COMPARATIVE STUDY BETWEEN IPSILATERAL PORT POSITIONING VERSUS CONTRALATERAL PORT POSITIONING IN ETEP FOR INGUINAL HERNIA SURGERY

Abstract

Background: Enhanced-view totally extraperitoneal (eTEP) repair is an increasingly used minimally invasive approach for inguinal hernia surgery. Port positioning is an important technical consideration that may influence ergonomics, visualization, operative efficiency and postoperative recovery. This study compares ipsilateral and contralateral port positioning during eTEP repair of inguinal hernias. Methods: A retrospective cohort study was conducted on 60 patients undergoing laparoscopic eTEP repair for inguinal hernia. Patients were divided into two groups of 30 each according to port placement: ipsilateral and contralateral to the hernia. Operative time, conversion, postoperative pain, ergonomic score, postoperative complications and time to return to work were compared between the groups. Statistical analysis was performed using the chi-square test, with a p-value <0.05 considered statistically significant. Results: The mean operative time was 68.5 minutes in the ipsilateral group and 72.1 minutes in the contralateral group, with no statistically significant difference (p=0.18). Patients undergoing contralateral port placement had a significantly shorter mean time to return to work (4.0 vs. 5.5 days, p=0.001) and higher ergonomic scores (8.4 vs. 6.9, p<0.001). Postoperative pain scores were significantly lower with contralateral port positioning (p=0.03). Conversion rates were comparable between the groups (p=0.27), and postoperative complications did not differ significantly (p=0.064). Conclusion: Both the port positions are efficient in performing the surgery.  Contralateral port positioning during eTEP repair provides superior ergonomics and is associated with reduced postoperative pain and earlier return to work without increasing operative time or postoperative complications. Triangulation of instruments is especially useful in huge inguinal and complex hernias.  It represents an useful alternative to ipsilateral positioning, particularly in anatomically challenging cases.