Journal Article: Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes
similar to those for unilateral TEP: population-based analysis of prospective data of 6,505
patients
Journal Category: Hernia
Journal Sub-Category: Inguinal
Article objective: Describe the outcomes of bilateral TEP vs standard unilateral TEP
1. The potential advantages of simultaneous inguinal hernia repair include:
a. Quicker recovery
b. Less operating time
c. Shorter length of stay
d. Patient convenience and economic saving.
e. Less hernia recurrence
In the article presented by Gass et al, the authors compared the outcome of simultaneous
laparoscopic bilateral inguinal hernia repair to unilateral laparoscopic inguinal hernia repair.
2. Regarding intra-operative and immediate post-operative data, which of the following
statements regarding laparoscopic bilateral TEPinguinal hernia repair compared to
laparoscopic unilateral inguinal hernia repair is true?:
a. Bilateral TEP is associated with an increased but not significant operating time.
b. Bilateral TEP is associated with increased operating time, intraoperative
complications, and post operative surgical complications.
c. Bilateral TEP is associated with increased operating time, but less intraoperative
and postoperative surgical complications.
d. Bilateral TEP is associated with less operative time, intraoperative complications
and postoperative surgical complications.
e. Bilateral TEP has the same operative time, intraoperative and postoperative
surgical complications.
3. Regarding post-operative outcomes, which of the following statements compares
regarding laparoscopic bilateral inguinal hernia repair to laparoscopic unilateral inguinal
hernia repair is true?:
a. Bilateral TEP is associated with a higher conversion rate.
b. Bilateral TEP is associated with similar length of stay, higher incidence of general
postoperative complications and conversion rates.
c. Bilateral TEP is associated with increased length of stay, higher incidence of
general postoperative complications and conversions rates.
d. Unilateral TEP is associated with less length of stay, general postoperative
complications and conversion rates.
e. Unilateral TEP is associated with similar hospital of stay, incidence of general
postoperative complications and conversion rates.
4. Gass et al. examine the strengths and limitations of this study. Ultimately, the authors
recognize which of the following to be true?
a. The availability of long-term data strongly supports the conclusions of this article.
b. Large sample size and prospectively collected data are an asset that this studies
possesses over other similar studies.Retrospectively collected data used in this
study was a benefit to overall study conclusion.
c. The ability compare different types of hernia repairs was unique to this
study.Sample size was considered small an potential problem.
Answers with Explanations:
1.
a. Quicker recovery
There is no data to support that bilateral inguinal hernia repair results in
quicker recovery compared to unilateral hernia repair. Many studies have
shown that the recovery time is the same.
b. Less operating time.
The operating time is longer with bilateral inguinal hernia repair compared
to unilateral hernia repair whether open or laparoscopically.
c. Shorter hospital stay.
The hospital stay is the same with bilateral inguinal hernia repair compared
to unilateral inguinal repair.
d. Patient convenience and economic saving.
The main advantages of bilateral inguinal hernia repair include patient
convenience and economic aspects because only one admission, one
anesthesia, and one period of convalescence are required.
e. Less hernia recurrence.
Data have shown that the hernia recurrence is the same with bilateral
compared to unilateral repair repair.
2. Regarding intra-operative and immediate post-operative data, which of the following
statements regarding laparoscopic bilateral TEPinguinal hernia repair compared to
laparoscopic unilateral inguinal hernia repair is true?:
a. Bilateral TEP is associated with an increased but not significant operating time.
Laparoscopic bilateral inguinal hernia repair is associated with a significant
increase in the operating time.
b. Bilateral TEP is associated with increased operating time, intraoperative
complications, and post operative surgical complications.
c. The duration of surgery was longer for the patients undergoing bilateral inguinal
hernia repair (86 minutes) than for those undergoing unilateral TEP (67 minutes)
(p<0.001) Patients undergoing bilateral TEP repair had slightly increased rates for
intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%; p = 0.002) and
surgical postoperative complications (bilateral 3.2% vs. unilateral, 2.3%; p
=0.026).Bilateral TEP is associated with increased operating time, but less
intraoperative and postoperative surgical complications.
Laparoscopic bilateral TEP is associated with increased operating time,
intraoperative and postoperative surgical complications compared to
unilateral TEP.
d. Bilateral TEP is associated with less operative time, intraoperative complications
and postoperative surgical complications.
Laparoscopic bilateral TEP is associated with increased operating time,
intraoperative and postoperative surgical complications compared to
unilateral TEP.
e. Bilateral TEP has the same operative time, intraoperative and postoperative
surgical complications.
Laparoscopic bilateral TEP is associated with increased operating time,
intraoperative and postoperative surgical complications compared to
unilateral TEP.
3.
a. Bilateral TEP is associated with a higher conversion rate.
The conversion rate is similar between bilateral TEP and unilateral TEP
(1.1% vs. 1.0%; p =0.699)
b. Bilateral TEP is associated with similar length of stay, higher incidence of general
postoperative complications and conversion rates.
No significant difference between bilateral TEP and unilateral TEP groups
were observed in terms of length of stay (2.5 vs.2.3 days; p=0.196),
general postoperative complications (1.0 vs. 0.7%; p= 0.151 or conversion
rates (1.1% vs. 1.0%; p =0.699)
c. Bilateral TEP is associated with increased length of stay, higher incidence of
general postoperative complications and conversions rates.
No significant difference between bilateral TEP and unilateral TEP groups
were observed in terms of length of stay (2.5 vs.2.3 days; p=0.196),
general postoperative complications (1.0 vs. 0.7%; p= 0.151 or conversion
rates (1.1% vs. 1.0%; p =0.699)
d. Unilateral TEP is associated with less length of stay, general postoperative
complications and conversion rates.
No significant difference between bilateral TEP and unilateral TEP groups
were observed in terms of length of stay (2.5 vs.2.3 days; p=0.196),
general postoperative complications (1.0 vs. 0.7%; p= 0.151 or conversion
rates (1.1% vs. 1.0%; p =0.699
e. Unilateral TEP is associated with similar hospital of stay, incidence of general
postoperative complications and conversion rates.
No significant difference between bilateral TEP and unilateral TEP groups
were observed in terms of length of stay (2.5 vs.2.3 days; p=0.196),
general postoperative complications (1.0 vs. 0.7%; p= 0.151 or conversion
rates (1.1% vs. 1.0%; p =0.699
4.
a. The availability of long-term data strongly supports the conclusions of this article.
No long-term data is available for the current study.
b. Large sample size and prospectively collected data are an asset that this studies
possesses over other similar studies.
The strength of the current study include the large sample size conferred a high
degree of statistical power for detecting clinically relevant significance, and the
prospectively collected data.
c. Retrospectively collected data used in this study was a benefit to overall study
conclusion.
The data was collected prospectively.
d. The ability compare different types of hernia repairs was unique to this study.
The data was comparing one type of inguinal hernia repair; bilateral and unilateral
TEP repair.
e. Sample size was considered small an potential problem.
The data was comparing one type of inguinal hernia repair; bilateral and unilateral TEP
repair.
References
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3. Ahmad SA, Schuricht AL. A comparison of patient recovery following unilateral and bilateral endoscopic
preperitoneal herniorrhaphy. JSLS, 1997; 1: 231-235.
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