ANALYSIS OF SHORT-TERM RESULTS IN THE TREATMENT BY TAPP OF INGUINOSCROTAL HERNIAS WITH PARTIALLY RESORBABLE MESH (4DTM COUSIN BIOTECH)
Authors: Sartori A , Bressan L , Gianluca B , Bonariol L , Bagolini F , Simone T , Sanna A 
Published: May 2024

Abstract

Background and Objectives
The treatment of inguinal hernias by laparoscopy has proven to be equally effective and safe compared to the open technique. Inguinal scrotal hernias account for approximately 6% of inguinal hernias, and their treatment is associated with major complications as described by Kockerling et al. and the preferred technique is Lichtenstein. The use of the laparoscopic technique with a transabdominal approach is safe although the cover rate is high and depends on the complexity of the hernia. We present short-term outcomes of transabdominal treatment of inguinoscrotal hernias with partially resorbable mesh.

Methods
A retrospective analysis of data from a prospective registry of patients who underwent transabdominal laparoscopic hernioplasty from 1 August 2022 to 31 December 2023 for bilateral or unilateral inguinal scrotal hernia. Data from patients treated with partially resorbable mesh (4Dtm Cousin) were analysed. The meshes used are made of 75% Poly-L-lactic Acid (PLLA) resorbable monofilament and 25% Polypropylene monofilament; the dimensions of the meshes are 12 × 15 cm and were fixed only with cyanoacrylate Two operators (A. S. and A. S.) had completed the learning curve and were able to treat complex cases of inguinal hernia. Operative time, intra-operative and short-term postoperative complications and acute and chronic pain and recurrences were considered. Patients undergoing laparoscopic surgery using other networks were not considered.

Results
A total of 39 patients with a mean age of 65.5 yr. (range 23–83 yr.) underwent surgery and the mean BMI was 27 (range 18–34). Five unilateral recurrent hernias, three unilateral and 31 bilateral inguinoscrotal hernias were treated; adhesion lysis was associated in four cases. Antibiotic prophylaxis with cephalosporin and antithrombotic prophylaxis with heparin was performed in all patients. All patients were operated on under general anesthesia and a bladder catheter was placed, which was removed at the end of the operation. The average operating time was 101 min for bilateral, (range 60–120 min), 45 min (range 35–90 min) in recurrences, and 40 min (range 36–70 min) in monolater’s hernia. There were no conversions; there were no intraoperative complications. In four cases, a seroma was evident and was aspirated until complete resolution. In one case there was post-operative pain, which was treated by the antalgic therapy doctor with infiltrations until resolution of the symptoms. In the 17-month follow-up (range 1–17 months) no recurrences were observed.

Conclusion
The laparoscopic treatment of scrotal inguinal hernias is a difficult operation that the surgeon can tackle not only after having completed the learning curve but also after having dealt with numerous cases of laparoscopic hernioplasty. The use of partially resorbable mesh offers the advantage of reduced chronic post-operative pain without compromising the occurrence of recurrences. However, a longer follow-up is essential to monitor and confirm the short-term outcomes, which are currently encouraging.