Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2017; 9(12): 264-269
Published online Dec 27, 2017. doi: 10.4240/wjgs.v9.i12.264
Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection
Masateru Yamamoto, Takashi Urushihara, Toshiyuki Itamoto
Masateru Yamamoto, Takashi Urushihara, Toshiyuki Itamoto, Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Toshiyuki Itamoto, Department of Gastroenterological and Transplant Surgery, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima 739-0046, Japan
Author contributions: Yamamoto M, Urushihara T and Itamoto T drafted the manuscript; Itamoto T has given the final approval of the version to be published; all authors read and approved the final manuscript.
Institutional review board statement: The procedure was approved by the Ethics Committee at the Prefectural Hiroshima Hospital.
Informed consent statement: All study participants were provided informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takashi Urushihara, MD, PhD, Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan. urushiha@hph.pref.hiroshima.jp
Telephone: +81-82-2541818 Fax: +81-82-2538274
Received: August 6, 2017
Peer-review started: August 7, 2017
First decision: September 6, 2017
Revised: November 6, 2017
Accepted: November 19, 2017
Article in press: November 19, 2017
Published online: December 27, 2017
Abstract
AIM

To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.

METHODS

A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.

RESULTS

Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min (range, 66 to 168), 136 min (range, 114 to 165), and 125 min (range, 108 to 156), with median bleeding amounts of 5 g (range, 1 to 26), 3 g (range, 1 to 52), and 5 g (range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.

CONCLUSION

Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.

Keywords: Inguinal hernia, Intestinal incarceration, Totally extraperitoneal inguinal hernia repair, Intraperitoneal inspection, Single incision

Core tip: Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection (iSTEP) makes hernia repairs safer and more effectively. Totally extraperitoneal inguinal hernia repair had the disadvantages for difficulty with confirming the type of hernia as well as difficulty with large indirect inguinal hernia, intestinal incompetence and postoperative prostatectomy. However, iSTEP can be used to diagnose the type of hernia easily. It enables observation of the opposite side and reconfirmation of treatment after mesh repair making the technique safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.