الفهرس Only 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
Mesh fixation in the laparoscopic pre-peritoneal repair of inguinal hernias is currently a debatable issue. Unstapled laparoscopic hernia repair has emerged as a preferable alternative; it avoids the complications associated with stapling and has attractive economic logistics. The present work evaluate the early outcome of unstapled laparoscopic totally extra-peritoneal hernia repair TEP with the reference to per and postoperative complications, early return to normal activity , chronic groin pain, and early recurrence.The present study included 30patients with 33 inguinal hernias (2 patients had a recurrent hernia and 3 patients had a bilateral hernia). The patients characteristics in this study : gender (29:1 Male:Female), mean age (36.816.11 ), size (24 inguinal & 9 Inguino-scrotal) & side of hernia(15 Rt & 11Lt) , did not differ from that found in most similar studies . All the patients were operated upon under general intravenous and inhalational anesthesia, with no anesthesia-related complications. Several studies have however demonstrated that TEP is feasible and safe in regional anesthesia (epidural or spinal). Most of the patients (21 =70 %) were operated by surgeons who have passed the learning curve. TEP has a longer and steeper learning curve due to the ‘‘inside out anatomical view”. Several studies suggested measures to overcome the learning curve. The mean operative time was 62 ±21.79 minutes (range 30-105 mins); the mean operative time of less experienced surgeons (72.8±21.67) was significantly higher than that of the more experienced (57.4±20.65). Dissection and creation of the pre-peritoneal space was successfully and safely performed using the telescopic dissection with similar results to that following ballon dissection as reported in the literature.We had no major per-operative complications. Minor per-operative complications however included peritoneal tears and bleeding. Peritoneal tears (PTs), occurred during repair of 14 hernias (46.7 %) ; 6 of the 14 tears (42.8%) were closed intra-operatively (by suture, endoloops or clips) and the remaining were left open .It is recommended to close PTs only if large and when measures to decompress the pneumoperitoneum fails. Bleeding from minor injury to the inferior epigastric or other small vessels occurred in5 cases;. All bleeding were minimal and stopped spontaneously or controlled by tamponation ; diathermy control was resorted to in only one patient . Difficult mesh placement was encountered during 8 hernia repairs due to not well preparing or to difficulty in unfolding the mesh after its placement ; no complications occurred as a result of this difficulty (eg. immediate or early recurrence or increased incidence of post-operative pain).