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Feasibility of a new approach for creating a preperitoneal space in transabdominal preperitoneal repair inguinal hernia repair: using a sandwich approach

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Abstract

Purpose

In Japan, transabdominal preperitoneal (TAPP) inguinal hernia repair is performed by firmly pulling the peritoneum inwards to lift it from the underlying deep layer of subperitoneal fascia. It decreases the postoperative pain and discomfort in the inguinal area. The aim of this study was to evaluate the feasibility of the sandwich approach, which is a new technique for creating a preperitoneal space.

Methods

The operation was performed via the sandwich approach. We made sure to protect the preperitoneal fascia areolar layer when making the preperitoneal space.

Results

We performed TAPP in 745 patients (876 hernias) treated between October 2006 and April 2015 at Himeji Medical Center and Kurashiki Central Hospital. Before October 2010, we did not use the sandwich approach, and recurrence was observed in three patients. From October 2010, we always used the sandwich approach and never experienced any cases of recurrence. Clavien–Dindo classification Grade 3 or higher postoperative complications occurred in 6 patients (0.8%) between October 2006 and April 2015. Mesh-related ileus was the most frequently observed morbidity. There were no cases of vas differentia or spermatic vessel injury, postoperative chronic pain, or urinary retention.

Conclusion

The sandwich approach is feasible as another standard dissective procedure for TAPP.

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Authors and Affiliations

  1. Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, 710-8602, Japan

    Yoshio Nagahisa, Kai Chen, Reo Sakurai, Nobuaki Hattori, Yusuke Kawamoto, Kazuki Hashida, Michio Okabe & Tadashi Itou

  2. Himeji Medical Center, Honmachi 64, Himeji City, Hyogo, 670-8520, Japan

    Shusaku Homma

Authors
  1. Yoshio Nagahisa
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  2. Shusaku Homma
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  3. Kai Chen
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  4. Reo Sakurai
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  5. Nobuaki Hattori
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  6. Yusuke Kawamoto
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  7. Kazuki Hashida
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  8. Michio Okabe
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  9. Tadashi Itou
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Corresponding author

Correspondence to Yoshio Nagahisa.

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Conflict of interest

NY, HS, CK, SR, HN, KY, HK, OM, and IT declare that they have no conflicts of interest.

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Nagahisa, Y., Homma, S., Chen, K. et al. Feasibility of a new approach for creating a preperitoneal space in transabdominal preperitoneal repair inguinal hernia repair: using a sandwich approach. Surg Today 47, 595–600 (2017). https://doi.org/10.1007/s00595-016-1435-0

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  • DOI: https://doi.org/10.1007/s00595-016-1435-0

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