Primary abandon-of-the-sac technique in laparoscopic inguinoscrotal hernia repair: A retrospective comparative study

Abstract

BACKGROUND: Laparoscopic inguinoscrotal hernia repair is a challenging procedure. The surgeon must perform large dissections to reduce the hernial sac, although he has the alternative technique of leaving the sac at the deep inguinal orifice level from the beginning.

OBJECTIVE: We aimed to determine the postoperative morbidity of laparoscopic inguinoscrotal hernia repair with the primary abandon-of-the-sac (PAS) technique and to compare it with complete dissection and reduction (CD). Operative times were compared as a secondary outcome.

METHODS: A retrospective analysis was conducted between January 2021 and May 2022. The minimum follow-up was 3 months. Postoperative morbidity and operative times in the PAS group were analyzed and compared with those in the CD group.

RESULTS: Seventy-eight patients were evaluated. The mean follow-up was 5 months (range, 3–18 months). PAS was performed in 15 patients, while the remaining 63 patients underwent CD. There were no significant differences in demographic and hernia characteristics. An overall morbidity of 30.7% was recorded. No statistical differences were observed in postoperative morbidity between the PAS group and the CD group (33.3% vs. 30.1%; P = 0.81). No statistical differences were found in terms of seromas (13.3% vs. 9.5%; P = 0.662), hematomas (6.6% vs. 9.5%; P = 0.727), or hydrocele (13.3% vs. 11.1%; P = 0.808). No recurrence or chronic pain was observed during the study period. Finally, a significantly shorter median operative time was recorded in the PAS group (50 vs. 80min; P = 0.0026).

CONCLUSION: The PAS technique is safe and feasible for the management of inguinoscrotal hernias. In our series, comparable morbidity rates were found when comparing it with CD. The benefit of the PAS technique is a significant reduction in operative time, despite the fact that it requires more postoperative ultrasounds.

Keywords

Abandon-of-the-sac / inguinoscrotal hernia / laparoscopic surgery

References

[1] Arregui ME, Young SB. Groin hernia repair by laparoscopic techniques: Current status and controversies. World J Surg 2005; 29: 1052- 7.

[2] Balakrishnan S, Singhal T, Samdani T, Hussain A, Shuaib S, Grandy-Smith S, et al. Laparoscopic inguinal hernia repair: Over a thousand convincing reasons to go on. Hernia 2008; 12: 493- 8.

[3] Medina JP, Auvieux R, Cerut RA, Porto EA, Pirchi DE. Hernioplasta inguinal laparoscópica totalmente extraperitoneal por incisión única. Rev Argentina Cirugía 2016; 108: 1- 10.

[4] Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2003; 90: 1479- 92.

[5] Pedroso LM, DE-Melo RM, DA-Silva NJ. Comparative study of postoperative pain between the lichtenstein and laparoscopy surgical techniques for the treatment of unilateral primary inguinal hernia. Arq Bras Cir Dig 2017; 30: 173- 6.

[6] Kapiris SA, Brough WA, Royston CMS, O’Boyle C, Sedman PC. Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: A 7-year two-center experience in 3017 patients. Surg Endosc 2001; 15: 972- 5.

[7] Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R. Scrotal hernias: A contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair. Surg Endosc 2000; 14: 289- 92.

[8] Ruze R, Yan Z, Wu Q, Zhan H, Zhang G. Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: A prospective randomized controlled study. Surg Endosc 2019; 33: 1147- 54.

[9] Daes J, Felix E. Critical view of the myopectineal orifice. Ann Surg 2017; 266: e1- 2.

[10] Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009; 250: 187- 96.

[11] Li W, Li Y, Ding L, Xu Q, Chen X, Li S, et al. A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs. complete sac reduction. Surg Endosc 2020; 34: 1882- 6.

[12] Morrell ALG, Malcher F, Morrell AG, Morrell-Junior AC. Primary abandon-of-the-sac (PAS) technique: preliminary results of a novel minimally invasive approach for inguinoscrotal hernia repair. ABCD Arq Bras Cir Dig 2020; 33: e1519.

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow