Outcomes of Endoscopic Totally Extraperitoneal (TEP) Hernia Repair for Clinically Occult Inguinal Hernia Diagnosed With Ultrasonography

Abstract

Background: Inguinal hernias are generally presented by groin mass and pain. An inguinal hernia can be diagnosed clinically in most cases but patients without a groin lump constitutes a diagnostic challenge. The firstline diagnostic imaging tool for these patients is ultrasound (US) and the recommended surgical procedure is laparoscopic-endoscopic repair. The aim of this retrospective study is to evaluate the postoperative results and complication rates of TEP technique in patients with contralateral occult hernias diagnosed with US and clinically diagnosed hernias. Methods: A retrospective study was conducted to evaluate the outcomes of TEP procedure in patients with radiologically diagnosed contralateral occult hernias and clinically diagnosed patients. All the defects were repaired by TEP technique and covered with a mesh that was placed extraperitoneally.Demographics, patient characteristics and perioperative data were obtained by reviewing the records. Results: A total of 109 patients were enrolled in the study. Most of patients were male and the mean age was 48.9 ± 14.6. The hernias of 56 patients were repaired unilaterally and the rest bilaterally. Right-sided hernias were more common than left-sided hernias. The morbidity rate was 7.1% in unilateral repair and 3.8% in bilateral repair. The recurrence rate was 3.6% in unilateral repair and 5.7% in bilateral repair. Conclusion: The reported incidence of clinical contralateral groin hernia after primary unilateral surgery is approximately 10% in some studies. If the contralateral side could be diagnosed before primary surgery, the risk of a second operation could be avoided. Laparoscopic surgery enables bilateral hernia repair without any additional incision with similar morbidity rates. There was no significant difference between unilateral and bilateral TEP repair for intraoperative and postoperative surgical complications. These results suggest that laparoscopic inguinal hernia repair is safe and effective surgical technique for both unilaterally and bilaterally. To prevent a second operation, all patients with suspected inguinal hernia should have an ultrasound before surgery.