COMPARATIVE ANALYSIS OF THE SURGICAL TREATMENT OF INGUINAL HERNIA BY ADAPTING THE TRANSABDOMINAL PRE-PERITONEAL LAPAROSCOPIC TECHNIQUE (TAPP) WITHOUT MESH FIXATION WITH THE TRADITIONAL OPEN LICHTENSTEIN TECHNIQUE (Atena Editora)

Abstract

Introduction: Inguinal hernioplasty is one of the most frequent operations in Brazilian university hospitals. Issues related to recurrences and complications are taken into consideration, when choosing the best surgical procedure for each patient. The two most used methods use the open approach proposed by Lichtenstein and the videolaparoscopic approach, usually by the transabdominal preperitoneal technique (TAPP). Due to the high cost of the mesh fixation devices (tackers), necessary for the positioning of the polypropylene mesh by laparoscopy, this method is currently rarely used in the Unified Health System (SUS). However, there is a recent tendency not to fix meshes in defects smaller than 2 centimeters when the surgery is performed using the minimally invasive approach. Goals: To evaluate the rate of recurrence and post-surgical complications in patients operated using the TAPP technique without mesh fixation, compared to those undergoing the traditional Lichtenstein method, in a Brazilian public hospital. Methods: To analyze the occurrence of surgical complications according to the Clavien-Dindo Classification and recurrences up to three months postoperatively, in a retrospective cohort of patients operated on at Hospital Universitário Cajuru, in Curitiba, between March 2019 and 2020. Results: A total of 116 patients were analyzed, 67 operated via TAPP and 49 via the traditional open route. The TAPP group had a greater number of cases with bilateral hernia, while those in the open route were significantly older (p=0.004). There was no significant difference in terms of recurrence (p=0.072) and complications (p=0.056) between the methods. Conclusion: Both approaches proved to be equivalent for inguinal hernia repair in a short-term postoperative comparison. This suggests that the TAPP technique adapted for not fixing the mesh in defects smaller than 2 cm can be used on a larger scale in Brazilian public hospitals, making it a positive cost-effective alternative within the scope of the SUS (Brazilian Unified Health System).