Laparoendoscopic Single-Site Inguinal Herniorrhaphy: Experience of a Single Institute

Abstract

Background: Minimally invasive techniques for inguinal herniorrhaphy have focused on developing the laparoendoscopic single-site (LESS) procedure to improve cosmesis. Outcomes of total extraperitoneal (TEP) herniorrhaphy vary considerably because of being performed by different surgeons. We aimed to evaluate the perioperative characteristics and outcomes of patients undergoing the LESS-TEP approach for inguinal herniorrhaphy and to determine its overall safety and effectiveness. Methods: Data of 233 patients who underwent 288 laparoendoscopic single-site total extraperitoneal approach (LESS-TEP) herniorrhaphies at Kaohsiung Chang Gung Memorial Hospital between January 2014 and July 2021 were reviewed retrospectively. We reviewed the experiences and results of LESS-TEP herniorrhaphy performed by a single surgeon (CHC) using homemade glove access and standard laparoscopic instruments with a 50 cm long 30° telescope. Results: Among 233 patients, 178 patients had unilateral hernias and 55 patients had bilateral hernias. About 32% (n = 57) of patients in the unilateral group and 29% (n = 16) of patients in the bilateral group were obese (body mass index ≥ 25). The mean operative time was 66 min for the unilateral group and 100 min for the bilateral group. Postoperative complications occurred in 27 (11%) cases, which were minor morbidities except for one mesh infection. Three (1.2%) cases were converted to open surgery. Comparison of the variables between obese and non-obese patients found no significant differences in operative times or postoperative complications. Conclusion: LESS-TEP herniorrhaphy is a safe and feasible operation with excellent cosmetic results and a low rate of complication, even in obese patients. Further large-scale prospective controlled studies and long-term analyses are needed to confirm these results.

Keywords: inguinal hernia; laparoendoscopic single-site surgery (LESS); total extraperitoneal approach (TEP).

Figure 1

The size of the inguinal sac. The superficial inguinal ring (SIR) was defined as a boundary. The inguinal sac beyond the SIR or into the scrotum was the infra-SIR type, while the hernia sac above the SIR was the supra-SIR type.

Figure 2

The homemade glove access and the wound retractor. (a) The homemade glove access was obtained using an 11 mm trocar and two 5 mm trocars; (b) The homemade glove access and the wound retractor (LAGIS^® WR-60ES) (before being attached).

Figure 3

The peritoneal tear was repaired during the operation. (a) A 2 cm peritoneal tear; (b,c) Hem-o-lok was used to close the tear.

Figure 4

The wound condition during outpatient department follow-up.