Starting Laparoscopic Inguinal Hernia in a Tertiary Hospital of a Developing Country

Abstract

Introduction: Transabdominal preperitoneal (TAPP) and Total extraperitoneal (TEP) are preferred choices of inguinal hernia repair. This study aims to find incidence of acute and chronic post-operative pain, operative time, learning curve and incidence of intra-operative and post-operative complications. Methods: This prospective observational,analytical, cohort hospital based study was conducted from December 2015- November 2018 in 152 adult patients aged 18-80 years. Results:TAPP was done in 177 inguinal hernias of 152 patients. Pain was significantly less at 48 hours post-operative(p=0.00).Pain was less in patients managed with light weight mesh (LWM) than with polypropylene (PP) mesh (p=0.00). There was no difference in pain when PP mesh was compared to 3D mesh (p=0.5) and LWM compared to 3D mesh (p=0.47). There was no difference in pain based on type of tackers used (p=0.47). The operative time averaged 65.72 minutes. A significant reduction in operative time was noted after first 50 number of cases (p=0.00).The intra-operative complications included injury to inferior epigastric artery and vas deferens in 2(1.12%) patients each. The post-operative complications were pneumoscrotom in 12(6.77%), seroma in 8(4.91%), cord induration in 1(0.56%), port site hematoma in 1(0.56%), mesh infection in 1(0.56%), recurrence in 1(0.56%) and inguinodynia in 12(7.89%) cases. Conclusions:TAPP is associated with less acute and chronic post-operative pain. The operative time is longer than past studies and learning curve is shorter than previous studies. The various intra and post-operative complications are similar to other studies.