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Laparoscopic Totally Extraperitoneal (TEP) Groin Hernia Repair in Patients After Contralateral TEP Groin Hernia Repair. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:79-83. [PMID: 34570075 DOI: 10.1097/sle.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The totally extraperitoneal (TEP) repair for groin hernia is considered difficult in patients with a healed surgical scar in the lower abdomen. We reported the feasibility of repair in those patients and found that the most frequent previous procedure in patients for whom the procedure was changed intraoperatively was a contralateral TEP after TEP repair. We now report an expanded patient cohort with a suggested unified treatment strategy. MATERIALS AND METHODS From 2006 to 2020, 443 patients underwent laparoscopic TEP groin hernia repair. A contralateral TEP after TEP repair was performed in 35 patients. The conversion rate after TEP was compared with that after other operations. Patients were divided into completed contralateral TEP after TEP repair (N=28) and changed procedure groups (N=7). Clinical characteristics were compared including age, body mass index, location and type of hernia, and interval after previous surgery. Multivariate analysis was performed to evaluate risk factors for conversion of the TEP procedure. RESULTS Patients undergoing contralateral TEP after TEP repair were significantly overrepresented among patients for whom the procedure was changed compared with other previous operations (P<0.01), with an odds ratio of 19.91. Comparing completed TEP after TEP repair and changed procedure groups, there were no significant differences regarding age (mean: 67 vs. 69 y old), body mass index (22.4 vs. 22.5 kg/m2), type of hernia (indirect or direct), or duration after previous TEP repair (median: 642 vs. 470 d) and identified no significant risk factors. CONCLUSIONS The contralateral TEP after TEP repair for groin hernia is feasible. However, dense adhesions may be present if balloon dissection was performed at the previous TEP repair, and it is necessary to carefully dissect being ready to convert to other procedures such as TAPP repair or an anterior approach.
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152
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Lee SR, Park JY. Comparison of laparoscopic transabdominal preperitoneal hernioplasty and laparoscopic iliopubic tract repair for Nyhus type II hernia in women. Surg Endosc 2021; 35:7260-7266. [PMID: 34542701 DOI: 10.1007/s00464-021-08739-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Indirect inguinal hernia with a dilated internal ring but an intact posterior inguinal wall is classified as Nyhus type II. Females have a higher incidence of indirect hernia than direct hernia. The purpose of this study was to evaluate the efficacy of laparoscopic iliopubic tract repair (IPTR) compared with laparoscopic transabdominal preperitoneal (TAPP) hernioplasty in treating women with Nyhus type II hernia. METHODS This retrospective study included 318 women aged ≥ 20 years who were treated for Nyhus type II hernia from January 2013 to December 2018. The patients were categorized into two groups in accordance with the operative technique: the TAPP group (33 patients) and the IPTR group (285 patients). In the IPTR group, intraabdominal suturing of the iliopubic tract and transversalis fascia arch was performed without mesh implantation. RESULTS The mean operation time was shorter in the IPTR group (17.2 ± 3.9 min) than the TAPP group (20.5 ± 8.1 min, p = 0.028). The postoperative complication rate was higher in the TAPP group than the IPTR group [6.1% (2/33) vs. 0.4% (1/285), respectively; p = 0.001]. Inguinodynia occurred in one patient in the TAPP group and no patients in the IPTR group. The hospital stay did not significantly differ between the two groups. The numeral rating scale pain scores at 1 day and 1 week postoperatively did not significantly differ between the two groups. There was no recurrence in either group. CONCLUSIONS Laparoscopic IPTR was safe and feasible for treating Nyhus type II hernia in women.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Jin Young Park
- Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea
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153
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Hada G, Zhang S, Song Y, Jaiswar M, Xie Y, Jian F, Lei W. Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy. Visc Med 2021; 37:315-322. [PMID: 34540948 DOI: 10.1159/000509895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/02/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction This study aimed to evaluate the safety of an inguinal hernia repair (IHR) under local anesthesia (LA) in the elderly with a perioperative continuation of antithrombotic therapy (AT). Methods A total of 120 patients undergoing elective primary IHR between August 2018 and August 2019 at the West China Hospital of China were prospectively studied, among which 60 patients also had coexisting cardiovascular diseases and had a continuation of AT perioperatively (antithrombotic group); the other 60 patients were not on any prior AT (control group). The primary endpoints were intra- and postoperative hemorrhagic complications, the required interventions for complications based on the Clavien-Dindo classification, and postoperative thromboembolic complications. The secondary endpoints were nonhemorrhagic complications, intraoperative duration, and postoperative length of stay (LOS). Results None of the patients in both groups had significant intraoperative bleeding >10 mL, and there were no significant differences between the 2 groups in terms of the postoperative hemorrhagic complications: bruising (2 vs. 0%, p = 1.000), serosanguinous soakage (7 vs. 3%, p = 0.679), and no hematoma was observed. Interventions required for encountered complications based on the Clavien-Dindo classification grade I (7 vs. 5%, p = 1.000) were assessed. There were no episodes of postoperative thromboembolic complications within 60 days in both groups. There were also no significant differences between the 2 groups in terms of nonhemorrhagic complications, intraoperative duration, and postoperative LOS (p > 0.05 in all). Conclusions The perioperative continuation of AT did not increase the risk of intra- and postoperative hemorrhagic complications following IHR in the elderly. Thus, IHR under LA seems to be safe and feasible in this setting.
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Affiliation(s)
- Gonish Hada
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sen Zhang
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghan Song
- Department of Day Care Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mukesh Jaiswar
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fushan Jian
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhang Lei
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
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154
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Okur O, Karaduman D, Tekgul ZT, Koroglu N, Yildirim M. Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study. Braz J Anesthesiol 2021; 71:505-510. [PMID: 34537121 PMCID: PMC9373607 DOI: 10.1016/j.bjane.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022] Open
Abstract
Background and objectives We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair. Methods This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics. Results The pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery. Conclusions Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.
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Affiliation(s)
- Onur Okur
- Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Sisli, Istanbul.
| | | | | | - Noyan Koroglu
- Izmir Katip Celebi University Medical School, Ataturk Training and Research Hospital, Izmir, Turkey
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Chai SW, Chiang PH, Chien CY, Chen YC, Soong RS, Huang TS. Sac transection versus sac reduction during laparoscopic herniorrhaphy: A systematic review and meta-analysis. Asian J Surg 2021; 45:981-986. [PMID: 34511364 DOI: 10.1016/j.asjsur.2021.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 08/06/2021] [Indexed: 11/02/2022] Open
Abstract
Hernia repair techniques have evolved recently; however sac handling remains a critical step. Transection of the herniated sac as opposed to total sac reduction may simplify the procedure. However, residual sac tissue may increase the risk for seroma formation. We performed a systemic review and meta-analysis to evaluate the safety and feasibility of transecting the hernia sac during laparoscopic herniorrhaphy. Relevant literature search was performed in PubMed, EMBASE, SCORPUS, and the Cochrane Library databases. Relevant studies that compared total reduction with transection of the herniated sac during laparoscopic herniorrhaphy were included. The primary outcome measure was the incidence of seromas. We also analyzed secondary outcomes including operative duration, postoperative pain scores, complications, and hernia recurrence rate. Of the 330 studies identified, four studies published between 2002 and 2020, with sample sizes ranging from 70 to 520 patients, met the inclusion criteria. Overall, 848 hernias were evaluated. We observed a high incidence of seroma formation in the sac transection group compared to that in the sac reduction group (OR 2.41; 95% CI 1.39 to 4.17, P = 0.002), but the groups did not differ significantly with respect to factor such as operative duration, postoperative complications, and pain score. Herniated sac transection during laparoscopic herniorrhaphy might be associated with a higher risk of seroma formation than that observed with sac reduction. The former approach did not show any significant benefits compared to the latter approach with respect to operative duration and postoperative complications.
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Affiliation(s)
- Shion Wei Chai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Po-Hsing Chiang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Chin-Ying Chien
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Yi-Chan Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ruey-Shyang Soong
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan
| | - Ting-Shuo Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, 20401, Taiwan.
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156
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Berri T, Brahmi K, Seddiki MMSE. Open new simplified totally extraperitoneal (ONSTEP) versus Lichtenstein repair for primary inguinal hernias. Ann R Coll Surg Engl 2021; 103:569-575. [PMID: 34464575 PMCID: PMC9774018 DOI: 10.1308/rcsann.2020.7105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic postsurgical pain (CPP) remains the main complication after Lichtenstein hernioplasty. The open new simplified totally extraperitoneal (ONSTEP) technique is a more recent transinguinal procedure that seems to be associated with less CPP. The aim of this study was to compare outcomes of the ONSTEP versus the Lichtenstein procedure for primary inguinal hernia. METHODS In this prospective, double-blinded and single-centre clinical trial, CPP at the six-month follow up assessed by a visual analogue scale was the primary endpoint. Secondary endpoints were operative time, perioperative complications, length of hospital stay, early pain, time to return to daily activities and to work, pain-related sexual dysfunction, aesthetic satisfaction and recurrence. RESULTS A total of 100 men were allocated to undergo either the Lichtenstein (n=50) or the ONSTEP (n=50) hernioplasty. The incidence of CPP was nonsignificantly lower in the ONSTEP group compared with the Lichtenstein group (28% vs 42%; p=0.142). However, the ONSTEP procedure required less operative time (42 vs 62min; p<0.001). Patients from the ONSTEP group resumed their daily activities earlier (5.94±3.9 days vs 8.56±5.14 days; p=0.009), had fewer postsurgical complications (5 vs 19; p=0.001) and expressed better satisfaction with the cosmetic result (p=0.041). No recurrence was observed after six months of follow up. CONCLUSION CPP was similar, but the ONSTEP technique was associated with shorter operating time, earlier return to normal daily activities, fewer postsurgical complications and better cosmetic results.
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Affiliation(s)
| | - K Brahmi
- University Hospital Center of Oran, Algeria
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157
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Hikino K, Koido M, Tomizuka K, Liu X, Momozawa Y, Morisaki T, Murakami Y, The Biobank Japan Project, Mushiroda T, Terao C. Susceptibility loci and polygenic architecture highlight population specific and common genetic features in inguinal hernias: genetics in inguinal hernias. EBioMedicine 2021; 70:103532. [PMID: 34392144 PMCID: PMC8374389 DOI: 10.1016/j.ebiom.2021.103532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The underlying pathology of inguinal hernia is still not fully known; thus, further investigations of genetic backgrounds is needed. Here, we aimed to identify genetic factors attributing to inguinal hernias and explore the polygenic architecture of which some components are population-specific, while others are more common among populations. METHODS We performed a genome-wide association study (GWAS) on subjects with inguinal hernias using BioBank Japan (BBJ) data with 1,983 cases and 172,507 controls, followed by a trans-ethnic meta-analysis with UK Biobank (UKBB) data. We performed downstream analyses in order to identify the mechanisms underlying inguinal hernias supported by genetic findings. FINDINGS We identified a locus closest to ELN, which encodes elastin, at the GWAS significant level. The trans-ethnic meta-analysis revealed 23 additional significant loci, including five loci newly identified not significant in BBJ or UKBB GWAS: TGFB2, RNA5SP214/VGLL2, LOC646588, HMCN2, and ATP5F1CP1/CDKN3. Downstream analyses revealed the overlap of GWAS significant signals in extracellular components, including elastin fiber formation. We also found a highly shared polygenic architecture across different populations (trans-ethnic genetic-effect correlation = 0•77, standard error = 0•26) and population-specific lead variants in ELN, indicating the critical role of elastin in inguinal hernias. INTERPRETATION We identified a significant locus of the ELN gene in the Japanese population and five additional loci across different populations. Downstream analyses revealed highly shared genetic architectures across populations and highlighted the important roles of extracellular components in the development of inguinal hernias. These findings deepen our understanding of the mechanisms underlying inguinal hernia. FUNDING The Japan Agency for Medical Research and Development (AMED) (Grant Number: JP19km0605001).
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Affiliation(s)
- Keiko Hikino
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan
| | - Masaru Koido
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan; Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokane-dai, Minato-ku, Tokyo 108-8639, Japan
| | - Kohei Tomizuka
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan
| | - Xiaoxi Liu
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan
| | - Takayuki Morisaki
- Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokane-dai, Minato-ku, Tokyo 108-8639, Japan
| | - Yoshinori Murakami
- Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokane-dai, Minato-ku, Tokyo 108-8639, Japan
| | - The Biobank Japan Project
- Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokane-dai, Minato-ku, Tokyo, 108-8639, Japan
| | - Taisei Mushiroda
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama City, Kanagawa, 230-0045, Japan; Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan; The Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
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Enodien B, Taha-Mehlitz S, Bachmann M, Staartjes VE, Gripp M, Staudner T, Taha A, Frey D. Analysis of Factors Relevant to Revenue Enhancement in Hernia Interventions (SwissDRG G09). Healthcare (Basel) 2021; 9:healthcare9070862. [PMID: 34356240 PMCID: PMC8306973 DOI: 10.3390/healthcare9070862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Since diagnosis-related groups (SwissDRG) were established in Switzerland in 2012, small and medium-size hospitals have encountered increasing financial troubles. Even though hernia repair operations are frequent, most hospitals fail to cover their costs with these procedures. Previous studies have focused mainly on analyzing costs and the contributing factors but less on variables that can be positively influenced. Therefore, this study aims to identify the relevant and influenceable factors for revenue growth in hernia repair surgery. Methods: Data from all patients who underwent the SwissDRG G09 surgery for a hernia in 2019 were analyzed. The contribution margin (CM4), as well as any over- or under-coverage, was correlated to case-specific costs. Results: A total of 168 patients received hernia repair surgery with the SwissDRG code G09. The average revenue/loss generated by one procedure was CHF −623.84. Procedures covered by the General Health Insurance (OKP) generated a loss of CHF −830.70 on average, whereas procedures covered by private insurance companies (VVG) generated revenue of CHF +1100 on average. Significant factors impacting the profitability of hernia repair operations were teaching during surgery (p < 0.005), the surgical operating time (p < 0.001), the total anesthesia time (p < 0.001), the number of surgeons present (p = 0.022), the insurance state of patients (p < 0.001), and the type of surgery (p < 0.01 for Lichtenstein’s procedure). Conclusions: This study reveals that hernia repair surgery performed under cost coverage by OKP is generally unprofitable. Our results further imply that the most important and influenceable factors for revenue enhancement are the quality and process optimization of the surgical department. To compensate for this deficit, hospitals should aim to increase the percentage of patients with private health insurance coverage in their procedures. Since outpatient surgery does not provide a valid alternative due to the low reimbursement by insurance companies, the cost efficiency of inpatient hernia repair needs to be increased by process optimization of the surgical department; for instance, by providing specialized hernia teams performing with shorter operation times and high quality.
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Affiliation(s)
- Bassey Enodien
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Stephanie Taha-Mehlitz
- Clarunis University Center for Gastrointestinal and Liver Diseases, 4002 Basel, Switzerland;
| | - Marta Bachmann
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | | | - Maike Gripp
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
| | - Tobias Staudner
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Anas Taha
- Department of Visceral and Thoracic Surgery Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
- Correspondence: ; Tel.: +41-52-266-4021
| | - Daniel Frey
- Department of Surgery, GZO Hospital, 8620 Wetzikon, Switzerland; (B.E.); (M.B.); (M.G.); (D.F.)
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
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Hasegawa S, Ogino N, Kanemura T, Sakao J, Fujii H, Kikkawa H, Tsujie M. Clinical characteristics of inguinal bladder hernias and total extraperitoneal repair. Asian J Endosc Surg 2021; 14:394-400. [PMID: 33084238 DOI: 10.1111/ases.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bladder hernia is relatively rare in cases of inguinal hernia. In some instances, bladder hernia may be treated as inguinal hernia if bladder prolapse is not recognized. Because of the rarity of inguinal bladder hernias, there are no related detailed reports from studies performed at a single institution. In our hospital, patients with suspected inguinal hernia undergo CT in the prone position, enabling the diagnosis of bladder hernia preoperatively. This study aimed to clarify the clinical characteristics of inguinal bladder hernias and consider noteworthy points in their laparoscopic treatment. METHODS This retrospective analysis included data from 32 consecutive patients with bladder hernia in 1126 patients with inguinal hernia. In each patient, the lengths of the hernial orifice and prolapsed bladder were measured on the CT images and intraoperatively. Totally extraperitoneal (TEP) repair was performed in all patients, who were then followed for 1 year postoperatively. RESULTS Inguinal bladder hernia was detected on CT in 32 of 1126 patients (2.8%). Among them, only five (15.6%) had urological symptoms such as pollakiuria or the sensation of residual urine. The 32 patients were classified into three groups according to hernia subtype: intraperitoneal (n = 12, 37.5%), para-peritoneal (n = 15, 46.9%), and extraperitoneal (n = 5, 15.6%). The prolapsed bladder of the extraperitoneal type was significantly shorter than that of the other subtypes. The prolapsed bladders were directly identified in the extraperitoneal space and repaired safely with TEP. One recurrence (3.1%) occurred 2 months postoperatively. CONCLUSION Preoperative CT and TEP are useful for the definitive diagnosis and treatment of inguinal bladder hernia.
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Affiliation(s)
- Shinichiro Hasegawa
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Nobuo Ogino
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Takashi Kanemura
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Jun Sakao
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Hitoshi Fujii
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Hiroyuki Kikkawa
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
| | - Masaki Tsujie
- Department of Surgery, Saiseikai Tondabayashi Hospital, Tondabayashi, Osaka, Japan
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160
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Koyama T, Xiang Z, Nagai T, Komoto M, Osawa N, Fujiwara I. Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair. Asian J Endosc Surg 2021; 14:353-360. [PMID: 33052022 DOI: 10.1111/ases.12869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Peritoneal injury during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is an intraoperative complication that affects accomplishment. We retrospectively examined the causes of peritoneal injury and methods of TEP repair. METHODS This study examined 58 patients with inguinal hernia (43 unilateral, 15 bilateral) who had undergone TEP repair; all procedures were performed by the same surgeon. The incidence of peritoneal injury, clinical characteristics that could have influenced peritoneal injury, and management of the injury were analyzed. RESULTS Peritoneal injury was noted in 16 inguinal hernias (21.9%, 16 /73). Injury occurred more frequently in right-sided hernias than in left-sided hernias (31.6% vs 11.4%, P = .049). No other factors were related to injury. Peritoneal injury occurred due to anatomical misrecognition in five hernias (31.3%, 5/16) and unintentional dissection in six hernias (37.5%, 6/16). All injuries due to unintentional dissection occurred in right-sided hernias. The procedures used for peritoneal injury repair were endoscopic suturing for 4 hernias, pre-tied loop ligation for 1 hernia, and ligation clips in 11 hernias. Additional techniques were required in three hernias repaired by endoscopic suturing (75% 3/4). After introduction of the ligation clips, endoscopic suturing was discontinued, and no additional techniques were needed. CONCLUSION Peritoneal injury more frequently occurred in right-sided inguinal hernia than in left-sided inguinal hernia during TEP repair. The common reasons for peritoneal injury were anatomical misrecognition and unintentional dissection. Repair using ligation clips is the best option for peritoneal injuries that occur during TEP repair.
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Affiliation(s)
- Tsuyoshi Koyama
- Department of Surgery, Meijibashi Hospital, Matsubara, Japan
| | - Zhang Xiang
- Department of Surgery, Moriguchi Ikuno Memorial Hospital, Moriguchi, Japan
| | - Tomohide Nagai
- Department of Surgery, Meijibashi Hospital, Matsubara, Japan
| | - Masahiro Komoto
- Department of Surgery, Meijibashi Hospital, Matsubara, Japan
| | - Naoshi Osawa
- Department of Surgery, Meijibashi Hospital, Matsubara, Japan
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Tazaki T, Sasaki M, Kohyama M, Sugiyama Y, Yamaguchi T, Takahashi S, Nakamitsu A. Laparoscopic transabdominal preperitoneal repair for recurrent groin hernia after failed anterior-posterior repair. Asian J Endosc Surg 2021; 14:470-477. [PMID: 33184994 DOI: 10.1111/ases.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The International Guidelines for Groin Hernia Management recommends an anterior repair after a failed posterior repair, and laparoscopic repair after a failed anterior tissue repair or Lichtenstein repair. However, there are not enough studies to guide decision-making for patients with recurrent hernia patients after combined anterior-posterior repair. We investigate the safety and usefulness of transabdominal preperitoneal repair (TAPP) for recurrent hernia patients after failed anterior-posterior repair. METHODS We conducted a retrospective analysis of 13 consecutive patients with recurrent groin hernia who underwent TAPP after prior anterior preperitoneal mesh repair (that created anterior and posterior scarring) between September 2013 and October 2018. The control group comprised 45 patients who underwent TAPP for recurrent hernia after anterior repair (43 nonmesh repairs and two Lichtenstein repairs). RESULTS There were no intraoperative complications, and chronic pain was not reported by the patients with prior anterior preperitoneal mesh repair. The mean operative time was 113 ± 31.3 minutes, and the mean postoperative stay was 1.62 ± 0.87 days. The Wong-Baker FACES rating scale score for pain on postoperative day 1 was 1.91 ± 1.5; on postoperative day 7, the score was 1.0 ± 0.89. None of these findings was significantly different from the findings in patients who had a prior anterior repair. A single patient experienced a further recurrence and underwent repeat TAPP. CONCLUSIONS The use of TAPP after failed combined anterior-posterior mesh repair may be feasible and safe for recurrent groin hernia. Further study is needed to determine long-term outcomes.
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Affiliation(s)
- Tatsuya Tazaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Masaru Sasaki
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Mohei Kohyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yoichi Sugiyama
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takuro Yamaguchi
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsushi Nakamitsu
- Department of Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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162
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Lakshmikantha N, Lakshman K. Bilateral Quadruple Groin Hernia—a Rare Case Report of Eight Groin Hernias in a Single Patient. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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163
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Xu X, Zhan M, Li X, Chen T, Yang L. In vivo Analysis of the Resistance of the Meshes to Escherichia coli Infection. Front Surg 2021; 8:644227. [PMID: 34250004 PMCID: PMC8264128 DOI: 10.3389/fsurg.2021.644227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/26/2021] [Indexed: 01/17/2023] Open
Abstract
Background: The mesh infection is mostly related to the gram-negative bacteria, such as Escherichia coli (E. coli) for emergency surgery of incarcerated hernia. However, few study investigated the effects of E. coli concentration, mesh materials and antibiotic prophylaxis on mesh infection after hernioplasty. The aim of this study was to evaluate the bacterial resistance to E. coli for three different materials of mesh, and to measure the minimum E. coli concentration for mesh infection with and without antibiotic prophylaxis in a rat model. Methods: Three types of mesh (polytetrafluoroethylene, polypropylene, and biologic meshes) were used in the repair of an acute ventral hernia rat model in the setting of different concentrations of E. coli loads and antibiotics. At the 8th day after surgery, mesh samples were sent for microbiologic and histologic analyses. Results: The positive rates of bacterial culture increased with E. coli concentration. The biologic mesh showed better bacterial resistance compared to polytetrafluoroethylene mesh and polypropylene mesh when the concentration of E. coli ranges from 106 CFU/ml to 108 CFU/ml (P = 0.002 and P = 0.029, respectively). Prophylactical ceftriaxone treatment could not decrease the colonization rate of E. coli at 106 CFU/ml or 108 CFU/ml in each group (P > 0.05). The scores of neovascularization in polypropylene mesh and biologic mesh were similar, which was higher than that of polytetrafluoroethylene mesh (P < 0.05). Compared with other meshes, biologic mesh showed better tolerance to 106 CFU/ml E. coli with respect to inflammation, depth of inflammation, neovascularization, cellular repopulation and foreign body giant cells. Conclusion: The biologic mesh had better E. coli resistance compared to polytetrafluoroethylene mesh and polypropylene mesh when the E. coli concentration is higher than 106 CFU/ml in rats. Antibiotic prophylaxis was useful when the contamination was not particularly severe.
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Affiliation(s)
- Xinsen Xu
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhan
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinxing Li
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Tao Chen
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Linhua Yang
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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Comment on: New Persistent Opioid Use After Inguinal Hernia Repair. Ann Surg 2021; 274:e897. [PMID: 34171858 DOI: 10.1097/sla.0000000000004854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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165
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Zacharakis D, Prodromidou A, Douligeris A, Hadzilia S, Kathopoulis N, Athanasiou S, Grigoriadis T. Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta-analysis. Neurourol Urodyn 2021; 40:1304-1332. [PMID: 34146436 DOI: 10.1002/nau.24691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
AIMS The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA). METHODS A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible. RESULTS Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. CONCLUSIONS LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.
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Affiliation(s)
- Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Anastasia Prodromidou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Athanasios Douligeris
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Sofia Hadzilia
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themos Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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Skolimowska-Rzewuska M, Mitura K. Essential anatomical landmarks in placement of an adequate size mesh for a successful ventral hernia repair. POLISH JOURNAL OF SURGERY 2021; 93:1-5. [PMID: 34552025 DOI: 10.5604/01.3001.0014.9349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Safe and effective hernia repair requires a surgeon to have the appropriate knowledge necessary to learn details of the surgical technique. Long-term results of treatment, even with the use of synthetic implants, have shown that recurrences were still a significant clinical problem concerning up to every fourth patient. Therefore, it was pointed out that the mere presence of synthetic material is not a solitary circumstance sufficient for a successful repair. A key finding in recurrence prevention has been to focus surgeons' attention on the relationship between the size of the hernia orifice and the mesh surface. An optimal ratio of these values has not been established yet, however, it is considered that the mesh surface area should be at least sixteen times larger than the area of the abdominal wall defect. In cases of medium and large hernias, in order to place an extensive mesh sheet in the appropriate anatomical space of the abdominal wall, an extensive dissection needs to be performed, including several different compartments. Therefore, a surgeon undertaking a hernia repair needs to know perfectly the anatomy and function of all the myofascial structures involved. Performing an incorrect dissection of a mistaken structure may lead to catastrophic abdominal deformities. Depriving the patient of the natural support of the abdominal wall provided by the muscles may lead to total or partial destabilization of the trunk and lead to disability. In this paper a detailed description of anatomical structures and its practical use has been presented.
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Affiliation(s)
| | - Kryspin Mitura
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Poland
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167
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Varga M, Köckerling F, Mayer F, Lechner M, Fortelny R, Bittner R, Borhanian K, Adolf D, Bittner R, Emmanuel K. Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair? Surg Endosc 2021; 35:2953-2964. [PMID: 32556698 DOI: 10.1007/s00464-020-07736-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date. METHODS In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques. RESULTS The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs). CONCLUSION In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.
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Affiliation(s)
- M Varga
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - M Lechner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Fortelny
- Sigmund Freud Medical University, Vienna, Austria
| | - R Bittner
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Borhanian
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenow University), Trubetskaya Street 8, b. 2., Moscow, Russia, 119992
| | - K Emmanuel
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
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168
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Faessen J, Schoemakers B, VAN Veenendaal N, Visschers R, Hoofwijk A, Stoot J. Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital. Minerva Surg 2021; 76:271-280. [PMID: 34080822 DOI: 10.23736/s2724-5691.21.08589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited. METHODS A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates. RESULTS Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min±17.2 vs. 71.9 min±19.9, P<0.001) and lower total costs (€ 974.51±266.67 vs. € 1165.32±285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8±13.4 min vs. 34.5±16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9±16.6 min vs. 41.7±18.7 min, P<0.001) and higher total costs in the unilateral open procedure (€ 1007.47±238.58 vs. € 909.35±305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons. CONCLUSIONS Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.
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Affiliation(s)
- Jelle Faessen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands -
| | - Bob Schoemakers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | | | - Ruben Visschers
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton Hoofwijk
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Jan Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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169
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Martín Duce A, Lozano O, Galván M, Muriel A, Villeta S, Gómez J. Results of Shouldice hernia repair after 18 years of follow-up in all the patients. Hernia 2021; 25:1215-1222. [PMID: 34009507 DOI: 10.1007/s10029-021-02422-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Evaluate the long-term efficacy of the Shouldice technique performed by non-specialized surgeons and also to reflex on the quality parameters necessary to safely assess hernia recurrence rates. METHODS During 3 years, a prospective study was conducted in 243 adult men who underwent surgery for primary inguinal hernias by 13 junior surgeons with an interest in hernia surgery. Using local anesthesia, a classic 4 step Shouldice repair, with polypropylene or polyester, was performed. All patients were followed for 18 years. The follow-up met the nine quality criteria proposed by the authors. RESULTS At 18 years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10 years, 5 of them secondary to a direct hernia, and the same after 18 years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3 years, the pain was considered moderate or severe in 4 patients (1.8%). CONCLUSIONS It is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30 years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia.
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Affiliation(s)
- A Martín Duce
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain. .,Department of General Surgery, Príncipe de Asturias University Hospital, Madrid, Spain.
| | - O Lozano
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - M Galván
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - A Muriel
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain.,Biostatistics Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Ramón y Cajal University Hospital, Madrid, Spain
| | - S Villeta
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
| | - J Gómez
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
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170
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Intraoperative handling of spermatic cord lipomas during inguinal hernia repair: a nationwide survey. Hernia 2021; 25:1331-1337. [PMID: 33993347 DOI: 10.1007/s10029-021-02425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cord lipomas can clinically resemble groin hernias and missed cord lipomas can potentially result in persistent symptoms. However, no international guideline exists concerning the management of cord lipomas found during inguinal hernia surgery. This study aimed to gain insight into how surgeons typically manage cord lipomas found during inguinal hernia surgery. METHODS A questionnaire was sent to all general surgeons in Denmark performing unsupervised laparoscopic inguinal hernia repair and Lichtenstein repair. The survey contained questions about demographic details and questions about how surgeons would handle cord lipomas. The questionnaire was created by the research team and face-validated on general surgeons. RESULTS A total of 58 surgeons (60%) responded to the questionnaire. The majority agreed that cord lipomas should not be left untouched. During laparoscopic repairs, 53% of the surgeons recommended that cord lipomas should be resected and removed if the anatomical circumstances allowed it. During Lichtenstein repair, the surgeons recommended that cord lipomas should always be resected and removed (49%) or that resection should depend on the size of the lipoma (44%). CONCLUSION When asking surgeons about their preferred handling of cord lipomas, they answered that the management of cord lipomas found during inguinal hernia surgery depends on anatomical circumstances such as the pedicle appearance, the lipoma mobility, and its size. If the cord lipoma is left untouched, the patients' hernia resembling symptoms could persist, why the surgeons predominantly preferred to resect and remove cord lipomas.
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171
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Mesh repair for lateral inguinal hernias: a non-evidence-based practice. Hernia 2021; 25:1183-1187. [PMID: 33983568 DOI: 10.1007/s10029-021-02423-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The EHS clinical guidelines recommend the use of mesh to repair symptomatic primary inguinal hernias (PIH) in adult males but, in spite of this, it begs the question as to why there is still place for tissue techniques. Lack of stratification of patients according to risk of recurrence in RCTs might be a cause of results disparity, since medial and mixed are hernias with higher risk of recurrence (HRRH), whereas lateral hernias present a lower risk (LRRH). OBJECTIVE To determine whether the lack of stratification may lead to questionable conclusions regarding the protective effect of mesh techniques and to identify other methodological flaws. METHODS In the RCTs included in the clinical guidelines that addressed recurrences of PIH after mesh and non-mesh techniques, we assessed the type of hernias classification used, the number needed to treat in LRRH and HRRH and the statistical power. RESULTS Most of trials were underpowered; five studies classified the hernia types; in the three studies that compared the recurrence rates of LRRH and HRRH the effect of mesh techniques was small; only two trials record data needed to calculate the NNT in LRRH (46 y 84 patients, respectively). CONCLUSION The idea that mesh techniques reduce the recurrence rate in all PIHs is not supported by high level of evidence. The NNT for pure lateral hernias was very high and should be interpreted taking into account chronic pain rates and costs.
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172
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Ferahman S, Donmez T, Surek A, Akarsu C, Aydin H, Cayirci CE, Emir NS, Karabulut M. Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia. Surg Laparosc Endosc Percutan Tech 2021; 31:571-577. [PMID: 33935260 DOI: 10.1097/sle.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations. MATERIALS AND METHODS This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n=77), SA (n=70), and EA (n=74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated. RESULTS Anesthesia time was the longest in the EA group (23.1±2.32 min) and significantly prolonged the operation time (P<0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P<0.001). While the rates of hypotension and headache were higher in regional anesthesia (P<0.001 and P<0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P=0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P<0.001). CONCLUSION Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.
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Affiliation(s)
| | | | | | | | | | | | - Nalan S Emir
- Anesthesiology, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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173
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Towfigh S. Reviewing the Interaction Between Cost, Quality, and Outcomes for Safe and Effective Hernia Repair: Which Technique Is Best? J Am Coll Surg 2021; 232:763-764. [PMID: 33896479 DOI: 10.1016/j.jamcollsurg.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
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174
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Rutegård M, Lindqvist M, Svensson J, Nordin P, Haapamäki MM. Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh. Br J Surg 2021; 108:138-144. [PMID: 33711123 PMCID: PMC10364858 DOI: 10.1093/bjs/znaa049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain. METHODS An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9-12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat. RESULTS A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group. CONCLUSION A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - M Lindqvist
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - J Svensson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences, Surgery, Östersund Research Unit, Umeå University, Östersund, Sweden
| | - M M Haapamäki
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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175
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Giddings HL, Fenton-Lee D. Australian general surgical trainee experience with inguinal hernia surgery: a review of international training programmes and the learning curve. ANZ J Surg 2021; 91:1138-1142. [PMID: 33908142 DOI: 10.1111/ans.16897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no publications addressing the level of experience Australian surgical trainees achieve in inguinal hernia surgery. Internationally, some training boards have set minimum competency requirements, but this is not true in Australia. The longer learning curve for laparoscopic inguinal hernia repairs (LIHRs) compared to open inguinal hernia repairs (OIHRs) has placed greater demands on trainees. METHODS Logbook data on OIHR and LIHR for Australian surgical trainees who graduated as fellows between 2013 and 2018 were obtained. A literature review was performed to analyse international published logbook numbers for surgical trainees from the past decade. International training board requirements, estimations of the learning curve and hernia society guidelines for each procedure were reviewed. RESULTS In total, 7946 operations were recorded from 58 trainees. On average 49.2 OIHRs (range 13-101), 21.5 LIHRs (range 1-94) and 71.1 inguinal hernia repairs overall (range 25-129) were performed during training. The European Hernia Society recommends that at least 30-50 of each procedure be performed during training. The learning curves for LIHRs (50-100 procedures) have been shown to be longer than for OIHRs (40-64 procedures). CONCLUSION Australian general surgical trainees are achieving adequate primary operator logbook numbers for OIHRs but are not completing the required number of LIHRs. The tailored approach to inguinal hernia repair requires skill in both open and laparoscopic repairs. This may not be possible with the current training structure in Australia.
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Affiliation(s)
- Hugh L Giddings
- Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Douglas Fenton-Lee
- Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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176
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Habib Bedwani NAR, Kelada M, Smart N, Szydlo R, Patten DK, Bhargava A. Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials. Br J Surg 2021; 108:14-23. [PMID: 33640918 DOI: 10.1093/bjs/znaa002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. METHODS A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. RESULTS Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). CONCLUSION Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
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Affiliation(s)
- N A R Habib Bedwani
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - M Kelada
- Imperial College School of Medicine, Imperial College London, London, UK
| | - N Smart
- Department of General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Gastrointestinal Surgery, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - R Szydlo
- Imperial College School of Medicine, Imperial College London, London, UK
| | - D K Patten
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Imperial College School of Medicine, Imperial College London, London, UK.,Deparment of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK
| | - A Bhargava
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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177
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Williams ML, McCarthy ASE, Lord SJ, Aczel T, Brooke-Cowden GL. Impact of ultrasound on inguinal hernia repair rates in Australia: a population-based analysis. ANZ J Surg 2021; 91:1604-1609. [PMID: 33870618 DOI: 10.1111/ans.16845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/09/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice. METHODS Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001-2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables. RESULTS Over the 18-year period, GU rates increased 13-fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182-146 per 100 000), bilateral IHRs have increased (35-46 per 100 000), laparoscopic IHR has increased (30-86 per 100 000) and open surgery has declined (187-106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = -0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001). CONCLUSION The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.
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Affiliation(s)
- Michael L Williams
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | | | - Sally J Lord
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Thomas Aczel
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Hawkesbury Hospital, Sydney, New South Wales, Australia
| | - Geoffrey L Brooke-Cowden
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Auburn Hospital, Sydney, New South Wales, Australia
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178
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Guillaumes S, Hoyuela C, Hidalgo NJ, Juvany M, Bachero I, Ardid J, Martrat A, Trias M. Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach. Hernia 2021; 25:1345-1354. [PMID: 33837883 DOI: 10.1007/s10029-021-02402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study is to evaluate the laparoscopic inguinal hernia repair (IHR) rate in Spain and identify the factors associated with the choice of this surgical approach. METHODS A retrospective cohort study of 263,283 patients who underwent IHR from January 2016 to December 2018 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary outcome was laparoscopic (LAP) rate utilization. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with LAP-IHR. RESULTS Only 5.7% (15,059) patients underwent LAP-IHR, whereas the remnant 94.3% (248,224 patients) underwent open repair. High variability in the LAP-IHR rate across the country was observed; ranged between provinces from 0 to 19.7%, for a unilateral hernia, and between 0 to 57.4% in the case of bilateral hernias. On multivariate logistic regression analysis, the patient place of residence was the most remarkable factor associated with the likelihood of receiving LAP-IHR (OR 4.96; p < 0.001). There were also significant differences favoring LAP-IHR for bilateral operation (OR 4.596; p < 0.001), insurance coverage (OR 4.439, p < 0.001) and self-pay patients (OR 2.317; p < 0.001), as well as a recurrent hernia (OR 1.780; p < 0.001), age younger than 65 years (OR 1.555; p < 0.001) and male sex (OR 1.162, p < 0.001). CONCLUSION LAP-IHR remains a not frequent choice among surgeons in Spain, even when dealing with recurrent and bilateral hernias. The results suggest that the choice of LAP-IHR could depend on the surgeon's preference rather than on the indication appropriateness.
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Affiliation(s)
- S Guillaumes
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.
| | - C Hoyuela
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - N J Hidalgo
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - I Bachero
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
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179
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Hagiwara K, Hayashi S, Suzuki T, Song K, Takayama T. Urinary bladder fistula following laparoscopic inguinal hernioplasty: a case report. BMC Surg 2021; 21:183. [PMID: 33827542 PMCID: PMC8028706 DOI: 10.1186/s12893-021-01183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention. Case presentation A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient’s clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period. Conclusions We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient’s condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.
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Affiliation(s)
- Ken Hagiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Shigeoki Hayashi
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takeki Suzuki
- Department of Surgery, Toride Medical Association Hospital, Ibaraki, Japan
| | - Keio Song
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
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180
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Kim SH, Jung HS, Park S, Cho SS. Inguinal hernia repair with or without mesh in late adolescent males. Ann Surg Treat Res 2021; 100:246-251. [PMID: 33854994 PMCID: PMC8019987 DOI: 10.4174/astr.2021.100.4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Inguinal hernia repair is one of the most common treatments worldwide, but there are few studies about the use of mesh in late adolescent patients because hernias are rare in this group. This study aimed to evaluate the postoperative outcomes of hernia repair with and without mesh in late adolescent patients. Methods We retrospectively reviewed the data of 243 male patients aged between 18 and 21 years who underwent inguinal hernia repair at a single institution from January 2013 to December 2017. We distinguished 2 groups depending on the repair method; mesh (n = 121) and no-mesh (n = 122) groups. We compared the baseline characteristics, immediate postoperative outcomes, and recurrence and chronic pain rates between the 2 groups. Results There were no significant differences between the mesh and no-mesh groups on immediate postoperative outcomes (length of stay: 18.5 ± 8.9 days vs. 17.0 ± 6.0 days, P = 0.139; postoperative complications: 8.2% vs. 6.6%, P = 0.821) and 2-year recurrence rate (0.8% vs. 2.6%, P = 0.194). There was a significant difference in the chronic pain rate (9.0% vs. 1.7%, P = 0.023). Conclusion Using mesh for inguinal hernia repair in late adolescent male patients increases chronic postoperative inguinal pain.
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Affiliation(s)
- Sung Hyun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea.,Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Sung Jung
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sejin Park
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Sik Cho
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea.,Department of Surgery, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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181
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Raguz I, Burger R, Vonlanthen R, Bueter M, Thalheimer A. Pitfalls of laparoscopic Re-TAPP in recurrent inguinal hernia repair-a plea for extended preoperative diagnostic. J Surg Case Rep 2021; 2021:rjab085. [PMID: 33815757 PMCID: PMC8007179 DOI: 10.1093/jscr/rjab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 11/14/2022] Open
Abstract
According to international guidelines, recurrent inguinal hernia should be treated by a surgical approach opposing of the primary strategy (anterior–posterior or posterior–anterior). However, recent evidence demonstrates feasibility and safety of re-laparoscopic repair of recurrent inguinal hernia after primary laparoscopy. For such a strategy, correct identification of anatomical structures is challenging, but absolutely crucial for a satisfactory postoperative result. This case of an unrecognized sliding hernia of the sigmoid colon during re-laparoscopy highlights that a precise physical examination as well as an extended preoperative radiological workup (ultrasound, computed tomography and/or magnetic resonance imaging of the abdomen and pelvis) should be considered prior to re-laparoscopy of recurrent inguinal hernia.
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Affiliation(s)
- Ivana Raguz
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Reint Burger
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Rene Vonlanthen
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Marco Bueter
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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182
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Comment on: "Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair". Hernia 2021; 25:1399-1400. [PMID: 33768352 DOI: 10.1007/s10029-021-02386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
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183
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Forester B, Attaar M, Lach M, Chirayil S, Kuchta K, Denham W, Linn JG, Haggerty SP, Carbray J, Ujiki M. Inguinal hernia mesh is safe in 1720 patients. Surg Endosc 2021; 36:1609-1618. [PMID: 33763744 DOI: 10.1007/s00464-021-08442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is substantial media and patient interest in the safety of mesh for hernia repair. However, there is a lack of data regarding health-related quality of life (HRQOL) outcomes in patients who undergo inguinal hernia repair (IHR) with mesh. The purpose of this study is report short and long-term postoperative quality of life outcomes in patients following IHR with mesh. METHODS We analyzed outcomes of 1720 patients who underwent IHR with mesh between 2008 and 2019 at a single institution from a prospectively maintained quality database. All surgeries were performed by four board-certified surgeons. HRQOL outcomes were measured using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys that were administered preoperatively, 3 weeks, 6 months, 1, 2, and 5 years postoperatively. Survey responses were summarized as mean with standard deviation or frequency with percentage. Postoperative SOMS scores were compared to preoperative scores using the two-tailed paired t test with a significance level of p < 0.05. RESULTS One (0.1%) patient experienced a mesh infection postoperatively. In terms of complications, 159 (9.2%) developed a seroma, 31 (1.8%) a hematoma, and 36 (2.1%) patients experienced a recurrence. SOMS Pain Impact, SOMS Pain Quality, and SOMS Pain visual analog scale at 3 weeks, 6 months, 1 year, 2 years, and 5 years were all improved from preoperative (all p < 0.05). At 5 years postoperatively, only 3.9%, 3.2%, and 3.1% of patients reported severe or disabling sensation of mesh, pain, and movement limitations, respectively. CONCLUSION Inguinal hernia repair with mesh results in a low rate of complications. A minority of patients had severe or disabling symptoms at 5-year follow-up and generally reported improvements in pain impact and quality in long-term follow-up.
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Affiliation(s)
- Beau Forester
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Mikhail Attaar
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Maya Lach
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Sebastian Chirayil
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Kristine Kuchta
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Woody Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John G Linn
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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184
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Martínez-Hoed J, Cordero-Bermúdez K, García-Pastor P, Pous-Serrano S, Ortiz-Cubero JA. The inguinal hernia management in Costa Rica according to a survey between surgeons: result comparison with 2018 International Groin Hernia Guidelines. BMC Surg 2021; 21:152. [PMID: 33743667 PMCID: PMC7981829 DOI: 10.1186/s12893-021-01156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. Purpose Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline’s recommendations. Method Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed
to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June–December 2019. Results 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein’s technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. Conclusions The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica’s national situation. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01156-9.
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Affiliation(s)
- Jesús Martínez-Hoed
- General Surgery Department, R. A. Calderón Guardia Hospital, San José, Costa Rica. .,Integrated Group for Complex Hernia Treatment, Calderón Guardia Hospital, San José, Costa Rica. .,General Surgery, Metropolitan Hospital, San José, Costa Rica. .,Costa Rica Hernia Association, San José, Costa Rica.
| | - Katherine Cordero-Bermúdez
- General Surgery Department, R. A. Calderón Guardia Hospital, San José, Costa Rica.,Costa Rica Hernia Association, San José, Costa Rica.,General Surgery, Clínica Bíblica Hospital, San José, Costa Rica
| | - Providencia García-Pastor
- General Surgery At Hospital Politécnico y Universitario La Fe, Valencia, Spain.,Short Stay and Wall Surgery Unit, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Salvador Pous-Serrano
- General Surgery At Hospital Politécnico y Universitario La Fe, Valencia, Spain.,Short Stay and Wall Surgery Unit, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - José A Ortiz-Cubero
- General Surgery Department, R. A. Calderón Guardia Hospital, San José, Costa Rica.,Integrated Group for Complex Hernia Treatment, Calderón Guardia Hospital, San José, Costa Rica
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185
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Tomaoglu K, Okmen H. Prosthetic mesh hernioplasty versus primary repair in incarcerated and strangulated groin and abdominal wall hernias with or without organ resection. Retrospective study. Langenbecks Arch Surg 2021; 406:1651-1657. [PMID: 33733286 DOI: 10.1007/s00423-021-02145-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and strangulated abdominal wall hernias with or without organ resection. METHODS Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary hernia repair (group II). The outcome of patients was observed for a mean follow-up period of 18.2 months. Categorical data were analyzed with the χ2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical analyses were realized with SPSS, version 18. P values < 0.05 were considered statistically significant. For multiple comparisons between types of hernia, the significance level was set to P < 0.0083 according to Bonferroni adjustment. RESULTS Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17-92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not. CONCLUSION Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the limited number of cases of the present study.
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Affiliation(s)
- Kamer Tomaoglu
- Faculty of Health Sciences, Department of General Surgery, School of Medical Sciences, Esenyurt University, Istanbul, Turkey.
| | - Hasan Okmen
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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186
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Sadava EE, Novitsky YW. Simulation in Hernia Surgery: Where Do We Stand? J Laparoendosc Adv Surg Tech A 2021; 31:551-555. [PMID: 33691482 DOI: 10.1089/lap.2021.0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Simulation seems to be the best method of improving medical attitude, technical skills, and operating times. A literature review of the available data in simulation for hernia surgery was performed. Surgical simulation has been included as a main requirement in residency programs and endorsed by several surgical societies. However, evaluating how simulation affects patient's outcomes is challenging. In addition, simulation training represents an institutional economic burden that could undermine its implementation and development. Published data support that simulation-based training is a highly efficient tool, thus, its implementation should be strongly encouraged.
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Affiliation(s)
- Emmanuel E Sadava
- Division of Abdominal Wall Surgery, Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Yuri W Novitsky
- Comprehensive Hernia Center, Columbia University Medical Center, New York, New York, USA
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187
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Edgerton C, Heshmati K, Herman A, Dey T, Dehkharghani R, Ramsis R, Robinson M, Vernon A, Ghushe N, Spector D, Shikora S, Tavakkoli A, Sheu EG. Fellowship training influences learning curves for laparoscopic sleeve gastrectomy. Surg Endosc 2021; 36:1601-1608. [PMID: 33620566 DOI: 10.1007/s00464-021-08372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure. Little is known about how surgeon training background influences the learning curve of this procedure. We examined operating times (OT), weight loss outcomes, and 30-day complications between surgeons with and without fellowship training in LSG. We hypothesize that post-residency training specific to LSG influences learning curves. METHODS Surgeons from a single institution were split into two groups: those who had not completed fellowship training in LSG (NF, n = 3), and those who had completed LSG specific training in fellowship (SGF, n = 3). OTs, BMI changes at 1 year, and 30-day readmissions, reoperations, and complications were extracted for the first 100 LSG cases of each surgeon. Data were analyzed in bins of 20 cases. Comparisons were made between cohorts within a bin and between adjacent bins of the same surgeon cohort. Logistic regression analyses were performed of OT and weight loss outcomes. RESULTS SGF surgeons showed no difference in OTs over their first 100 cases. NF surgeons had statistically significant increased OTs compared to SGF surgeons during their first 60 cases and progressively shortened OTs during that interval (109 min to 78 min, p < 0.001 for NF surgeons vs. 73 min to 69 min, SGF surgeons). NF surgeons had a significantly steeper slope for improvement in OT over case number. There was no correlation between case number and weight loss outcomes in either group, and no differences in 30-day outcomes between groups. CONCLUSION Surgeons who trained to perform LSG in fellowship demonstrate faster and consistent OR times on their initial independent LSG cases compared to surgeons who did not, with no correlation between case number and weight loss outcomes or safety profiles for either group. This suggests that learning curves for LSG are achieved during formal case-specific fellowship training.
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Affiliation(s)
- Colston Edgerton
- Division of Gastrointestinal Surgery, Center for Metabolic and Bariatric Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Keyvan Heshmati
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ashley Herman
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Tanujit Dey
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Robab Dehkharghani
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ramsis Ramsis
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Malcolm Robinson
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ashley Vernon
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Neil Ghushe
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - David Spector
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Scott Shikora
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ali Tavakkoli
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Eric G Sheu
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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188
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Kykalos S, Machairas N, Ntikoudi E, Dorovinis P, Molmenti EP, Sotiropoulos GC. Inguinal Hernias in Cirrhotic Patients: From Diagnosis to Treatment. Surg Innov 2021; 28:620-627. [PMID: 33599535 DOI: 10.1177/1553350621995058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cirrhosis has a strong association with abdominal wall hernias, especially in the presence of concomitant ascites. Major predisposing factors for hernia formation in this particular group of patients include increased intra-abdominal pressure and decreased muscle mass due to poor nutrition. Management of these patients is highly challenging and requires an experienced multidisciplinary surgical and medical approach. The aim of our review is to clarify crucial diagnostic and management approaches. Crucial medical and technical issues on this topic are widely discussed with special focus on indication, timing, and type of surgical repair, with an additional reference to the actual role of laparoscopy.
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Affiliation(s)
- Stylianos Kykalos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Nikolaos Machairas
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | | | - Panagiotis Dorovinis
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Ernesto P Molmenti
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Georgios C Sotiropoulos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Incidence and Risk Factors for Long-Term Mesh Explantation Due to Infection in More than 100,000 Hernia Operation Patients. J Am Coll Surg 2021; 232:872-880.e2. [PMID: 33601005 DOI: 10.1016/j.jamcollsurg.2020.12.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infectious complications after hernia operation are potentially disastrous, often requiring long-term antibiotic administration, debridement, and mesh explantation. Our objective was to describe the long-term incidence and risk factors for synthetic mesh explantation due to infection after hernia operation in a large cohort. STUDY DESIGN Retrospective database study using Veterans Affairs Surgical Quality Improvement Program and chart review of veterans undergoing abdominal or groin hernia repair with synthetic mesh implantation during 2008-2015. The main outcome was mesh explantation due to infection within 5 years. RESULTS The study population consisted of 103,869 hernia operations, of which 74.3% were inguinal, 10.7% umbilical, and 15.0% ventral. Explantation incidence was highest among ventral (1.5%). Median explantation interval overall was 208 days. In multivariable logistic regression, all obesity levels from pre-obesity to obesity class III were associated with higher explantation risk. American Society of Anesthesiology physical status classification of 3 to 5 was associated with odds ratio (OR) of 1.7 (95% CI, 1.28 to 2.26), as was longer operative duration (OR 1.83; 95% CI, 1.51 to 2.21), and contaminated or dirty surgical wound classification (OR 2.27; 95% CI, 1.11 to 4.64). Umbilical repair (OR 6.11; 95% CI, 4.14 to 9.02) and ventral repair (OR 14.35; 95% CI, 10.39 to 19.82) were associated with higher risk compared with inguinal. Open repair was associated with a higher risk compared with laparoscopic (OR 3.57; 95% CI, 2.52 to 5.05). Deep incisional surgical site infection within 30 days of operation was more likely to result in long-term mesh explantation (29.2%) than either superficial (6.4%) or organ space infection (22.4%). CONCLUSIONS Mesh explantation for infection is most common after ventral hernia repair. Risk factor optimization is crucial to minimize such an end point.
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Affiliation(s)
| | - William J O'Brien
- Department of Surgery, Boston, MA; Center for Organization and Implementation Research, Boston, MA
| | | | - Kamal M F Itani
- Department of Surgery, Boston, MA; Veterans Affairs Boston, Department of Surgery, Boston University, Boston, MA; Harvard Medical School, Boston, MA.
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190
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Gang S, Kim MJ, Park JW, Ryoo SB. Laparoscopic removal of mesh migrating into the sigmoid colon after totally extraperitoneal (TEP) laparoscopic inguinal hernia repair with positive faecal occult blood test. BMJ Case Rep 2021; 14:14/2/e237167. [PMID: 33542008 PMCID: PMC7868236 DOI: 10.1136/bcr-2020-237167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.
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Affiliation(s)
- Sujin Gang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Seoul National University Cancer Research Institute, Seoul, Korea (the Republic of)
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of),Seoul National University Cancer Research Institute, Seoul, Korea (the Republic of)
| | - Seung-Bum Ryoo
- Seoul National University Cancer Research Institute, Seoul, Korea (the Republic of),Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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191
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Razafinimanana M, Aoun O, Durond S, Pasquier P, Kassi F, Malgras B. Relevance of Antibiotic Prophylaxis in Non-Mesh Inguinal Hernia Repair in Remote and Poor Medical Settings in Sub-Saharan Africa. Surg Infect (Larchmt) 2021; 22:752-756. [PMID: 33538650 DOI: 10.1089/sur.2020.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Because of the poor local medical conditions, and because the surgical site infection (SSI) rate after hernia repair in sub-Saharan Africa is higher than in developed countries, deployed surgeons within Role 2 usually perform non-mesh inguinal herniorrhaphy. Regarding antimicrobial prophylaxis, the latter currently is not recommended in non-mesh inguinal hernia repairs. Our study aimed at assessing the relevance of antibiotic prophylaxis in non-mesh inguinal hernia repair within a Role 2 surgical structure deployed in sub-Saharan Africa. Methods: From January 1 to December 31, 2019, we conducted a non-randomized prospective study in a French Role 2 military surgical structure deployed to Abidjan, Republic of Côte d'Ivoire. We included all patients presenting with uncomplicated inguinal hernia. All subjects underwent open herniorrhaphy through a groin incision. The primary endpoint was the occurrence of an SSI. Results: We recorded 120 open hernia repairs. Antimicrobial prophylaxis was administered in 70 interventions (60%). An SSI was reported in 13 cases (11%). Multivariable logistic regression analysis of SSI occurrence, according to the administration of intra-operative antimicrobial prophylaxis, showed a 0.219 odds ratio with a 95% confidence interval of 0.05-0.84 and p = 0.028. This finding was in favor of its significant protective effect on the risk of SSI after open non-mesh inguinal hernia repair, taking into account the American Society of Anesthesiologists score, Body Mass Index, and recurrence status. Conclusion: Administration of intra-operative antimicrobial prophylaxis in open non-mesh inguinal hernia repair in remote and poor medical settings, for example during deployment conditions as in our study, was associated with a reduction of the SSI rate.
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Affiliation(s)
- Meva Razafinimanana
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France
| | - Olivier Aoun
- 5th Armed Forces Medical Center, Strasbourg, France
| | - Sandrine Durond
- French Military Center for Epidemiology and Public Health, Marseille, France
| | - Pierre Pasquier
- Department of Anesthesiology and Intensive Care, Percy Military Training Hospital, Clamart, France.,French Military Medical Academy, Ecole du Val-de-Grâce, Paris, France
| | - Fulgence Kassi
- Department of Digestive and General Surgery, Cocody Teaching Hospital, Abidjan, République de Côte d'Ivoire
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.,French Military Medical Academy, Ecole du Val-de-Grâce, Paris, France
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192
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Li WM, Sun YB, Li YJ, Xu PY, Xu QW, Ding LL. A randomised controlled study on the effects of hernial sac stump fenestration on ultrasound seroma prevention in laparoscopic Type III inguinal hernia repair. J Minim Access Surg 2021; 18:25-30. [PMID: 33605930 PMCID: PMC8830572 DOI: 10.4103/jmas.jmas_185_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The incidence of ultrasound seromas has significantly increased after large hernial sac surgery. Several methods are available for preventing ultrasound seromas, but the clinical results are poor. It has also been demonstrated that hernial sac stump fenestration during laparoscopic incisional hernia repair surgery can significantly decrease the incidence of ultrasound seromas. Materials and Methods Ninety patients aged 18-75 years who were treated in our hospital for primary Type III indirect inguinal hernia from March 2017 to March 2018 were randomised to a preventive fenestration group and a control group. All patients underwent transabdominal preperitoneal repair. The number of ultrasound seromas in the inguinal regions and ultrasound seroma volume on day 6 and months 1 and 3 after surgery in the two groups were compared. The secondary outcomes included length of surgery, urinary retention, acute pain, chronic pain, length of hospitalisation, recurrence rate and other complications. Results There were no significant differences in demographic characteristics. Ultrasound seroma incidence and ultrasound seroma volume on day 6 and months 1 and 3 after surgery were significantly lower in the preventive fenestration group than that in the control group. There were no significant differences in the length of hospitalisation or incidence of acute pain or urinary retention between the two groups. Conclusions Hernial sac stump fenestration after hernial sac transection in inguinal hernia repair surgery is a simple method that can effectively reduce post-operative ultrasound seromas.
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Affiliation(s)
- Wei-Ming Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yan-Bo Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yi-Jun Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Peng-Yuan Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Qing-Wen Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Li-Li Ding
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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193
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Cyanoacrylate Glue Versus Absorbable Tacks in Mesh Fixation for Laparoscopic Extraperitoneal Inguinal Hernia Repair: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2021; 31:291-297. [PMID: 34047299 DOI: 10.1097/sle.0000000000000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cyanoacrylate glue (Glubran 2) is a synthetic adhesive mesh fixation material. Its utility is being evaluated in laparoscopic total extraperitoneal (TEP) inguinal hernia repair (IHR). A multicentre randomized controlled trial was performed comparing Glubran 2 to standard of care absorbable tacks, particularly assessing chronic postoperative inguinal pain and its effects. MATERIALS AND METHODS Patients undergoing elective TEP IHR at 2 centers from 2017 to 2019 were randomly assigned to Glubran 2 or absorbable tack mesh fixation, and followed for 6 months. All other aspects of surgery and aftercare remained the same. Surgeons documented operative and fixation time, and the placement of fixation on standardized diagrams. Via a questionnaire, aspects of inguinal pain were evaluated before surgery, and at various time-points postoperatively over 6 months. Postoperative clinical factors were also collected. RESULTS A total of 106 operative sides were randomized to either glue (51) or tack (55) mesh fixation over a 14-month period. Similar median operative times between tack (83.0 min) and glue fixation (75.0 min) were observed. There were no significant surgical complications or observed hernia recurrences in either group. There was no significant difference in pain scores between the 2 groups at all time-points after analysis through mixed effects modeling. Temporal pain profiles over time were also similar. Totally, 55% of patients in the glue group had returned to work within 2 weeks of surgery. There was no increase in complications or pain scores despite regular lateral fixation of glue in these patients. CONCLUSION Adding to known data, we observed no significant difference in postoperative pain, demonstrating that cyanoacrylate glue is a viable and safe alternative fixation method to absorbable tacks in laparoscopic TEP IHR. As secondary outcomes, cyanoacrylate glue permits some patients to return to work early, and we observed regular lateral mesh glue fixation without increased pain or complications.
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194
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Yura M, Yo K, Hara A, Hayashi K, Tajima Y, Kaneko Y, Fujisaki H, Hirata A, Takano K, Hongo K, Yoneyama K, Nakagawa M. Indirect inguinal hernia containing portosystemic shunt vessel: A case report. World J Clin Cases 2021; 9:509-515. [PMID: 33521123 PMCID: PMC7812899 DOI: 10.12998/wjcc.v9.i2.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inguinal hernia repair is one of the most common general surgical operations worldwide. We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.
CASE SUMMARY We report a 72-year-old man who had a 4 cm × 4 cm swelling in the right inguinal region, which disappeared with light manual pressure. Abdominal-pelvic computed tomography (CT) revealed a right inguinal hernia containing an expanded portosystemic shunt vessel, which had been noted for 7 years due to liver cirrhosis. We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring. Then, we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen. The hernia sac was returned as well. We encountered no intraoperative complications. After discharge, groin seroma requiring puncture at the outpatient clinic was observed.
CONCLUSION If an inguinal hernia patient has portal hypertension, ultrasound should be used to determine the contents of the hernia. When atypical vessels are visualized, they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.
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Affiliation(s)
- Masahiro Yura
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Kikuo Yo
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Asuka Hara
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Keita Hayashi
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Yuki Tajima
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Yasushi Kaneko
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Kumiko Hongo
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Kimiyasu Yoneyama
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
| | - Motohito Nakagawa
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka 2540065, Kanagawa, Japan
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195
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Randomized and Comparative Clinical Trial of Bovine Mesh Versus Polypropylene Mesh in the Repair of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2021; 30:26-29. [PMID: 31876883 DOI: 10.1097/sle.0000000000000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The type of mesh (synthetic vs. biological) play integral roles in the recovery and long-term outcomes of patients undergoing hernia repair. The aim of this study was to determine whether a biological mesh from bovine pericardium is equivalent to a standard polypropylene mesh in an open inguinal hernia repair using the Lichtenstein technique. MATERIALS AND METHODS A prospective, randomized, double-blinded, single-center trial was conducted to evaluate the safety and efficacy of a biological mesh compared with a commonly used polypropylene mesh using Lichtenstein's inguinal hernia repair in a 6-month study. Patients were evaluated for recurrence and complications by a blinded surgeon at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS A total of 132 patients were randomized into experimental group receiving the bovine mesh (n=66) and control group receiving the standard polypropylene mesh (n=66). No recurrences were diagnosed in both arms within 6-month follow-up. Patients in the experimental group reported markedly less groin pain during the 3-month postoperative assessment period compared with the control group. There were no statistically significant differences in other complications, such as incision inflammation, physical limitation, testicular problems, and foreign body sensation, between the 2 groups. CONCLUSIONS Biological mesh is safe and effective in repairing inguinal hernia, with comparable intraoperative and early postoperative morbidity to the synthetic mesh.
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196
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Fernandez-Alberti J, Iriarte F, Croceri RE, Medina P, Porto EA, Pirchi DE. Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair. Hernia 2021; 25:1301-1307. [PMID: 33400027 DOI: 10.1007/s10029-020-02357-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following previous laparo-endoscopic repair. Laparoscopic treatment of recurrences after previous LR is controversial. The purpose of this study was to determine the safety, feasibility, and reliability of a repeated transabdominal preperitoneal laparoscopic repair (reTAPP) for a recurrent hernia. METHODS We analyzed and compared a series of patients with recurrent inguinal hernia after LR who underwent repair by a conventional approach with similar patients who underwent reTAPP between January 2010 and December 2018. RESULTS Between January 2010 and December 2018, 2488 transabdominal preperitoneal laparoscopic inguinal hernia (TAPP) repairs were performed. Recurrence was observed in 46 (1.8%). Of these patients, 18 (39%; Group 1; G1) underwent conventional open repair (Lichtenstein technique) and 28 (61%; Group 2; G2) reTAPP. In G2, repair was successful in 24 patients (86%); however, four cases (14%) needed conversion to OS because of technical difficulties. Two patients re-recurred (4.3%), one in G1 which was resolved in a third approach with a reTAPP and the other in G2 which was resolved with OS. CONCLUSION ReTAPP surgery for recurrences after previous TAPP repair proved to be safe and was associated with a shorter length of hospital stay and morbidity and recurrence rates comparable to OS at a highly specialized center. Randomized studies with a larger number of cases are necessary to confirm these findings and draw more robust and objective conclusions.
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Affiliation(s)
- Joaquin Fernandez-Alberti
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina.
| | - Facundo Iriarte
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Raul Eduardo Croceri
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Pablo Medina
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Eduardo Agustin Porto
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Daniel Enrique Pirchi
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
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197
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Niebuhr H, Malaibari Z, Dag H, Reinpold W, Köckerling F. Dynamic Inguinal Ultrasound (DIUS) in diagnosing groin hernias: Technique, examples and results. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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198
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Kakiashvili E, Bez M, Abu Shakra I, Ganam S, Bickel A, Merei F, Drobot A, Bogouslavski G, Kassis W, Khatib K, Badran M, Kluger Y, Almog R. Robotic inguinal hernia repair: Is it a new era in the management of inguinal hernia? Asian J Surg 2021; 44:93-98. [DOI: 10.1016/j.asjsur.2020.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 02/02/2023] Open
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Seker D, Seker G, Bayar B, Ergul Z, Kulacoglu H. Topical antibiotic prophylaxis in Lichtenstein hernia repair and comparison of three methods: A prospective randomized clinical trial. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Proietti F, La Regina D, Pini R, Di Giuseppe M, Cianfarani A, Mongelli F. Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias. Surg Endosc 2020; 35:6643-6649. [PMID: 33258030 DOI: 10.1007/s00464-020-08165-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP. METHODS The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed. RESULTS Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43rd operation, once the 90% proficiency on the logarithmic tendency line was achieved. The corrected operative time resulted 71.1 ± 22.0 vs. 60.8 ± 13.5 min during and after the learning curve (p = 0.011). Only one intraoperative complication occurred during the learning curve and required an orchiectomy. Postoperatively, three complications (one seroma, one hematoma, and one mesh infection) required invasive interventions during the learning curve, while no cases were recorded after it (p = 0.312). CONCLUSION Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time.
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Affiliation(s)
- Francesco Proietti
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland.
| | - Davide La Regina
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Matteo Di Giuseppe
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland
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