Clinical efficacy of laparoscopic transabdominal partial extraperitoneal technique for lower abdominal marginal hernia

Objective To investigate the clinical efficacy of laparoscopic transabdominal partial extraperitoneal technique (TAPE) for lower abdominal marginal hernia. Methods The retrospective and descriptive study was conducted. The clinical data of 58 patients with lower abdominal marginal hernia who were admitted to Fujian Medical University Union Hospital between January 2011 and June 2018 were collected. There were 15 males and 43 females, aged (65±11)years, with a range of 54-76 years. All patients underwent laparoscopic TAPE. Observation indicators: (1) intra- and post-operative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications to August 2018. Measurement data with normal distribution were represented as Mean±SD and count data were expressed as absolute numbers. Results (1) Intra- and post-operative situations: 58 patients underwent successfully TAPE. Diameter of hernia ring was (7.0±2.9)cm. Six of 58 patients underwent hybrid surgery due to severe adhesion of the intestine and abdominal wall, and adhesion was separated by a small abdominal incision. Two patients with recurrent hernia underwent TAPE after removal of the old patch. One, 1, and 1 patient combined with left direct inguinal hernia, right indirect inguinal hernia, and right direct inguinal hernia had simultaneous repair during the operation. The operation time and volume of intraoperative blood loss were (153±46)minutes and (20±10)mL. Early ambulation was encouraged without the limitations of anesthesia. A liquid diet was begun at 24 hours, and a semi-liquid diet was begun at 48 hours after the operation. The duration of postoperative hospital stay were (3.8±1.1)days. Pressure dressing was routinely adapted till 3 months after the operation. (2) Follow-up: all patients were followed up for (22±19)months. Seven of 58 patients had postoperative complications. Among them, 3 patients with seroma were cured by fine needle aspiration and pressure bandaging, 2 with intestinal obstruction were cured by conservative treatment including fasting, gastrointestinal decompression, purgative enema, inhibition of secretion of digestive juices, and fluid infusion, 1 with Trocar hernia was cured by tension-free repair under general anesthesia and had no recurrence, 1 with wound infection was healed after anti-infection and dressing change treatment. There was no recurrence, patch infection, chronic pain, urinary frequency and urgency or other complications found in other patients. Conclusion TAPE is safe and effective for lower abdominal marginal hernia. Key words: Hernia; Marginal hernia; Incisional hernia; Complications; Preperitoneal; Hernia repair; Mesh repair; Laparoscopy