Clinical application of the dissection of the preperitoneal space without electrocoagulation in laparoscopic transperitoneal inguinal hernia repair throughout of the whole process

Abstract

Introduction: The dissection of the preperitoneal space is performed using a monopolar instrument to prevent bleeding in laparoscopic transabdominal preperitoneal hernia repair (TAPP). It may also cause energy injuries and nerve damage.

Aim: To assess the effectiveness and safety of dissection of the preperitoneal space without electrocoagulation (DPSWE) in TAPP throughout the process.

Material and methods: A retrospective analysis of data of 134 patients was made. The electrocoagulation group (EG) relied on monopolar instruments. In the non-electrocoagulation group (NEG) mainly scissors were used without electrocoagulation. The patients were followed for up for 3 months. Intraoperative and postoperative conditions and other complications were observed.

Results: The VAS scores in the NEG were lower than those in the EG (p < 0.05). The operation time in the NEG was shorter than that in the EG (p < 0.05). Hospitalization expenses, scrotal seroma formation, and rupture of hernia sac in the NEG were lower than those in the EG (p < 0.05). The intraoperative bleeding volume above 20 ml in the NEG was higher than that in the EG. There was no significant difference in the incidence of postoperative bleeding, vas deferens injury, intestinal injury, surgical site infection, length of hospital stay, urinary retention and hernia recurrence in the NEG and the EG (p > 0.05). There was no significant difference in the incidence of surgical site infections (SSIs) in the NEG and the EG.

Conclusions: DPSWE is effective and safe. DPSWE may reduce postoperative pain and have no significant increase in postoperative bleeding.

Keywords: inguinal hernia; laparoscopic hernia repair; postoperative complications; scissor dissection; transabdominal preperitoneal.

Photo 1

Certain tension of the tissue was maintained with the left hand to reduce the possibility of bleeding

Photo 2

The separation of Bogros space was achieved through the closed scissors, sometimes using an aspirator or non-damaging forceps for separation

Photo 3

The scissors were slightly opened and striped the hernia sac off the preperitoneal space

Photo 4

The scissors are slightly opened to separate the danger triangle and the pain triangle. The peritoneum was separated by slowly peeling along the surface of the TF with scissors

Photo 5

The separation of the spermatic cord mainly relies on opened scissors to peel off loose connective tissue