Users Online : 107 About us |  Subscribe |  e-Alerts  | Feedback | Login   
Journal of Minimal Access Surgery Current Issue | Archives | Ahead Of Print Journal of Minimal Access Surgery
           Print this page Email this page   Small font sizeDefault font sizeIncrease font size 
  Search
 
  
 ¤   Similar in PUBMED
 ¤  Search Pubmed for
 ¤  Search in Google Scholar for
 ¤Related articles
 ¤   Article in PDF (248 KB)
 ¤   Citation Manager
 ¤   Access Statistics
 ¤   Reader Comments
 ¤   Email Alert *
 ¤   Add to My List *
* Registration required (free)  


 ¤  Abstract
 ¤ Introduction
 ¤  Materials and me...
 ¤ Results
 ¤ Discussion
 ¤ Conclusion
 ¤  References
 ¤  Article Tables

 Article Access Statistics
    Viewed2748    
    Printed38    
    Emailed3    
    PDF Downloaded186    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents     
ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 2  |  Page : 123-128
 

Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial


1 Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Port-Said, Egypt
2 Department of Surgery, Suez Canal University, Ismailia, Egypt

Date of Submission16-Oct-2013
Date of Acceptance24-Oct-2013
Date of Web Publication24-Mar-2015

Correspondence Address:
Aly Saber
19 Al-Guish Street, Port-Fouad, Port-Said
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.153809

Clinical trial registration ACTRN12613001050741

Rights and Permissions

 ¤ Abstract 

Introduction: The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence. Materials and Methods: A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections. Results: The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B. Conclusion: In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence.
Trial Registration ACTRN12613001050741


Keywords: Open preperitoneal, recurrent hernia, TAPP, transinguinal approach


How to cite this article:
Saber A, Hokkam EN, Ellabban GM. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial. J Min Access Surg 2015;11:123-8

How to cite this URL:
Saber A, Hokkam EN, Ellabban GM. Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial. J Min Access Surg [serial online] 2015 [cited 2019 May 23];11:123-8. Available from: http://www.journalofmas.com/text.asp?2015/11/2/123/153809



 ¤ Introduction Top


Inguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence and there is little available evidence on the optimal management of recurrent inguinal hernia. [1] The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy and therefore failure rate of these repairs using an open anterior approach may reach as high as 36%. [2],[3] In 1988, Nyhus stated that the evolution of the posterior preperitoneal approach for recurrent inguinal hernia repair made it the procedure of choice for the management of all recurrent groin hernias. [4] In previous published data, the author reported that posterior preperitoneal approach gives results far superior to those of the commonly used anterior approach. [1]

The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with the well-known advantages of a minimally invasive approach. [5] A recent study stated that for the treatment of recurrent inguinal hernias, the first choice should be given to the laparoscopic method, especially for young, physically active, non-obese patients. [6] Some researchers advised that greater efforts should be undertaken to make laparoscopic repair easier, safer, and less expensive. [7] The present work aimed at comparing three approaches in repair of recurrent inguinal hernia: anterior inguinal approach, open properitoneal repair and transabdominal pro-peritoneal repair regarding complications and early recurrence.


 ¤ Materials and methods Top


Materials

Patients in this study were divided randomly into three main groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach, those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. All of our patients were gentlemen with total number was 180 patients; 60 for each group, their ages ranged between 42 and 65 years. The study started from January 2007 to April 2011 and included all patients having unilateral recurrent inguinal scrotal and irreducible hernias. Patients with primary inguinal hernia, patients with marked obesity (BMI >35) and ASA grade 3 and beyond were excluded.

Sample Size and Randomization

Calculation of the sample size included the number of participants to be recruited for the study using the mathematical equation. The authors used two equations to calculate the minimum number required to reliably answer the research question. Randomization was performed prior to the study using a computer-generated table of random numbers for group assignment. [1]

Surgical Teams and Study Sites

Operations were performed in Port-Fouad general hospital, Port-Fouad, Port-Said, Egypt and in the university hospital, department of surgery, Faculty of medicine, Suez Canal University, Egypt.

Operative Techniques

  1. The open preperitoneal approach to the inguinal region was performed under general or regional anesthesia, as originally described by Nyhus. [4] Through a lower abdominal transverse incision, the anterior rectus sheath was incised and the rectus muscle reflected medially. The preperitoneal space was cleaved with blunt dissection, exposing the myopectineal orifice. The cord was explored and the hernias were reduced. A 15 ×15 cm 2 polypropylene mesh with a slit was inserted in the preperitoneal space and fixed with non-absorbable sutures to pubic tubercle and Cooper's ligament. The mesh was passed behind the cord and manipulated to lay flat against the posterior inguinal floor overlapping the entire myopectineal orifice. [1]
  2. The anterior tension-free repair, as defined by Lichtenstein et al., was performed using 6 × 11 cm 2 polypropylene mesh. Large pore-sized (1.6 mm), monofilament heavy-weight polypropylene meshes were used (Prolene® ; Ethicon, Egypt). Really our patients were oriented to the type of repair and the other observers were unaware to operative techniques of the study groups. [1]
  3. The laparoscopic transabdominal preperitoneal repair (TAPP):


The hernia defect was inspected. The properitoneal space was dissected from lateral to medial at the level of the retroinguinal (Bogros') space, with parietalization of the spermatic cord posteriorly and outwards. The dissection was continued medially toward the retropubic space, extending behind the symphysis pubis and iliopubic tract, exposing the pectineal ligament. The peritoneum forming the hernia sac was pulled in, separating it from the cord structures. A 15 × 10 cm 2 sheet of polypropylene mesh was placed so as to cover the Hesselbach's triangle, the indirect space, and the femoral ring areas. The mesh was fixed using an endoscopic multifire hernia stapler (Ethicon, Johnson and Johnson), beginning at the pubic tubercle and proceeding laterally. The peritoneum is tightly closed using 3/0 running vicryl suture. The trocars are removed under direct vision, and the peritoneum is deflated. The fascia at the two 10/12 mm port site is closed using 2-0 Prolene sutures. [5]

End Points

The primary end point of the study was the recurrence of the hernia, defined as a clinically detectable characteristic swelling in the groin and diagnosed by two authors. The secondary end points were time off from work, defined as the number of days between the day of surgery and the first day a patient returned to work, postoperative pain, scrotal swelling, and wound infections. Regarding the postoperative pain, we considered the Visual Analog Scale pain score, prosthesis awareness and return to normal physical activity. Chronic pain was defined as pain lasting more than 3 months and was studied in relation to age, body mass index and operative procedure. [1]

Here we used the already adopted simplified scoring system by Saber et al., [1] for the method of pain assessment. This system is a 3-scale system; with maximum score as 7 points and minimum as 2 points.

  1. Analog Scale pain score (1-10): Mild (1-4) = 1 point, moderate (5-7) = 2 points, severe (8-10) = 3 points.
  2. Prosthesis awareness: Yes = 1 point, no = 0 point.
  3. Physical activity: Pain only on exertion = 1 pain limits some daily activity = 2, disabling pain = 3.


Ethical Consideration

Written consents were obtained from all patients before the study. The steps of operative interferences were explained to all patients. The local ethics committee had approved all operative procedures. Ethical approval for this study was granted by the ethical review committee under supervision of the general director of Port- Fouad general hospital, Port-Fouad, Port-Said, Egypt.

Statistical Analysis

The statistical tests were run on a compatible personal computer using the Statistical Package for Social Scientists (SPSS) for windows 15. Chi-square distribution was used for studying the frequencies of recurrence, pain, hospital stay, and postoperative complications. The values were expressed as means ± standard errors of deviation. The mean values of the groups were compared by one-way analysis of variance (ANOVA) and paired comparisons of the groups were done using the paired student t-test. P < 0.05 was considered significant.


 ¤ Results Top


There was no statistical difference between the three groups regarding patients' age and body mass index [Table 1].
Table 1: Showing subdivision of the three groups regarding age and body mass index

Click here to view


Age ranged between 42 and 65 years with a mean age as 53.5 years. Follow-up assessment was at the 1st week after discharge then at 1st month and through regular visit of 6 months duration or by a telephone call thereafter. Follow up included patients' complaint, if any, clinical examination and ultrasonography if needed. The maximum follow-up period was 60 months and the minimum was 22 months with a mean value as 41 ± 26.87 months. A complete follow-up was obtained in 56/60 (93.3%) of patients in group A, 54/60 (90%) of patients in group B, and 58/60 (96.2%) in group C.

The mean operative time in group A was 71.6 min ± 25.47 (40-120). In group B, the mean value was 94.7 min ± 28.5 (60-150). In group C, the operative time was calculated just after the induction of anesthesia and including the time required for the setup of the laparoscopy. The mean operative time in group c was 122.5 min ± 31 (80-170). [P = 0.6]. The mean hospital stay was 1- 3 days (2.1 ± 0.8) in group A, 2-6 days (3.7 ± 1.5) in group B and 1-2 days (1.3 ± 0.5) in group C. In the other hand, the mean time to return work was 8.2 ± 1.15 (7-10) days in group A while in group B was 11.2 ± 2.3 (7-15) and in group C was 7.6 ±1.4 (6-9) days. Therefore, the mean time off from work in group A was 10.3 ± 1.95 days and in group B was 14.9 ± 3.8 while in group C was 8.9 ± 1.9 [P < 0.05].

Chronic postoperative pain was observed in 8 patients in group A (13.33%) , in 18 patients in group B (30%), and 6 patients in group C (10%). [Table 2] shows the detailed descriptions of pain in the three groups as well as the final pain score per patient [P < 0.003]. The authors found that 6/8 patients in group A were in the age group <50 years and the other two were >50 year while regarding the body mass index, all 8 patients were <30. In group B, 12/18 patients were in the age group <50 and BMI <25 kg/m 2 and the remaining 6 were in the age group >50 and BMI <30 kg/m2. However, 5/6 patients in group C were in the age group <50 years while regarding the body mass index, all 6 patients were <30. All patients who were aware of the presence of prosthesis and pain on exertion belonged to the smaller age group <50 and the less BMI <25 kg/m 2.
Table 2: Showing the detailed descriptions of pain in both groups as well as the fi nal pain score per patient

Click here to view


Regarding the early postoperative complications, 6 patients (10%) in group A developed mild scrotal swelling due to tissue edema not for hematoma formation and wound seroma formation while in group B, the figure was higher as 12 patients (20%) experienced mild to moderate scrotal swelling and seroma. In group C, only 4 patients (6.7%) showed mild scrotal swelling. Wound infection was seen in three patients (5%) in groups A and B necessitating only dressing in the outpatient clinic under cover of systemic antibiotics with no need to remove the mesh but those patients developed re-recurrence thereafter. In group C, four patients (6.7%) showed superficial port site infection necessitating only dressing in the outpatient clinic. Testicular atrophy was not seen and only two recurrences (3.3%) in group A all over the period of follow up. Five cases of testicular atrophy (8.3%) and four cases of hernia recurrence (6.25%) were seen in group B. However, in group C three patients came with recurrence with no testicular atrophy reported [P ≥ 0.05]. Moreover, the overall postoperative complication rates were 18.3% and 40% in group A and group B, respectively with significant distribution {P < 0.01} [Table 3].
Table 3: Showing the detailed descriptions of results in the three groups with corresponding P-values

Click here to view



 ¤ Discussion Top


The ideal method for repair of inguinal hernia would cause minimal discomfort to the patient, both during the surgical procedure and in the postoperative course. It would be technically simple to perform and easy to learn, would have a low rate of complications and recurrence, and would require only a short period of convalescence. [5] However, the most effective method in any given patient is not clearly defined and consequently surgery for recurrent inguinal hernia after mesh repair is usually a difficult operation due to the disadvantage of re-operating through dense fibrotic scar tissue around the mesh with the risk of testicular damage and a large number of local hematoma. [1],[8],[9]

To avoid the disadvantage of re-operating through scar tissue and dense fibrotic scar tissue around the mesh, the open posterior preperitoneal mesh repair was popularized by Nyhus [4] as a good alternative for recurrent inguinal hernias. In previous study, Saber and co-workers [1] reported that open preperitoneal hernia repair offers many advantages over the transinguinal repair for recurrent hernia. This approach gives results far superior to those of the commonly used anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) procedure generally is accepted for the repair of primary and recurrent hernias that follow conventional transinguinal repair. [10]

In the present study, we found that the time of hospital stay and sick leaves and accordingly the time off from work all were reduced in patients with open posterior preperitoneal approach and TAPP compared with the anterior approach and the difference was statistically significant. Many studies of same interest reported less hospital stay and rapid return to physical activity. [1],[9],[10],[11]

Chronic postoperative pain is strongly related to two main patient-related factors; age and body mass index or three surgery ¾ related factors such as surgery for recurrence with anterior approach, operations performed in specialist hernia centers, and finally the experience of the surgeon. [1] The total laparoscopic preperitoneal (TAPP) and then the open preperitoneal approach in the present study significantly reduced the final chronic pain score per patient in comparison with the anterior transinguinal approach and our data came in concordance with studies of same interest. [5],[6],[11],[12 ]

There are many studies traced patient age in relation to occurrence chronic pain and found that the risk of chronic pain decreased with increasing age. [1],[13],[14],[15] Our data regarding this point came in concordance with these reports. The BMI is another studied factor for chronic pain occurrence where many investigators found good correlation between less BMI values and chronic pain [1],[14],[15],[16] and our data in the present study supported these finding.

The postoperative complications of hernia repair were estimated regarding the rate and traced regarding the type in similar previous studies as early and delayed forms. [1] Early complication, defined as that occurring within 1 month of surgery, are wound seroma, sepsis, scrotal edema and hematoma formation while the long-term complications, assessed at 3 months are testicular atrophy and recurrence. [1],[17],[18],[19] In published literatures, the overall postoperative complication rates were 18-38% [20] and may reach as high as 49.7% in some series [21] and in our study, the overall complication rate was 19.7% in both groups A and C and 34.36% in group B due to more tissue dissection and manipulation.

Wound hematoma and superficial wound infections are the most common problems in previous series and serious complications, such as major hemorrhage, pubic osteitis and testicular atrophy, occur in less than one percent of patients undergoing herniorrhaphy. [20],[21] Minor complications such as seroma formation, wound sepsis, and scrotal hematoma were seen in the three groups in the present study but with more incidence in group B. This observation met with data reported by other investigators. [1],[5],[13],[14],[18]

Long term complications such as testicular atrophy and recurrence were traced by many researchers who reported 0% incidence for testicular atrophy and 0% or very low incidence (1.5%) for recurrence in their studies. [1],[14],[22],[23] while others found 4.38% hernia recurrence after posterior preperitoneal repair [24] 10% in the open anterior approach [25] while other data ranged between 2% and 14%. [5],[20],[22] In a multicenter study, there was no significant difference in the recurrence rate between laparoscopic and open methods of hernia repair was revealed. [26] However, while the laparoscopic technique has a significantly lower re-recurrence rate than the open technique, there is no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation. [27] Accordingly, we found that recurrence rate was statistically insignificant in the three groups and this finding met with other data in published literatures. [5],[26],[27] An indirect comparison between TAPP and open (OHR) techniques by considering randomized, controlled trials in a network meta-analysis, the following outcomes were considered: Operative time, postoperative complications, hospital stay, postoperative pain, time to return to work and recurrences. This study showed that TAPP improved clinical outcomes compared with OHR. [28]

Testicular dysfunction, atrophy and necrosis as a result of ischemic orchitis is a well-known complication after anterior inguinal hernia repair with 1% occurrence following primary herniorrhaphy and 5% in recurrent cases [29],[30],[31] but in open preperitoneal repair, the procedure is safe as it effectively eliminates testicular complications. [1] Laparoscopic repair seems favorable in terms of better preservation of testicular functions. A significant decrease in testicular volume and less improvement in blood flow is seen after open repair where there is significant reduction in serum testosterone, follicle stimulating (FSH), and leutinizing (LH) hormones level. [32]

Testicular ischemia and necrosis are thought to be due to acute thrombosis of the pampiniform venous plexus rather than arterial injury, as there is collateral arterial flow to the testis from the inferior epigastric, vesical, prostatic, and scrotal arteries. [29] Testicular atrophy is thought to be more common after open procedures particularly recurrent inguinal hernias due to greater manipulation of the spermatic cord beyond the pubic tubercle and during dissection of the distal hernia sac. [30] According to these finding, we found that no testicular atrophy was seen in patients of both groups A and C but seen in two patients of group B (4.25%) due to operating within the fibrotic field with tissue reaction around the mesh.


 ¤ Conclusion Top


In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair offers many advantages. It is inexpensive, has a low recurrence rate, and allows the surgeon to cover all potential defects with one piece of mesh. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications, and recurrence.

 
 ¤ References Top

1.
Saber A, Ellabban GM, Gad M, Elsayem K. Open preperitoneal versus anterior approach for recurrent inguinal hernia: A randomized study. BMC Surg 2012;12:22.  Back to cited text no. 1
    
2.
Campanelli G, Pettinari D, Nicolosi FM, Cavalli M, Avesani EC. Inguinal hernia recurrence: Classification and approach. Hernia 2006;10:159-61.  Back to cited text no. 2
    
3.
Prins MW, Koning GG, Keus EF, Vriens PW, Mollen RM, Akkersdijk WL, et al. Study protocol for a randomized controlled trial for anterior inguinal hernia repair: Transrectus sheath preperitoneal mesh repair compared to transinguinal preperitoneal procedure. Trials 2013;3:14:65.   Back to cited text no. 3
    
4.
Nyhus LM, Pollak R, Bombeck CT, Donahue PE. The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique. Ann Surg 1988;208:733-7.  Back to cited text no. 4
    
5.
Hamza Y, Gabr E, Hammadi H, Khalil R. Four arm randomized trial comparing laparoscopic and open hernia repairs. Egyptian J Surg 2009; 28:110-117.  Back to cited text no. 5
    
6.
Demetrashvili Z, Qerqadze V, Kamkamidze G, Topchishvili G, Lagvilava L, Chartholani T, et al. Comparison of Lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias. Int Surg 2011;96:233-8.  Back to cited text no. 6
    
7.
Bittner R, Schwarz J. Inguinal hernia repair: Current surgical techniques. Langenbecks Arch Surg 2012;397:271-82.  Back to cited text no. 7
    
8.
Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, et al. Danish Hernia Database. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 2011;58:C4243.  Back to cited text no. 8
    
9.
Katri KM. Open preperitoneal mesh repair of recurrent inguinal hernia. Hernia 2009;13:585-9.  Back to cited text no. 9
    
10.
Peitsch WK. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: A retrospective 17-year analysis with 1,123 hernia repairs. Surg Endosc 2013 Sep 17. [Epub ahead of print].  Back to cited text no. 10
    
11.
Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 2012;26:3355-66.   Back to cited text no. 11
    
12.
Li J, Wang X, Feng X, Gu Y, Tang R. Comparison of open and laparoscopic preperitoneal repair of groin hernia. Surg Endosc 2013; 27:4702-10.  Back to cited text no. 12
    
13.
Karatepe O, Acet E, Altiok M, Adas G, Cakýr A, Karahan S. Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty. Hippokratia 2010;14:119-21.  Back to cited text no. 13
    
14.
Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology 2010;112:957-69.  Back to cited text no. 14
    
15.
Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT. Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg 2013;79:829-36.  Back to cited text no. 15
    
16.
Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R. Analysis of post-surgical pain after inguinal hernia repair: A prospective study of 1,440 operations. Hernia 2007;11:517-25.   Back to cited text no. 16
    
17.
Tolver MA, Strandfelt P, Forsberg G, Hjørne FP, Rosenberg J, Bisgaard T. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 2012;151:556-63  Back to cited text no. 17
    
18.
Millat B. Fédération de Recherche EN CHirurgie (FRENCH). Inguinal hernia repair. A randomized multicentric study comparing laparoscopic and open surgical repair. J Chir (Paris) 2007;144:119-24.  Back to cited text no. 18
    
19.
Timiþescu L, Turcu F, Munteanu R, Gîdea C, Dra˘ ghici L, Ginghina˘ O, et al. Treatment of bilateral inguinal hernia - minimally invasive versus open surgery procedure. Chirurgia (Bucur) 2013;108:56-61.  Back to cited text no. 19
    
20.
Farooq O, Rehman BU. Recurrent inguinal hernia repair by open preperitoneal approach. J Coll Physicians Surg Pak 2005;15:261-5.  Back to cited text no. 20
    
21.
Nienhuijs SW, Van Oort I, Keemers-Gels ME, Strobbe LJ, Rosman C. Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair. Br J Surg 2005;92:33-8.  Back to cited text no. 21
    
22.
Farooq O, Batool Z, Din AU, Ullah AA, Butt Q, Kibryia RI. Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia. J Coll Physicians Surg Pak 2007;17:465-8.  Back to cited text no. 22
    
23.
Wright D, Paterson C, Scott N, Hair A, O'Dwyer PJ. Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: A randomized controlled trial. Ann Surg 2002;235:333-7.  Back to cited text no. 23
    
24.
Kurzer M, Belsham PA, Kark AE. Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg 2002;89:90-3.  Back to cited text no. 24
    
25.
Beg MA, Mehdi SH, Siddiqui SS. Early complications of inguinal hernia repair. Prof Med J 2007;14:119-22.  Back to cited text no. 25
    
26.
Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: Results of a prospective randomized multicenter trial. Hernia 2008;12:385-9.   Back to cited text no. 26
[PUBMED]    
27.
Shah NR, Mikami DJ, Cook C, Manilchuk A, Hodges C, Memark VR, et al. A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc 2011;25:2330-7.  Back to cited text no. 27
    
28.
Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, et al. Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 2012;26:3355-66.   Back to cited text no. 28
    
29.
Moore JB, Hasenboehler EA. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: Case report of a rare complication. Patient Saf Surg 2007;7:1-3.  Back to cited text no. 29
    
30.
Chu L, Averch TD, Jackman SV. Testicular infarction as a sequela of inguinal hernia repair. Can J Urol 2009;16:4953-4.  Back to cited text no. 30
    
31.
Rönkä K, Vironen J, Kokki H, Liukkonen T, Paajanen H. Role of orchiectomy in severe testicular pain after inguinal hernia surgery: Audit of the Finnish Patient Insurance Centre. Hernia 2013. [In press]  Back to cited text no. 31
    
32.
Singh AN, Bansal VK, Misra MC, Kumar S, Rajeshwari S, Kumar A, et al. Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: A prospective randomized controlled trial. Surg Endosc 2012;26:1304-17.  Back to cited text no. 32
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
 

    

© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04