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This study designed to compare the new laparoscopic dual approach to inguinal hernia repair with trans-abdominal preperitoneal (TAPP) and lichtenstein repair (open procedure)
inguinal hernioplasty is a procedures where synthetic mesh is used to strengthen the inguinal tissues sites for hernia repair different methods used which is either anterior approach (open Lichtenstein) or laparoscopic posterior approach through the abdomen (TAPP) comparing these two methods by new approach which is considered to some extent a modified TAPP by pneumo-dissection of pre-peritoneal space with abdominal approach by lap. repair
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| group A (dual approach lap hernioplasty) | Experimental | dual approach laparoscopic inguinal hernioplasty by combination of TAPP (group B) and pneumo-dissection preperitoneal instead of sharp dissection |
|
| group B (TAPP) | Active Comparator | trans-abdominal preperitoneal hernioplasty (TAPP) after induction of pneumoperitoneum through peritoneal approach peritoneal incision and preperitoneal dissection then mesh fixation done |
|
| group C (Lichtenstein hernioplasty) | Active Comparator | open inguinal hernioplasty (lichtenstein) repair through inguinal incision and dissection of the sac anteriorly , excision of the sac and then mesh fixation in the posterior wall of inguinal canal |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| dual approach laparoscopic inguinal hernioplasty | Procedure | after pneumoperitoneum is done preperitoneal pneumo-dissection is done and then peritoneal incision done . dissection preperitoneally and sac dissection will be easy approached |
| Measure | Description | Time Frame |
|---|---|---|
| operative time | operative time will be measured in minutes for each procedure.and comparing three groups ( dual approach , TAPP and Lichtenstein ) in operative time which determined as follow:
| from the inflation of the abdomen till deflation and port closure ---for lichtenstein from skin incision to skin closure. |
| Measure | Description | Time Frame |
|---|---|---|
| intraoperative injuries | abdominal visceral injuries cord structure injuries | intra operative |
| intra operative bleeding | mild bleeding and oozing controlled by cautery bleeding from inferior epigastric artery or testicular artery major vascular injury |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| mostafa A. hamad, professor | Assiut university hospital faculty of medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Assiut university hospital | Asyut | 71515 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26099622 | Result | Nasr MM. Early results of dual approach hernioplasty (DAH): an innovative laparoscopic inguinal hernioplasty technique. Surg Endosc. 2016 Mar;30(3):1113-8. doi: 10.1007/s00464-015-4308-5. Epub 2015 Jun 23. |
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| ID | Term |
|---|---|
| C034807 | tetra-4-amidinophenoxypropane |
| D014945 | Wound Healing |
| ID | Term |
|---|---|
| D012038 | Regeneration |
| D001686 | Biological Phenomena |
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comparative study between three procedures of inguinal hernioplasty; open (LICHTENSTEIN), TAPP, and laparoscopic DUAL APPROACH (modified TAPP)
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this is a randomized trial where the participants are selected randomly to each of the previous three groups , and the post operative assessment of complication and pain done by different surgical residents whom are not informed about the groups of study.
| TAPP | Procedure | pneumoperitoneum is done and then through abdominal approach peritoneal dissection in done and sac reduction and then mesh fixation |
|
| (lichtenstein) repair | Procedure | inguinal incision is done and inguinal canal approach anteriorly and then sac dissection and excision then mesh fixation to posterior wall and closure the incision in layers |
|
| intraoperative |
| post operative pain | pain measured by visual analog scale from 0 no pain to 10 the worst pain ever. | immediately post operative and 6 ,12, 24 hours and two weeks post operative |
| post operative wound complication | wound seroma , hematoma either small with conservative treatment and large need intervention wound infection either superficial skin and S.C. or mesh infection | 2 weeks post operative ,3 ,6 and 12 months postoperative |
| post operative chronic pain | post operative paraesthesia , bricking pain, dull-aching pain. measured by visual analog scale (VAS) from 0 no pain to 10 the worst pain ever | follow up at 3 months , 6 months and one year for pain assessment by VAS |
| recurrence | post operative inguinal swelling confirmed clinically as a recurrent hernia | 3 months, 6 months and one year |