LAPAROSCOPIC TRANSA-BDOMINAL PRE-PERITONEAL MESH HERNIOPLASTY FOR INGUINAL HERNIAS: A TERTIARY CARE INSTITUTE EXPERIENCE.

Introduction: In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. Laparoscopic hernioplasty is the latest technique with several advantages over open procedures like reduced post operative pain, shorter recovery period. However the steeper learning curve and cost of the procedure have been cited as limiting factor. Aims and objectives: To study the outcome of laparoscopic transabdominal pre-peritoneal mesh hernioplasty for inguinal hernias in terms of operative time, complications, Hospital stay and recurrence. Material and methods: This study was carried out from December 2011 to January2017. Case records of 112 patients that underwent trans-abdominal pre-peritoneal (TAPP) by a single surgical team were followed prospectively for a period of 1 year. All patients, above 18 years of age with uncomplicated inguinal hernia were included in the study. Complicated hernias, patients unfit for general anesthesia, patients with previous lower abdominal or pelvic surgery and patients unwilling to take part in study were excluded from the study. Data regarding, operative time, complications, chronic post operative pain, hospital stay and recurrence were recorded and evaluated. Results: 112 patients presenting with uncomplicated inguinal hernias were operated over a period of five years. The age of the patients ranges from 15-70 years. There were 106 (94.64 %) male patients and 6 (5.35%) female patients. Mean operative time was 55 minutes (range 40-110 minutes).The complications that occurred, were bleeding 1(0.89%), conversion to open 1(0.89%), seroma 4(3.57%), urinary retention 4 (3.57%), chronic pain 3 (2.67%) and recurrence 3 (2.67%). No incidence of bowel injury, bladder injury, spermatic cord injury, scrotal hematoma, mesh infection and port site infection has been reported. Average Hospital stay was 1.2 days (1-3). 97.33% were satisfied with their repair and returned to work after with a median of 15.1 days (12-21 days). Conclusion: We concluded that TAPP is an effective and safe procedure with low prevalence of chronic pain, that was generally of a mild, infrequent nature, faster convalesce and return to productive activity with fewer complications and a recurrence rate as low as that of an open mesh repair. However operative time is prolonged which decreases with experience. Learning curve is not as steep as claimed, and considering advantages, the cost of the procedure should not be a limiting factor even in developing countries.