Impact of previous appendectomy on the outcomes of endoscopic totally extraperitoneal inguinal hernioplasty

Abstract

Previous lower abdominal surgery presents a technical challenge during endoscopic totally extraperitoneal inguinal hernioplasty. Whether the presence of appendectomy scarring and adhesions will adversely influence the outcomes of totally extraperitoneal inguinal hernioplasty remains largely unknown. The objectives of the present study were to evaluate the safety of totally extraperitoneal inguinal hernioplasty in patients with a history of appendectomy and examine its impact on the perioperative outcomes. Between November 1999 and September 2003, patients who underwent totally extraperitoneal inguinal hernioplasty and had previous appendectomy were recruited as the appendectomy group. For each case patient, 3 age-matched cohorts were randomly selected during the same period. Perioperative data and postoperative outcomes were compared between the 2 groups of patients. A total of 92 patients, 23 cases and 69 controls, were recruited. There was no predominance of either direct or indirect inguinal hernia in the appendectomy group. One patient in the appendectomy group required conversion to transabdominal preperitoneal inguinal hernioplasty because of adhesions. The incidence of peritoneal tear and operative time was higher and longer in the appendectomy group respectively but the differences were not significant. Comparisons of the mean duration of hospitalization, postoperative morbidity rates, pain scores, and time taken to resume normal activities showed no significant difference between the 2 groups. Totally extraperitoneal inguinal hernioplasty in patients who had previous appendectomy was technically safe. A higher incidence of peritoneal tear was anticipated in the presence of appendectomy scarring and adhesions. Postoperative recovery and outcomes were equivalent to those who had no history of appendectomy.