الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Groin hernia repair is considered to be one of the most commonly performed operations by general surgeons; however, there is no ”gold standard” operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities.
The laparoscopic revolution has increased the debate about the safest and most effective inguinal hernia repair. This revolution has broadened our understanding of inguinal anatomy and hernia repair. At the least, surgeons should be aware of the current indications and contraindications for laparoscopic inguinal hernia repair, because some hernias should have a laparoscopic repair. To increase versatility, surgeons should consider becoming skilled at both techniques, with the understanding that outcomes are optimal if one is committed to achieving expertise in laparoscopic repair.
Laparoscopic repairs have excellent results in the hand of skilled surgeons. It results in low postoperative pain, lower postoperative analgesics use, fewer wound infection, and quick return to daily activity and working.
TAPP repair of inguinal hernia is an operation that is ideally suited to the Day Surgery Unit. It is associated with low rates of immediate post-operative complications and need for overnight stay.
With increasing the number of laparoscopically operated inguinal hernias, many questions aroused regarding the postoperative recurrence and complications rates especially postoperative pain. This prospective study was the first one comparing between the outcomes of totally sutures technique (for mesh fixation and PF closure) and totally tacks technique in laparoscopic TAPP inguinal hernia repair regarding operative time, cost benefits, and postoperative complications.
Our study was conducted on 80 adult patients presenting with inguinal hernias. The included cases were divided by randomized method (closed envelops) into two groups, group (A); control group, included 40 patients who underwent laparoscopic TAPP repair by totally tacks and group (B); experimental group, included 40 patients who underwent laparoscopic TAPP repair by totally sutures. All cases were operated by or under supervision of consultant surgeons.
Patients were followed up after discharge in the outpatient clinic at 1 week, 1 month, 2 months, 3 months, 6 months and 12 months to assess surgical site complications, early and late postoperative pain and recurrence of hernia.
By comprasion between the two groups, there was a non-significant statistical difference in both groups regarding the demographics of the patients, comorbidities and preoperative data. The operative time showed a highly significant difference in favor of group A than group B (87.5 min versus 117 min respectively).
As regard the postoperative data, we did not have a significant difference between both groups in hospital study (25.6 hours in group A versus 23.6 hours in group B). We had only one case (2.5%) of recurrence in group A versus no cases in group B. As regard the cost analysis, each case in tack group needed one tack gun which costed (530$), while each case in group B needed one prolene suture and one vicryle suture (10 $).
By using VAS for postoperative pain assessment, there was no a significant difference between both groups from 1st postoperative day up to 2 months but there was a significant difference in favor of suture group from 3 months to 1 year postoperative.
Based on our prospective randomized study, a few preliminary conclusions can be made: Although totally sutures technique (for mesh fixation and peritoneal flap closure in laparoscopic transabdominal preperitoneal inguinal hernia repair) was a significantly longer in operative time, but it provided a significant improvement in late postoperative pain with a significant lower cost than tack technique with no significant difference in recurrence at short term follow up.