG) the distribution was 12 and 14, respectively. When operated laparoscopically, all groin hernias but one were repaired in the TAPP approach and most ventral hernias were repaired using the IPOM + approach. During the peri-operative period there were 3 mortalities (1 in the LG). There were no significant differences between the groups in minor or major complications. Mean follow-up time in the LG was 27.9 months and 29.4 months in the OG. There was no significant difference in recurrence rates. Long-term results showed better outcome in the LG regarding pain at rest, difficulty doing exercise and local discomfort., Conclusion: Laparoscopic emergent repair of incarcerated hernias is a safe and feasible approach, with better short and long-term results compared to the open approach., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Robotic camera steering systems have been developed to facilitate endoscopic surgery. In this study, a randomized controlled trial was conducted to compare conventional human camera control with the AutoLap™ robotic camera holder in terms of efficiency and user experience when performing routine laparoscopic procedures. Novelty of this system relates to the steering method, which is image based., Methods: Patients undergoing an elective laparoscopic hemicolectomy, sigmoid resection, fundoplication and cholecystectomy between September 2016 and January 2018 were included. Stratified block randomization was used for group allocation. The primary aim of this study was to compare the efficiency of robotic and human camera control, measured with surgical team size and total operating time. Secondary outcome parameters were number of cleaning moments of the laparoscope and the post-study system usability questionnaire., Results: A total of 100 patients were randomized to have robotic (50) versus human (50) camera control. Baseline characteristics did not differ significantly between groups. In the robotic group, 49/50 (98%) of procedures were carried out without human camera control, reducing the surgical team size from four to three individuals. The median total operative time (60.0 versus 53.0 min, robotic vs. control) was not significantly different, p = 0.122. The questionnaire showed a positive user satisfaction and easy control of the robotic camera holder., Conclusion: Image-based robotic camera control can reduce surgical team size and does not result in significant difference in operative time compared to human camera control. Moreover, robotic image-guided camera control was associated with positive user experience., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Trocar site hernia (TSH) is often underestimated after minimally invasive surgery. Scarce information is available about the incidence of TSH in patients undergoing laparoscopic hernioplasty. We aimed to evaluate the incidence and risk factors of umbilical TSH after laparoscopic TAPP hernioplasty in patients with and without an associated umbilical hernia., Methods: A retrospective analysis of a prospectively collected database of all patients who underwent laparoscopic inguinal TAPP repair during 2013-2018 was performed. After TAPP repair, the umbilical fascia was closed either by a figure-of-eight stitch with absorbable suture (G1) or by umbilical hernioplasty if it was present (G2). Multivariate logistic regression analysis was used to determine the TSH risk factors. Comparative evaluation regarding demographics, and operative and postoperative variables was performed., Results: A total of 535 laparoscopic TAPP repairs were included. There were 359 (67.1%) patients in G1 and 176 in G2 (32.9%). Surgical site infection was higher in G2 (G1: 0.6% vs G2: 5.7%, p = 0.001). Overall TSH rate was 3.9% after a mean follow-up of 20 (12-41) months. Performing a concomitant umbilical repair significantly increased the risk of umbilical TSH (G1: 2.2% vs G2: 7.4%, p = 0.004). TSH rates in G2 were similar in patients with simple suture or mesh repairs (p = 0.88). Rectus abdominis diastasis (OR 37.8, 95% CI:8.22-174.0, p < 0.001) and inguinal recurrence (OR 13.5, 95% CI:2.04-89.5, p = 0.007) were independent risk factors for TSH., Conclusion: Although trocar site hernia after laparoscopic TAPP repair has a low incidence, its risk is significantly increased in patients with a concomitant umbilical hernia repair, rectus abdominis diastasis, and/or inguinal recurrence., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Surgical management of an asymptomatic inguinal hernia is controversial but given that most of the patients will develop symptoms, the hernioplasty seems to be a reasonable option. We aimed to compare postoperative outcomes after transabdominal preperitoneal (TAPP) repair between patients with symptomatic bilateral hernia (SBH) and patients with one symptomatic hernia and an asymptomatic contralateral hernia (ACH)., Methods: A consecutive series of patients undergoing bilateral laparoscopic TAPP from July 2014 to June 2018 were included. Symptomatic hernia was defined as a groin bulge associated to pain and altered patient's daily activities. Patients were divided into two groups, those with SBH and those with one symptomatic hernia in whom an ACH was diagnosed by physical examination or ultrasound when clinical assessment was inconclusive. Demographics, operative, and postoperative outcomes were compared. Quality of life (QoL) was assessed before and after surgery in both groups., Results: A total of 305 bilateral TAPP repairs were included; 102 (33, 4%) patients had SBH and 203 (66, 6%) had ACH. There were no significant differences between groups regarding age, gender, body mass index, active smoking, and comorbidities. Operative time (SBH: 125 vs. ACH: 132 min, p = 0.13) and overall 30-day morbidity were similar between groups (SBH: 14, 7% vs. ACH: 13, 8%, p = 0.82). After a mean follow-up of 30 (10-48) months, the recurrence rate was 1, 4% and 2, 2% in SBH and ACH, respectively (p = 0.53). QoL after surgery improved significantly and similarly in both groups., Conclusion: Bilateral laparoscopic TAPP in the setting of an asymptomatic hernia did not increase morbidity and had similar outcomes when compared to patients with bilateral symptoms. A comprehensive preoperative evaluation of the contralateral groin should be routinely performed, mainly by physical examination, and a bilateral repair may be proposed if an asymptomatic contralateral hernia is detected.

Background: Seroma is the most common early minor complication of inguinal hernia repair. Seromas generally resolve spontaneously within a few weeks, but can sometimes cause other complications. The optimal ways to repair inguinal hernia and handle the hernial sac are still debatable. Large scale, prospective, randomized, controlled studies focusing on the correlation between transection of the hernial sac and seroma formation are scarce., Methods: A total of 159 adult male patients with primary indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal repair were recruited. The patients were randomized to undergo either complete dissection or transection of the hernial sacs. Patients were followed up at postoperative 7 days, 1 and 3 months, looking specifically for seroma. Seroma was diagnosed via physical examination, and a prestructured form was used to evaluate patient recovery and define the type of seroma present at each follow-up visit., Results: There were 83 patients in the completely dissected group and 76 in the transected group. The overall incidence of postoperative seroma was 12.6% (n = 20). The χ 2 test demonstrated that significantly more patients developed seroma in the transected group than in the completely dissected group (18.4% vs. 7.2%, p = 0.034); there were also significant differences between the two groups in the incidences of seroma at postoperative 7 days (18.4% vs. 6.0%, p = 0.016) and 1 month (14.5% vs. 4.8%, p = 0.037). Seroma formation was correlated with age, body mass index, use of anticoagulants, hernia type, hernia size, sac size, and operative time. There were no significant differences between the two groups in the degree of postoperative pain and time taken for the resumption of outdoor activities., Conclusions: When using the laparoscopic transabdominal preperitoneal technique for indirect inguinal hernia repair, the risk of postoperative seroma formation is greater after transection compared with complete dissection of the hernial sac.

Background: Previous observational studies have demonstrated the safety of discharging patients after laparoscopic appendectomy within the same day without hospitalization. The application of Enhanced Recovery After Surgery (ERAS) guidelines has resulted in shorter length of stay, fewer complications, and reduction in medical costs. The aim of this study was to investigate if ERAS protocol implementation in patients with acute uncomplicated appendicitis decreases the length of stay enough to allow for ambulatory laparoscopic appendectomy., Methods: In this prospective, randomized controlled clinical trial, 108 patients were randomized into two groups: laparoscopic appendectomy with ERAS (LA-E) or laparoscopic appendectomy with conventional care (LA-C). The primary endpoint was postoperative length of stay. The secondary end points were time to resume diet, postoperative pain, postoperative complications, re-admission rate, and reoperation rate., Results: From January 2016 through May 2017, 50 patients in the LA-E group and 58 in the LA-C were analyzed. There were no significant differences in preoperative data. Regarding the primary end point of the study, the ERAS protocol significantly reduced the postoperative length of stay with a mean of 9.7 h (SD: 3.1) versus 23.2 h (SD: 6.8) in the conventional group (p < 0.001). The ERAS protocol allowed ambulatory management in 90% of the patients included in this group. There was a significant reduction in time to resume diet (110 vs. 360 min, p < 0.001) and less moderate-severe postoperative pain (28 vs. 62.1%, p < 0.001) in the LA-E versus LA-C group. The rate of complications, readmissions, and reoperations were comparable in both groups (p = 0.772)., Conclusions: ERAS implementation was associated with a significantly shorter length of stay, allowing for the ambulatory management of this group of patients. Ambulatory laparoscopic appendectomy is safe and feasible with similar rates of morbidity and readmissions compared with conventional care.

Background: Day-case surgery (DCS) has become increasingly popular over recent years, as has laparoscopic liver resection (LLR) for the treatment of benign or malignant liver tumours. The purpose of this prospective study was to demonstrate the feasibility of minor LLR as DCS., Methods: Prospective, intention-to-treat, non-randomised study of patients undergoing minor LLR between July 2015 and December 2017. Exclusion criteria were resection by laparotomy, major LLR, difficult locations for minor LLR, history of major abdominal surgery, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child > A and/or portal hypertension, significant medical history and exclusion criteria for DCS. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were the reason for exclusion, complication data, criteria for DCS evaluation, satisfaction and compliance with the protocol., Results: One hundred sixty-seven patients underwent liver resection during the study period. LLR was performed in 92 patients (55%), as DCS in 23 patients (25%). Reasons for minor LLR were liver metastasis (n = 9), hepatic adenoma (n = 5), hepatocellular carcinoma (n = 4), ciliated hepatic foregut cyst (n = 2) and other benign tumours (n = 3). All day-case minor LLR, except two patients, consisted of single wedge resection, while one patient underwent left lateral sectionectomy. There were four unplanned overnight admissions (17.4%), one unscheduled consultation (4.3%), two hospital readmissions (8.6%) and no major complications/mortality. Compliance with the protocol was 69.5%. Satisfaction rate was 91%., Conclusion: In selected patients, day-case minor LLR is feasible with acceptable complication and readmission rates. Day-case minor LLR can therefore be legitimately proposed in selected patients.

Background: There is a scarcity of data on long-term results after laparoscopic hernia repair. Herein we report on the outcome of a group of patients who were followed up for 5 years in a multicenter study on hernia repair.Methods: A total of 100 patients with 127 hernias were randomized to undergo either transabdominal preperitoneal (TAPP) or Shouldice hernia repair. Follow-up was by clinical examination and standardized questionnaire.Results: Of the 100 patients who underwent surgery, 84 were available for follow-up at 5 years. The TAPP procedure was less painful than the Shouldice repair, with fewer patients receiving narcotic analgesics. The median time to return to 100% activity was shorter in the laparoscopic group (21 days) than in the Shouldice group (40 days). Up to 60 months after the operation, the complication rate was lower in laparoscopically repaired hernias (19/66) than in the open group (25/61). There were two recurrences (3.9%) in the TAPP group and five in the Shouldice group (10.2%).Conclusion: The TAPP hernia repair yields comparable or better results than Shouldice herniorrhaphy in terms of postoperative pain, recovery, and recurrence rate. [ABSTRACT FROM AUTHOR]

Background: In the era of open surgery, emergency open cholecystectomy has been shown for many reasons to be preferred to delayed surgery for acute cholecystitis. Despite the fact that elective laparoscopic cholecystectomy (LC) has become the gold standard for the treatment of symptomatic gallstone disease, the same procedure remains controversial for the management of acute cholecystitis because it is considered to be associated with more complications and an increased risk of common bile duct injuries than interval LC after resolution of the acute episode. The purpose of this report is to describe our experience with LC for acute cholecystitis during a 10-year period. Methods: Patients undergoing laparoscopic surgery have been entered prospectively into a database since 1995. Those who underwent surgery before 1995 were added retrospectively to the same database. Patients were included in this study if they underwent emergency laparoscopic cholecystectomy for suspected acute cholecystitis. The diagnosis was based on clinical, laboratory, and echographic examinations. Analysis was performed to identify risk factors associated with conversion or morbidity. Results: Of the 1,212 patients subjected to LC between 1990 and 1999, 268 (151 women and 117 men), with a mean age of 53 years, underwent surgery on an emergency basis for suspected acute cholecystitis. Their mean age (p = 0.002) and the proportion of men (p <0.001) were higher than in the elective group. delay before admission and surgery varied widely, but 72% of the patients underwent surgery within 48 h of admission. an intraoperative cholangiography, attempted in 218 patients, was successful in 207 (95%). histologic examination confirmed acute cholecystitis in 82% of the patients. conversion was necessary in 15.6% of the cases. it occurred more frequently in patients who underwent surgery later than 48 (p = 0.03) or 96 h (p = 0.006) after admission. no other predictor of conversion was found. overall morbidity was 15.3%, and major morbidity was 4.4%. the only risk factor for morbidity was a bilirubin level greater than 20 mmol/l (p = 0.02). three partial lesions of the common bile duct occurred. all were recognised and repaired immediately with no adverse effect. there was no difference in the overall rate of biliary complications between the patients operated for acute cholecystitis and those who underwent elective surgery. no reoperation was necessary, and there was no mortality. conclusions: although lc is safe and effective for acute cholecystitis, its associated morbidity and conversion rate are higher than for elective lc. the conversion rate decreases with experience. when surgery is performed within 2 or maximally 4 days of admission, in experienced hands, lc represents the treatment of choice for acute cholecystitis. intraoperative cholangiography should be performed in every case because it helps to clarify the anatomy and allows for early diagnosis and repair of bile duct injuries. [ABSTRACT FROM AUTHOR]

Background: Although there have been case reports describing trocar site herniation after laparoscopic fundoplication, its overall prevalence and the risk factors for its development are unclear. Methods: The records of 320 patients undergoing primary laparoscopic fundoplication as treatment for gastroesophageal reflex disease (GERD) or hiatal hernia between 1991 and 1999 were reviewed retrospectively. Placement of the initial supraumbilical trocar was by the open Hassan technique in all patients. Results: Nine patients (five male) with a mean age 54 years (range, 37-75) developed trocar site herniation, for an overall prevalence of 3%. The mean interval between surgery and diagnosis was 12 months (range, 4-21). In all patients, the hernia occurred at the supraumbilical camera port site. Patients with trocar hernias tended to have a higher body mass index (BMI) than those without hernias (mean BMI, 29.4 kg/m2 vs 27.2 kg/m2, p = 0.13). None of the patients developed intestinal obstruction as a consequence of herniation. To date, all but one of the hernias have been repaired. Six of them required the insertion of a prosthetic mesh. Conclusions: The prevalence of trocar site herniation after laparoscopic fundoplication was minimal at 3%. All hernias occurred at the midline supraumbilical port, the only site where open trocar insertion was employed. As a consequence of these observations, we have developed a new method of open trocar placement. This method utilizes a paramedian skin incision and separate fascial incisions through anterior and posterior rectus sheathes, with retraction of the rectus abdominis muscle laterally. [ABSTRACT FROM AUTHOR]

Background: We designed a study to determine the rate of intra- and postoperative complications as well as the rate of recurrences in elective operated femoral hernias treated via the laparoscopic technique. Methods: Between 1993 and 1998, we performed 1,097 operations in our department using the laparoscopic transabdominal preperitoneal (TAPP) technique. Femoral hernias amounted to only 4.6% (51 cases) of these patients. The male/female ratio was 1:2. The data concerning the operations and pre- and postoperative treatment were recorded prospectively. The patients were followed up at 2 weeks and 1 year after the operation. Results: We encountered one intraoperative bladder lesion, one subcutaneous port site infection, two postoperative hematomas that required reoperation, and two nerve irritation syndromes, which disappeared spontaneously after 6 months. Two patients developed an ileus; one required laparoscopic reintervention, and the other was treated with conventional open reoperation and intestinal resection. There were no recurrences. Conclusions: The application of the laparoscopic approach to the treatment of femoral hernias using the TAPP technique in nonemergency situations is highly effective. To date, we have seen no recurrences. Although the rate of major complications is low, current surgical techniques need to be perfected to avoid the type of complication recognized in this study. [ABSTRACT FROM AUTHOR]

The application of laparoscopic techniques in digestive surgery to areas in which there was no previous experience has favored the appearance of new complications and clinical situations that were not observed during the open era. Initial opinion considered that stones left in the abdominal cavity were harmless, and a few clinical and experimental studies supported this opinion. But cumulative reports of cases suggest a potential danger. From 1991 to date, 49 cases of complications related to stones left in the abdominal cavity have been reported with severe complications that required an open surgical procedure. Stone spillage has not always been considered an indication of conversion of laparoscopic cholecystectomy but is now accepted as a source of infrequent but severe complications that may require a reintervention for treatment. Therefore it is recommended that efforts should be made to retrieve all spilled stones; the surgical procedure should be prolonged until this is achieved, in order to reduce one source of unpredictable morbidity. Open retrieval should be considered in selected cases if a large number or large stones are lost. [ABSTRACT FROM AUTHOR]

Background: The problem of recurrence after laparoscopic hernia repair is relatively new, and the best way to handle it remains uncertain. The question of whether an open approach, a laparoscopic approach, or some combination of techniques should be preferred has not yet been resolved. The purpose of this study was to determine if the laparoscopic approach could deal with the problem safely and successfully.Methods: A retrospective review was done of the cases performed at the Center for Hernia Repair by one surgeon between July 1991 and September 1999. Laparoscopic hernioplasties for hernias that had previously been repaired laparoscopically were analyzed. All remedial repairs were begun using a transabdominal approach.Results: Seventeen of 1960 hernias repaired were for failed laparoscopic repairs. Ten were repaired totally laparoscopically and two via an open approach with mesh, while five required a small anterior counterincision. There were no serious complications and one recurrence.Conclusion: The laparoscopic transabdominal approach to failed laparoscopic repairs is feasible, safe, and reliable when used in combination with a modified anterior approach when appropriate. [ABSTRACT FROM AUTHOR]

Background: We performed a prospective study to evaluate the safety and efficacy of laparoscopic hernia repair in our hospital. Methods: A total of 2500 consecutive laparoscopic transabdominal hernia repairs (TAPP) were performed in 1952 patients. Their average age was 59 years. We used a mesh. 12 × 15cm. Results: The average operating time was 32 mins. We had a recurrence rate of 1.04%. There were 89 complications (3.56%). Three were bladder injuries, one of which necessitated conversion to an open laparotomy. Three of 38 hematomas required open exploration. Three patients were reoperated because of nerve irritation. An incarcerated trocar hernia occurred in six cases. There was one wound infection at the umbilical incision. There were no infections or incompatibility reactions at the mesh. The complication rate declined over time. At the same time, the rate of recurrence decreased as we acquired more experience in laparoscopic hernia repair. Conclusion: Laparoscopic hernia repair can be performed safely, with low rates of recurrences and few complications are low. This technique achieves good results combined with the benefits of minimal invasive procedures. [ABSTRACT FROM AUTHOR]

Background: The use of a mesh in transabdominal preperitoneal laparoscopic hernia repair (TAPP) caries the risk of late rejection or infectious complications related to the mesh. The aim of this study was to describe the extent of these complications.Methods: We performed a retrospective study of 500 consecutive patients with TAPP for inguinal hernia.Results: Late mesh rejection was observed in three patients at 5-19 months after surgery. The mesh was removed via a suprapubic midline incision. At 3-4 month's follow-up, none of the patients had recurrence of the hernia, even though no hernia repair had been done.Conclusion: Late mesh rejection is a potential complication of TAPP and has to be considered when choosing the surgical method of hernia repair. [ABSTRACT FROM AUTHOR]