2005 SAGES Abstracts

POSTER ABSTRACTS
adhesion between plug and peritoneum in these two cases.
The third case was newly developed direct hernia after indirect
hernia repair and the operative procedure was not unusual.
The operative time averaged 56 min (range, 28-90) and all
patients were discharged within 23 h. These patients were followed
3 to 32 months and no recurrences were observed.
Conclusion: We have found that laparoscopic TEP repair of
recurrent hernia with previous mesh and plug repair is feasible
without removing plug. Comprehensive understanding of the
anatomy of the hernia is critical. Further investigation with
long term follow-up is needed to assess the safety and efficacy
of this technique for recurrent hernia with previous mesh and
plug repair.
P321–Hernia Surgery
TEP INGUINAL HERNIA REPAIR: WHICH MESH AND HOW TO
FIX IT?, Asim Shabbir BS, Shridhar Iyer BS, Wei Keat Cheah
BS,Raj H Sidhu BS,Charles TK Tan BS,Davide Lomanto MD,
Minimally Invasive Surgical Centre (MISC), National University
Hospital, Singapore
Laparoscopic hernia surgery is gaining its role because of the
benefits to patients that are evident from many published RCT
when compared lap to open repair: less postop pain and analgesic
consumption, earlier return to normal activities and
work,less chronic pain and permanent paraesthesia. But technical
factors are important to achieve satisfactory results. A
review of our experience was undertaken involving 280 consecutive
patients who underwent 350 extraperitoneal inguinal
hernia repair (1998-2003) at the National University
Hospital,Singapore. We performed 234 unilateral repair and
116 bilateral repair. The hernia repair was performed using
three methods.In group 1: polypropilene mesh was anchored
with spiral tacker (n=229);group B, polypropylene mesh without
anchoring (n=51)and in group 3 a multifibre polyester
anatomic mesh was utilized (n=70). The mean age was 49
years (range 20-81)and 85% were men. The overall mean operative
time was 50 min (range:35-180 min); bilateral repairs
took 27% longer than unilateral repairs. Complications rate
was significantly lower in group 3 (2.8%) compared to group 2
(13.7%) and group 1 (5.6%). The recurrence rate was: 11.3%
when the mesh was not anchored, 1.6 % when the mesh was
anchored and no recurrence was recorded when anatomic
mesh was utilized (mean follow-up:9 mnths). There was no
recurrence detected in the last 112 cases (70: anatomic mesh;
42: polypropilene mesh and tacker). The overall mean inpatient
hospital stay was 1.4 days, and of the last 30 cases, 70%
were performed as outpatient. Laparoscopic inguinal hernia
repair is a relatively new approach in the long history of groin
hernia repair. To achieve an acceptable recurrence and complication
rate, surgical technque is very important. An adequate
anatomical dissection together with a correct mesh placement,
orientation and anchoring are the key factors. Data from our
study showed that using anatomic mesh we can achieve the
same recurrence and morbidity rate as using mesh plus fixation
with tacker but with lesser cost. Laparoscopic approach
remains an alternative and feasible method to open hernia
surgery. In our 6 years experience, TEP hernia repair can be
done with minimum morbidity and in the majority of cases
can indeed be performed in the Day Surgery setting especially
once the learning curve has overcomed, and the repair can be
accomplished with good clinical outcome.
P322–Hernia Surgery
LAPAROSCOPIC TOTAL EXTRAPERITONEAL (TEP) INGUINAL
HERNIA REPAIR UNDER EPIDURAL ANAESTHESIA: A
DETAILED EVALUATION, Pawanindra Lal MD, Nikhil Gupta,
Prejesh Philips MD,RamKrishna Kajla MD,Jagdish Chander
MD,Vinod K Ramteke MD, Department of Surgery, Maulana
Azad Medical College & Lok Nayak Hospital, New Delhi, India.
BACKGROUND: Laparoscopic total extraperitoneal (TEP)
inguinal hernia repair is as efficacious as the open
Lichtenstein?s, can be learnt with proper training, incurs lesser
post-operative pain, better cosmesis and early return to work.
The one major factor preventing the widespread acceptance of
laparoscopic TEP is the requirement for general anaesthesia
(GA) for its conduct. This study attempts to evaluate whether
laparoscopic TEP can be performed under lesser invasive
anaesthesia such as regional anaesthesia, its feasibility and
limitations.
Method: A total of 22 patients were studied between Jan 2002
and March 2003 in a tertiary care referral hospital. Epidural
anaesthesia was given using a lumbar epidural catheter and
2% Lignocaine with Adrenaline (Adr) achieving a sensory level
of T6. Standard technique for laparoscopic TEP using three
midline infraumbilical ports was used.
Results: A total of 22 cases (20 unilateral, 2 bilateral) were
operated. The mean operating time was 67.8 (range 40-110)
mins. All 22 cases were started using epidural anaesthesia of
which 15 (68.1%) were completed under epidural anaesthesia
and 7 (31.9%) were converted to GA. No cases were converted
to open. The only intraoperative complications were pneumoperitoneum
and shoulder tip pain (9 cases each). There was
no statistical difference between the cases conducted under
epidural (67.6 mins) and those converted to GA (69.3 mins) or
between the conversion rates of smaller versus larger hernias
in this study (p value 0.22). Significant association of success
of the procedure was seen with a sensory level of T6 (cases
upto T6 and above :15 cases of which 2 were converted-conversion
rate 13.3% and cases with sensory level was below T6:
7 cases of whoch 5 were converted: conversion rate 71.4%.
p=0.014) and adequate epidural catheter length (P=0.015).Of
the 9 cases with severe shoulder tip pain, 6 were converted to
GA-67%; p=0.006, p