Volume : 7, Issue : 5, May - 2018

A PROSPECTIVE STUDY COMPARING LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) AND TOTALLY EXTRAPERITONEAL(TEP) INGUINAL HERNIA REPAIR WITH MODIFIED ANTERIOR PRE PERITONEAL (MODIFIED APP) INGUINAL HERNIA REPAIR

Rajeev Sinha, Yasharth Sharma, Om Kumar Sharma, Albail Singh Yadav

Abstract :

<p class="MsoNormal" style="margin-top:0in;margin-right:3.0pt;margin-bottom:0in;&#10;margin-left:0in;margin-bottom:.0001pt;text-align:justify;mso-outline-level:&#10;4;background:white"><b style="mso-bidi-font-weight:normal"><span style="font-size:10.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-fareast-font-family:&quot;Times New Roman&quot;;color:black;mso-themecolor:text1;&#10;mso-fareast-language:EN-IN">In literature,there are only limited studies available that have been done<span style="mso-spacerun:yes">&nbsp; </span>comparing the results of laparoscopic(TAPP and TEP) inguinal hernia repair with open anterior pre peritoneal inguinal hernia repairs . The aim of this study is to compare the <span style="mso-font-kerning:18.0pt;mso-bidi-font-weight:bold">laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair with modified anterior pre peritoneal (Modified APP) inguinal hernia repair,which is a novel method of approaching the pre peritoneal space, anteriorly via the deep inguinal ring.<span style="mso-spacerun:yes">&nbsp; </span></span><span style="text-transform:uppercase;mso-bidi-font-weight:bold"><span style="mso-spacerun:yes">&nbsp;</span>METHODS: </span>Prospective analysis of medical documents of 135 patients operated during 2015-2017 at MLB Medical College, Jhansi, India was done . Outcome parameters included operation time,postoperative complications, acute<span style="mso-spacerun:yes">&nbsp; </span>postoperative pain and chronic pain, hospital stay, recurrence and cost effectiveness of the two procedures.<span style="text-transform:uppercase;&#10;mso-bidi-font-weight:bold"> RESULTS: </span>75 patients underwent laparoscopic repair and 60 patients underwent Modified APP. Modified APP took considerably lesser time as compared to laparoscopic repair(</span></b><b style="mso-bidi-font-weight:&#10;normal"><span style="font-size:10.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">26.70&plusmn;1.174 vs 36.45&plusmn;1.898 (mean);p&lt;0.0001).Post operative complications,were more in laparoscopic group as compared to Modified APP group (Seroma-3 in laparoscopic group,0 in open group; chronic groin pain-1<span style="mso-spacerun:yes">&nbsp; </span>in open group,0 in the laparoscopic group).Laparoscopic repair had lesser acute post operative pain,shorter hospital stay,was more expensive.There were no recurrences in both the groups .</span></b><b><span style="font-size:10.0pt;&#10;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;&quot;Times New Roman&quot;;color:black;mso-themecolor:text1;text-transform:uppercase;&#10;mso-fareast-language:EN-IN">CONCLUSIONS:</span></b><b style="mso-bidi-font-weight:&#10;normal"><span style="font-size:10.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1"> Laparoscopic repair of inguinal hernia offers various advantages over modified app but in a country like India where patients usually come from a poor background ,Modified APP seems to offer all the benefits of laparoscopic repair at a reasonable price.</span></b><b><span style="font-size:10.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-fareast-font-family:&quot;Times New Roman&quot;;color:black;mso-themecolor:text1;&#10;text-transform:uppercase;mso-fareast-language:EN-IN"><o:p></o:p></span></b></p>