Background
Data are insufficient to compare transabdominal preperitoneal repair (TAPP) and total extraperitoneal (TEP) techniques of laparoscopic inguinal hernia repair. There is very scant data ...comparing the two techniques in terms of long-term outcomes, which include chronic groin pain, quality of life, and time to return to normal activity. This prospective, randomized, controlled trial compared TEP versus TAPP techniques of laparoscopic inguinal hernia repair in terms of these long-term outcomes.
Methods
This study was conducted from May 1, 2007 to March 30, 2012. Patients with uncomplicated groin hernia were randomized to transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) techniques. A total of 160 patients were randomized to group I (TEP) and 154 patients to group II (TAPP). Pain was assessed with Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 h, 1 week, 6 weeks, 3, 6, and 12 months, and yearly thereafter. Quality of life was assessed with Short Form–36 version 2 (SF 36v2) preoperatively and postoperatively at 3 months follow-up.
Results
Demographic, clinical profiles, intraoperative, and early postoperative parameters were well matched. There was significantly higher acute pain following TAPP repair; however, the chronic groin pain was comparable in both TEP and TAPP. Preoperative pain and immediate postoperative pain had significant correlation with chronic groin pain. Significant improvement from preoperative to postoperative quality of life was seen in both TEP and TAPP repairs, but there was no difference between TEP and TAPP in postoperative period. Time to return to normal activity also was similar between the two groups.
Conclusions
The TEP and TAPP techniques of laparoscopic repair of inguinal hernia have comparable long-term outcomes in terms of incidence of chronic groin pain, quality of life, and resumption of normal activities. Chronic groin pain had a significant correlation with preoperative pain and early postoperative pain. However, TAPP was associated with significantly higher incidence of early postoperative pain, longer operative time, and cord edema, whereas TEP was associated with a significant higher incidence of seroma formation. The cost was comparable between the two.
Staging laparoscopy (SL) plays an important role in avoiding unnecessary non-therapeutic laparotomy in radiologically resectable hepatopancreaticobiliary (HPB) malignancy patients. The limitation of ...SL is to detect deep-seated malignancy. The addition of laparoscopic ultrasonography for identifying metastatic lesions or locally unresectable disease improves the diagnostic yield of SL.
This prospective, observational study was conducted in a single unit of the tertiary care centre between 2017 and 2019. All the patients of HPB malignancy who were radiologically resectable underwent SL and laparoscopic intraoperative ultrasonography. Metastatic disease patients were either underwent palliative bypass procedures or abandoned depending on the condition of the patient. Patients who had resectable disease underwent standard surgical procedures.
Forty patients of HPB malignancy with potentially resectable on radiological imaging underwent SL and diagnostic ultrasonography. Out of 40, 21 patients had periampullary, 14 had carcinoma gallbladder and 5 patients had distal cholangiocarcinoma. Metastatic lesions were identified on laparoscopy in eight patients and the diagnostic yield of SL is 20%. Addition of laparoscopic ultrasonography identified one haemangioma which was false positive on laparoscopy and underwent the radical standard procedure. Four patients were unresectable so the procedure was abandoned and another three patients underwent a bypass procedure.
Laparoscopic ultrasonography during SL can detect deep-seated metastatic lesions and decide the management in resectable disease.
Background
Laparoscopic inguinal hernia repair is still not the gold standard for patients with inguinal hernia. The aim of this study was to compare testicular dysfunction, incidence and factors ...influencing chronic groin pain, and quality of life after laparoscopic and open mesh repair.
Methods
One hundred twenty patients were studied in a prospective randomized trial. One hundred seventeen patients completed the required follow-up, 60 following laparoscopic repair and 57 following open repair. Testicular functions were assessed by testicular volume, blood flow, and hormones, and quality of life was assessed with Short Form 36 version 2 preoperatively and postoperatively at 3 months. Pain was assessed at different time intervals preoperatively and postoperatively.
Results
Preoperative profiles of both groups were well matched. A significant decrease in testicular volume (
p
= 0.01) and less improvement in blood flow (
p
= 0.048) was seen after open repair. There was also a significant reduction in serum testosterone level (
p
= 0.02) with a significant increase in FSH and LH level (
p
< 0.001); however, there was no testicular atrophy. Incidence and severity of chronic groin pain were significantly less after laparoscopic repair during normal and strenuous activities, though they were similar to those after open repair during rest after 3 months postoperatively. Age, preoperative pain, pain at 1 week, and open repair were found to be independent risk factors for chronic pain on multivariate analysis. Quality of life was significantly better postoperatively in terms of physical functions, role physical, bodily pain, and general health after laparoscopic repair.
Conclusion
Laparoscopic repair seems favorable in terms of better preservation of testicular functions, lower incidence of acute and chronic groin pain, and significant improvement in quality of life when compared to open repair. Younger age, preoperative pain, pain after 1 week postoperatively, and open mesh repair were found to be significant risk factors for chronic groin pain.
Background
Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the “best groin hernia repair.” The present prospective randomized controlled trial was done to ...compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair.
Methods
The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form.
Results
One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (
p
= 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (
p
< 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (
p
= 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9,
p
= 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (
p
< 0.05).
Conclusions
In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.
Early graft function is crucial for successful kidney transplantation. Intravascular volume maintenance is paramount in ensuring reperfusion of transplanted kidney. This study was planned to compare ...whether the timing of fluid infusion can help to decrease amount of fluid given without altering early graft function during renal transplantation.
The present study included forty recipients, randomized into standard (Group-S) or targeted fluid therapy (Group-T). Group S received fluid according to conventional fasting deficit while Group T received at 1 ml/kg/h from the start of surgery till start of vascular anastomosis after which fluid infusion rate in both group was increased to maintain a central venous pressure of 13-15 mm of Hg till reperfusion. Primary outcome measured was serum creatinine level on first postoperative day while secondary outcomes were IV fluid given, perioperative hemodynamics, onset of diuresis, graft turgidity, urine output, and renal function during first 6 postoperative days.
The study showed Group T postoperatively had early fall in serum creatinine (day 3) than S (day 6) although this difference was not statistically significant. Group T had received significantly less fluid per kg of dry weight (T-42.7 ± 9.7 ml/kg, S-61.1 ± 11.1 ml/kg,
< 0.001), had early diuresis, better graft turgidity and urine output than Group S.
Targeted hydration significantly decreases the total amount of fluid infused during the intraoperative period without altering early graft function. Targeted hydration during vascular anastomosis produced stable hemodynamics and early diuresis without any side-effects pertaining to hypo or hyper-volemia.Clinical trial identifier number-CTRI/2016/07/007111.
Abstract Study objective To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. ...Design Prospective, randomized, double-blind trial. Setting Operating rooms in a tertiary care hospital of Northern India. Patients One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. Interventions Patients were randomized into two groups normal saline (NS) group and 5% dextrose (D) group. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250 ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100 ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. Measurements Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Main results Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24 h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). Conclusions Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly.
These are inter-society guidelines for performance of laparoscopic surgery during COVID-19 pandemic that has affected the way of surgical practice. The safety of healthcare workers and patients is ...being challenged. It is prudent that our surgical practice should adapt to this rapidly changing health environment. The guidance issued is based on global practices and national governmental directives. The Inter-Society Group urges you to be updated with the developing situation and evolving changes.
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