The classical TAPP repair and modified TAPP surgical method: A comparative randomized parallel group study of Inguinal Hernia

Abstract

Background: The objective of meticulous closure of peritoneum is to prevent internal herniation while covering the mesh adequately to avoid contact between mesh and abdominal viscera. The study proposes - same objective can also be achieved with non-closure of peritoneum. Objective: To compare equality of clinical outcome of simultaneous bilateral Trans abdominal preperitoneal (TAPP) repair of inguinal hernia by classical TAPP, with meticulous closure of peritoneal flap and modified TAPP , with peritoneal non closure and controlled release of pneumoperitoneum. Study to answer the research question--“Is meticulous closure of peritoneal flap, the only way to provide adequate cover for the mesh in TAPP repair?†Materials and Method: Between August 2011 and July 2012, 130 inguinal hernias of 65 patients who underwent TAPP repair were randomised in two groups. One group (n=65) of hernias received classical repair with peritoneal closure (control), while the other (n=65) without closure (study). The primary endpoints were bowel related complications and recurrence. Results: The two groups were comparable in age and types of hernia. TAPP was successfully done in all cases. No bowel related complication and recurrence occurred in either group. Mean operating time was significantly less with modified TAPP (65 min vs. 76 min, p<0.05). Lower Incidence of chronic pain (3% VS 13.84%, P=0.007) and seroma (7.69% vs. 15.38%) was achieved during mean follow up of 628 days. Conclusion: The randomised prospective parallel group study demonstrated equality in clinical outcome on both primary end points by providing equivalent peritoneal cover for the mesh as meticulous peritoneal closure does in classical TAPP.