Clinical Application of the Modified Neck-Shoulder Technique Based on Membrane Autopsy in Laparoscopic Totally Extraperitoneal Prosthesis for Indirect Inguinal Hernia

Abstract

Abstract Objective: To investigate the anatomical basis and clinical application value of the modified neck-shoulder technique based on membrane autopsy in laparoscopic totally extraperitoneal prosthesis (TEP) for tension-free repairs of indirect inguinal hernia. Methods:In this retrospective cohort study, we analyzed the clinical data of 136 patients with indirect inguinal hernia who underwent laparoscopic TEP for tension-free repairs in Department of gastroenterological surgery Unit 1, the First Hospital of Putian City, Fujian Province from June 2017 to June 2020. The patients were divided into the modified neck-shoulder technique group (68 cases) and the traditional surgery group (68 cases) according to the different surgical methods. The intraoperative and postoperative conditions of the two groups were compared. Results:Both the modified neck-shoulder technique group and the traditional surgery group completed the herniorrhaphy. Compared with the traditional surgery group, the modified neck-shoulder technique group had a shorter operation time [(37.15±5.320) min vs. (54.04±5.202) min, t=18.472, p<0.001], less intraoperative blood loss [(5.53±1.634) ml vs. (16.21±3.375) ml, t=23.544, p<0.001], lower incidence of intraoperative peritoneal injury [3 cases (4.41%) vs. 9 cases (13.26%), χ²=3.29, p=0.07], lower intraoperative conversion rate [1 case (1.47%) vs. 8 cases (11.76%), χ²=5.83, p=0.016], and lower incidence of postoperative chronic pain [1 case (1.47%) vs. 12 cases (17.65%), χ²=10.291, p=0.001], all of which were statistically significant (p<0.05). Both groups were followed up for 12 months after surgery. Relapse was not observed in any case. Conclusion: Based on the surgical principles of the open neck-shoulder technique and the understanding of the membrane autopsy in the inguinal region, our center has summarized a set of operation procedures called the “modified neck-shoulder technique” for laparoscopic TEP for tension-free repairs of indirect inguinal hernia. This new surgical technique could quickly and accurately separate and cross the interlayer gap in the preperitoneal space under the enlarged view of the laparoscope, allow the high ligation and detachment or return of the hernia sac, and make the placement of the patch more reliable, reduce collateral damage, reduce postoperative complications, and save operation time.