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Background: There are several methods for the ligation of structures during minimally invasive
operations. The hem-o-lok clip is a nonabsorbable polymer clip with a lock engagement
feature. There are few reports about its use in minimally invasive general surgical procedures.
Objectives: In this report, we describe our experience with the hem-o-lok clip during basic,
minimally invasive, general surgery procedures and the adverse events during application
of the hem-o-lok.
Patients and Methods: We retrospectively reviewed all laparoscopic appendectomies (LAs),
cholecystectomies (LCs), and splenectomies (LSs), performed by 6 general surgeons at a
university-affiliated hospital over 4 years. Clip failure was defined as intraoperative or postoperative
bleeding due to clip malfunction that necessitated placement of another clip, conversion
to an open procedure, or postoperative re-exploration. Leakage from the cystic duct
and appendiceal stump was also considered clip failure. A search of the US Food and Drug
Administration Manufacturer and User Facility Device Experience (MAUDE) database using
the appropriate keywords was performed on July 7, 2011. This online resource contains reports
of adverse events involving medical devices.
Results: Over a 4-year period, 856 laparoscopic operations, comprising 770 LC, 55 LS, and 31
LA, were performed. We did not observe any incidence of clip failure. There were 22 reports of
hem-o-lok clip failure in the MAUDA database. Eighty-two percent (n = 18) of clip failures were
reported during laparoscopic nephrectomy. There was no report of failure after LA. There
were 2 reported clip failures after LC (with bile leakage) and 1 after LS (tearing of splenic vessels
with intraoperative bleeding). There was also a report of migration of the hem-o-lok clip
into the common bile duct, which occurred 4 years after a complicated LC.
Conclusions: Hem-o-lok clips that are properly applied during basic laparoscopic procedures
are a secure option for the ligation of the structures. Surgeons must be educated regarding
the proper application technique.

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Background: Inguinal hernia is the most prevalent surgical disease in clinical practice. Endoscopic inguinal hernia repair has been shown to be slightly superior to open approaches. Recent modifications in the minilaparoscopic technique may improve the totally extraperitoneal repair (TEP) results. Objectives: We have performed a prospective study to analyze the feasibility of laparoscopic inguinal hernia repair using mini instruments. Main measured outcomes included postoperative pain, return to work activities and aesthetics. Technical aspects, including operative time and intraoperative and postoperative complications were also analyzed. Patients and Methods: From October, 2009 to May, 2011 consecutive patients undergoing TEP inguinal hernia repair using miniinstruments were included in the study protocol. Exclusion criteria was the same as for standard laparoscopic hernia repair. In all cases, a standardized laparoscopic technique using mini instruments was performed. A study protocol was applied prospectively for data collection, including operative time, hospital stay, need for pain medication, return to work and, patient’s aesthetic evaluation of the scars. Results were expressed in Mean ± SD. Results: Sixty consecutive patients diagnosed with inguinal hernia underwent TEP inguinal hernia repair using mini instruments. Of these, 53 were men and seven were women. The mean age was 50 ± 32 years. In eight cases, the hernias were recurrent and ten were bilateral. A total of 70 hernias were treated. The average operative time was ± 35 min. The mean hospital stay was 18 ± 6 hours. Analgesia was necessary for more than 2 days in 8 patients (13.3 %). There was one conversion to open surgery. Sixteen of the male workers (37 %) had to take 1 week off work. In total, 58 (96 %) of the patients considered the aesthetic outcome to be excellent. Patients were followed for 30 days. No recurrences were noted in this period. Conclusions: Totally extraperitoneal endoscopic inguinal hernia repair using mini instruments is feasible, and applicable to routine surgical practice with good short-term clinical and aesthetic results. Further comparative studies with standard laparoscopic extraperitoneal and open hernia repair are needed to access its long term results.

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Background

Preliminary studies have indicated advantages of mesh fixation using fibrin glue in TAPP compared with tack fixation.

Objectives

We report the results of a prospective experience in fixing mesh during TAPP with absorbable tacks.

Patients and Methods

50 consecutive men (who had bilateral inguinal hernia) were enrolled and followed up for at least 1 year. The primary measured outcome was pain experienced in day 1 of post-op. The secondary outcomes measured were postoperative scores of pain at rest, discomfort, and fatigue, foreign-body sensation, and hernia recurrence after 12 months. The outcomes were measured using a visual analogue scale, a verbal rating scale and numerical rating scales. A comparison was done within a historical group with the same demographic and hernia characteristics where the meshes have been fixed with fibrin glue.

Results

The group of tacks ‘TAPP’ showed good results concerning the level of pain, fatigue and foreign body sensation comparable with those of the historical group. There were significant differences concerning the length of surgery where absorbable tacks performed better. Regarding cost of surgery, the fibrin glue showed effective results.

Conclusions

The use of absorbable tacks during TAPP confers significant benefit regarding the operating time, however it is a disadvantage due to the cost when compared with fibrin glue.