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Long-term follow-up of endoscopic totally extraperitoneal direct inguinal hernia repair using the Endoloop technique

Surgical Endoscopy
Emma Clout, Mirun Thayaparan, Cameron Douglas, Christophe R. Berney



The pre-tied suture Endoloop™ technique for plication of the weakened transversalis fascia is efficient in post-operative seroma prevention, after laparoscopic/endoscopic direct inguinal hernia repair. No studies have evaluated long-term tolerability of this new technique in regards to chronic pain and hernia recurrence.


Prospective longitudinal evaluation study of consecutive patients treated with Endoloop™ for M2 or M3 direct defects, during endoscopic totally extraperitoneal approach. Meshes were secured with fibrin sealant only. All patients had a minimum 2.8 years (median 5.9 years) follow-up. First outcome was chronic groin/testicular pain; secondary outcome parameters included hernia recurrence and Quality of Life (QoL). Patients were assessed by phone interview using the validated Carolinas Comfort Scale (CCS), questioned regarding recurrence and asked to present for clinical review as needed.


112 patients (median age 57 years) with 141 direct hernia defects were included during the study period of 2008–2014. An Endoloop™ was used on 127 occasions—79 M2 and 48 M3 direct hernias. One patient had an early recurrence requiring an open repair and was therefore excluded. Thirty-three of the remaining one hundred and eleven patients (29.7%) were lost to long-term follow-up. According to their CCS range, 70 patients (88.6%) were very satisfied with their results, 8 (10.1%) were satisfied, and only one patient (1.3%) who reported chronic groin pain was unsatisfied. There was no reported long-term hernia recurrence.


The PDS Endoloop™ technique for closure of direct inguinal hernia defects is well tolerated with low risk of hernia recurrence, chronic pain, and excellent QoL. This reliability persists to long-term follow-up.

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