1000 TEP inguinal hernia repairs
1000 consecutive Laparoscopic TEP inguinal hernia repairs - The North Bristol Experience
We report a consecutive, nonselective series of 704 patients undergoing 1000 TEP repairs between 1996 and 2005; concurrent femoral (14) and umbilical (12) hernias were also repaired along with varicocelectomy (2) and vasectomy (3).
The median operating time was 17 minutes (range 7-75mins). There were two conversions. Complications comprised: secondary haemorrhage (2) from inferior epigastric vein division (settled conservatively), exuberant granulation tissue at the periumbilical port (2) and a bladder perforation (repaired laparoscopically).
90% of patients drove on the third postoperative day. The median time to normal activity was 4 days (1-24days). The median time to return to employment in 304 professional/self employed patients was 3 days (range 2-17 days). 35 patients had exercised induced self-limiting thigh pain (lateral cutaneous nerve neuropraxia). Two patients experienced excessive/palpable scar tissue around their properitoneal mesh and one chronic pain. There have been 5 recurrences; two since altering the surgical technique in 1997 to use a 13x15cm anchored mesh. One patient has developed a paraumbilical hernia. To date, no patient has developed an intra-abdominal complication.
TEP is an easily taught, learnt, safe, effective technique with low morbidity and with sufficient experience is significantly quicker to perform than an open hernia repair. It allows motivated patients an early return to fulltime employment. The choice between open and laparoscopic repair is a subjective decision for patient and surgeon and should not be based upon cost to the NHS Trust.
AR Dixon et al., 2005