1
|
Kamani F, Ghorbani H, Mahmoudabadi FD, Chavoshinejad M, Hakiminezhad M, Zareifar N, Mirzadeh M, Nodoushan SMHT, Mohebbi M, Javanbakht M, Soltani AE. Modified Lichtenstein hernioplasty with concomitant tissue repair: a retrospective study on postoperative chronic pain. BMC Surg 2024; 24:222. [PMID: 39103814 DOI: 10.1186/s12893-024-02513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE To assess the effectiveness of a modified Lichtenstein Repair combined with Herniorrhaphy in reducing postoperative chronic pain and enhancing recovery and quality of life in inguinal hernia patients. METHODS This retrospective study, conducted at the Taleghani training center between January 2021 and February 2023, retrospectively examined 289 hernia surgeries, of which 130 employed a modified Lichtenstein technique. The investigation encompassed a detailed analysis of patient demographics, employed surgical techniques, operative methods with a focus on minimal dissection, and an evaluation of postoperative outcomes. RESULTS In this study of 289 participants, primarily males aged 60-80 years, the modified technique group demonstrated a notably lower incidence of hernia recurrence (1.5%) compared to the Lichtenstein group (3.1%). Additionally, the modified technique was more effective in reducing postoperative pain, with a significantly lower mean Visual Analogue Scale (VAS) score of 0.15, compared to 0.31 in the Lichtenstein group. This suggests enhanced patient comfort and a potentially quicker recovery in the modified technique group. CONCLUSION The modified Lichtenstein hernioplasty technique, characterized by minimal tissue trauma and precise mesh placement, emerges as an effective approach in inguinal hernia repair. It offers significant benefits in reducing postoperative discomfort and chronic pain, thereby enhancing patient recovery and overall quality of life. This method aligns with current surgical trends towards patient-centric and minimally invasive procedures.
Collapse
Affiliation(s)
- Fereshteh Kamani
- Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Helia Ghorbani
- Midwifery and Nursing School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Mahdi Hakiminezhad
- Department of General Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Zareifar
- Department of Medical Science, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Mirzadeh
- Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Mohebbi
- Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Clinical Science Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
2
|
Lillo-Albert G, Villa EB, Boscà-Robledo A, Carreño-Sáenz O, Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis. Hernia 2024; 28:1427-1439. [PMID: 38837072 DOI: 10.1007/s10029-024-03077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia. METHODS Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI). RESULTS Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92). CONCLUSIONS This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
Collapse
Affiliation(s)
| | - Elvira Buch Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
| | - Andrea Boscà-Robledo
- Department of HPB Surgery and Transplantation, La Fe University Hospital, University of Valencia, Valencia, Spain
| | - Omar Carreño-Sáenz
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - José Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jesús Martínez-Hoed
- Unit of Abdominal Wall Surgery. R. A. Calderón Guardia Hospital, San José, Costa Rica
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| |
Collapse
|
3
|
Zwols TLR, van der Bilt ARM, Veeger NJGM, Möllers MJW, Hess DA, Brandsma HT, Jutte E, Veldman PHJM, Eker HH, Koning GG, Pierie JPEN. Learning and implementation of TransREctus sheath PrePeritoneal procedure for inguinal hernia repair. Hernia 2024; 28:1309-1315. [PMID: 38760626 PMCID: PMC11297057 DOI: 10.1007/s10029-024-03031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/17/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique's inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice. METHODS All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience. RESULTS In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40-80 procedures, > 80 procedures). CONCLUSION Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques.
Collapse
Affiliation(s)
- T L R Zwols
- Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
| | | | - N J G M Veeger
- MCL Academy, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J W Möllers
- Department of Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - D A Hess
- Department of Surgery, Antonius Hospital, Sneek, The Netherlands
| | - H T Brandsma
- Department of Surgery, Antonius Hospital, Sneek, The Netherlands
| | - E Jutte
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - P H J M Veldman
- Department of Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - H H Eker
- Department of Surgery, University Hospital, Ghent, Belgium
| | - G G Koning
- Department of Surgery, Euregio Hospital, Nordhorn, Germany
| | - J P E N Pierie
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
Guidi Lyra V, Brandão Dos Santos S, Bevilacqua Trigo Rocha C, Guimarães FAG, Riva WJ. Comparison of postoperative chronic inguinal pain between the lichtenstein and laparoscopic techniques in the treatment of inguinal hernia: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03099-5. [PMID: 39031236 DOI: 10.1007/s10029-024-03099-5] [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: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient. METHODS The search conducted until May 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tool and ROBINS I tool. Thirteen studies were included. RESULTS: The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence. CONCLUSION The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.
Collapse
Affiliation(s)
- Valentina Guidi Lyra
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil.
| | - Sofia Brandão Dos Santos
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Carolina Bevilacqua Trigo Rocha
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Fernando Augusto Garcia Guimarães
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Wagner José Riva
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| |
Collapse
|
5
|
Kong L, Wang J, Guo K. Effect of general and spinal anaesthesia on post-operative wound healing during laparoscopic totally extraperitoneal inguinal hernia repair: A meta-analysis. Int Wound J 2024; 21:e14670. [PMID: 38361225 PMCID: PMC10869659 DOI: 10.1111/iwj.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Abstract
Totally extraperitoneal prosthetic (TEP) is a surgical technique for the treatment of hernia. The purpose of this research is to compare the efficacy of both general anaesthesia and spine anaesthesia for TEP herniorrhaphy. The number of patients who received TEP operations related to the injury from 2008 to 2022 was counted in this study. Patients with TEP operation were classified into general anaesthesia and spine anaesthesia. In this research, 186 related articles were found in the data base, and in the end, 8 were analysed. This study involved 2452 cases of hernia. The data of the operation time, the infection of the wound and the bleeding of the wound were analysed. The analysis of the data was done with RevMan 5.3. Results indicated that there was no significant difference between general anaesthesia and spinal anaesthesia in post-surgical rates for post-operative wound infection (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.49-1.83; p = 0.86); In general anaesthesia, there was no difference in the risk of post-operative wound haematoma when compared with those treated with spinal anaesthesia (OR, 2.96; 95% CI, 0.37-23.69; p = 0.31). In the seven trials, there was no difference in the duration of the surgery between the general anaesthetic and the spinal anaesthesia group (mean difference, -1.44; 95% CI, -4.11 to 1.22; p = 0.29). Data from the available meta-analysis indicate that there is no difference in the risk of post-operative wound infection or wound haematoma when treated with TEP.
Collapse
Affiliation(s)
- Liang Kong
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jiming Wang
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Kai Guo
- Department of AnaesthesiologyPeople's Hospital Affiliated to Shandong First Medical UniversityJinanChina
| |
Collapse
|
6
|
Dong H, Li L, Feng HH, Wang DC. Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci 2023; 16:138-147. [PMID: 37964861 PMCID: PMC10641249 DOI: 10.1016/j.sopen.2023.10.006] [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: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Background Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.
Collapse
Affiliation(s)
- Hui Dong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Li Li
- Department of Pediatric Surgery, Zigong First People's Hospital, Zigong 643000, Sichuan, China
| | - Hui-He Feng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| |
Collapse
|
7
|
Thölix AM, Kössi J, Harju J. One-year outcome after open inguinal hernia repair with self-fixated mesh: a randomized controlled trial. Langenbecks Arch Surg 2023; 408:369. [PMID: 37733083 PMCID: PMC10514172 DOI: 10.1007/s00423-023-03106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The aim of this study was to analyze pain after surgery with the use of self-fixated meshes, which are commonly used as an alternative for sutured mesh in open inguinal hernia repair. METHODS This prospective randomized clinical trial was conducted from November 2018 to March 2021, with a follow-up duration of 12 months. Male patients, aged 18-85, and suitable for day case surgery, were included. The patients received the self-adhesive Adhesix™ mesh or the self-gripping Progrip™ mesh in open inguinal hernia surgery. The primary outcome was the number of additional follow-up visits due to post-operative pain. Secondary outcomes included intensity of pain, quality of life measures, and complications. RESULTS Two hundred seventy patients were included in this trial, 132 with Adhesix™ (A group), and 138 with Progrip™ (P-group). All patients' medical records were reviewed 12 months after surgery, and 207 patients (76.2%) completed 12-month follow-up. The number of patients needing additional follow-up visits 3-12 months after surgery were comparable (A group 3/3.0%, P-group 6/5.6%). The numeric rating scale was low at 12 months after surgery (at rest A 0.21, P 0.34, at exercise A 0.78, P 0.90). The incidence of chronic pain, that is moderate or severe pain during exercise, was 5 patients (5.2%) with Adhesix™ and 8 patients (7.4%) with Progrip™ (P = 0.333). Two hernia recurrences (1.0%) were established, one in each group. CONCLUSION At 1 year after hernia surgery, the use of self-gripping and self-adhesive meshes lead to successful pain reduction and quality of life improvement. TRIAL REGISTRATION CLINICALTRIALS com NCT03734224.
Collapse
Affiliation(s)
- Anna-Maria Thölix
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jukka Harju
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
8
|
Comparing functional outcomes in minimally invasive versus open inguinal hernia repair using the army physical fitness test. Hernia 2023; 27:105-111. [PMID: 35953738 DOI: 10.1007/s10029-022-02650-6] [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: 05/16/2022] [Accepted: 07/03/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The advantages of minimally invasive inguinal hernia repair (MIHR) over open hernia repair (OHR) continue to be debated. We compared MIHR to OHR by utilizing the Army Physical Fitness Test (APFT) as an outcome measure. METHODS The APFT is a three-component test scored on a normalized 300 point scale taken semiannually by active-duty military. We identified 1119 patients who met inclusion criteria: 588 in the OHR group and 531 in the MIHR group. Changes in APFT scores, time on post-operative duty restrictions (military profile), and time interval to first post-operative APFT were compared using regression analysis. RESULTS Postoperatively, no APFT score change difference was observed between the OHR or MIHR groups (- 7.3 ± 30 versus - 5.5 ± 27.7, p = 0.2989). Service members undergoing OHR and MIHR underwent their first post-operative APFT at equal mean timeframes (6.6 ± 5 months versus 6.7 ± 5.1, p = 0.74). No difference was observed for time in months spent on an official temporary duty restriction (military profile) for either OHR or MIHR (0.16 ± 0.16 versus 0.15 ± 0.17, p = 0.311). On adjusted regression analysis, higher pre-operative APFT scores and BMI ≥ 30 were independently associated with reduction in post-operative APFT scores. Higher-baseline APFT scores were independently associated with less time on a post-operative profile, whereas higher BMI (≥ 30) and lower rank were independently associated with longer post-operative profile duration. Higher-baseline APFT scores and lower rank were independently associated with shorter time intervals to the first post-operative APFT. CONCLUSION Overall, no differences in post-operative APFT scores, military profile time, or time to first post-operative APFT were observed between minimally invasive or open hernioplasty in this military population.
Collapse
|
9
|
Posthuma JJ, Sandkuyl R, Sloothaak DA, Ottenhof A, van der Bilt JDW, Gooszen JAH, Verbeek PCM, In't Hof KH. Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial. Hernia 2023; 27:119-125. [PMID: 35925503 PMCID: PMC9931826 DOI: 10.1007/s10029-022-02651-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10-35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair. METHODS A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation. RESULTS A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed. CONCLUSION We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups.
Collapse
Affiliation(s)
- J J Posthuma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | - R Sandkuyl
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - D A Sloothaak
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - A Ottenhof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - J D W van der Bilt
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J A H Gooszen
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P C M Verbeek
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - K H In't Hof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| |
Collapse
|
10
|
Sayadishahraki M, Safaee M, Alinezhad Z. Evaluation and Comparison on the Results of Totally Extraperitoneal Laparoscopic Surgery under General and Spinal Anesthesia for Inguinal Hernia. Adv Biomed Res 2022; 11:123. [PMID: 36798913 PMCID: PMC9926035 DOI: 10.4103/abr.abr_11_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background Totally extraperitoneal (TEP) hernia repair surgery is one of the recently considered hernioplasty methods. Here, in the current study, we aimed to compare the results of TEP hernia repair surgery in the two groups of general anesthesia and spinal anesthesia. Materials and Methods This is a randomized clinical trial that was performed in 2018-2019 in Isfahan on 106 patients undergoing TEP inguinal hernia repair. Patients were randomly divided into two groups. The first group underwent TEP inguinal hernia repair surgery under general anesthesia and the second group of patients underwent TEP inguinal hernia repair surgery under spinal anesthesia. Data regarding surgery duration, intensive care unit admission, pain of patients, mean of analgesic injections after the surgery, and complications such as urine retention, seroma, and hematoma, and wound infection were collected. Data were compared between two groups. Results We found significantly higher duration of surgery in the spinal anesthesia group (P = 0.02). Patients in the spinal anesthesia group had shorter duration of nutrition regime beginning (P = 0.002) and lower frequencies of urine retention (P = 0.001). Further analysis showed that the mean pain severity was significantly lower in spinal anesthesia group compared to general anesthesia during postoperation measurements (P = 0.001) and patients in spinal anesthesia group received less postoperation analgesics compared to the other group (P = 0.001). Conclusion TEP surgery under spinal anesthesia was associated with better clinical results such as lower postoperative pain and analgesics injections compared to general anesthesia.
Collapse
Affiliation(s)
- Masoud Sayadishahraki
- Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masumeh Safaee
- Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zarir Alinezhad
- Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Zarir Alinezhad, Department of General Surgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| |
Collapse
|
11
|
Gutlic A, Rogmark P, Gutlic N, Petersson U, Montgomery A. Pain with sexual activity at 1 and 3 years: Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial). Surgery 2022; 172:1463-1470. [PMID: 36038370 DOI: 10.1016/j.surg.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Pain at sexual activity induced by an inguinal hernia or as a cause of its repair is not thoroughly studied. Reported frequencies are between 25% and 30% preoperatively and 10% and 15% postoperatively. The primary aim was to analyze pain at sexual activity at 1 year comparing total extraperitoneal with Lichtenstein repair in a randomized setting. METHODS Men, 30 to 60 years old, with a primary inguinal hernia were randomized to total extraperitoneal without mesh fixation or Lichtenstein repair. A questionnaire on pain prevalence, frequency, intensity, and impairment of sexual functions caused by pain at sexual activity was introduced. Clinical examination, a questionnaire on sexual function, and the 36-Item Short Form Survey were performed preoperatively and at 1 and 3 years postoperatively. A risk factor analysis for pain at sexual activity as performed. RESULTS A total of 243 patients (111 total extraperitoneal and 132 Lichtenstein) were included between 2008 and 2014; 97% remained for 1-year and 90% for 3-year analysis. Preoperative pain at sexual activity was reported in 35%, with a reduction to 5.9% in total extraperitoneal and 12.5% in Lichtenstein (P = .098) at 1 year and 7.0% in total extraperitoneal and 9.3% in Lichtenstein (P = .566) at 3 years. Quality of life preoperatively was markedly reduced in patients with pain at sexual activity but restored almost to norm levels at 1 and 3 years. New pain at sexual activity (harm) was seen in 8 patients (3.6%) at 1 year. Risk factors for having postoperative pain at sexual activity were preoperative pain and Lichtenstein technique. CONCLUSION Pain at sexual activity in inguinal hernia patients is more common than suspected and reduces quality of life. Repair will markedly reduce pain at sexual activity and restore quality of life in most patients without difference between techniques. Patients should be informed on a potential relation between having an inguinal hernia and sexual impairment.
Collapse
Affiliation(s)
- Allan Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden.
| | - Peder Rogmark
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Nihad Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Ulf Petersson
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| |
Collapse
|
12
|
Yamamoto K, Koda K. Favorable outcomes of transabdominal compared with transinguinal preperitoneal inguinal hernia repair. MINIM INVASIV THER 2022; 31:962-968. [DOI: 10.1080/13645706.2022.2050258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kaisuke Yamamoto
- Department of Surgery, National Hospital Organization Chiba Medical Center, Chiba City, Chiba, Japan
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara City, Chiba, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara City, Chiba, Japan
| |
Collapse
|
13
|
Varying convalescence recommendations after inguinal hernia repair: a systematic scoping review. Hernia 2022; 26:1009-1021. [PMID: 35768670 DOI: 10.1007/s10029-022-02629-3] [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: 01/18/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The most recent international guideline on inguinal hernia management recommends a short convalescence after repair. However, surgeons' recommendations may vary. The objective of this study was to give an overview of the current convalescence recommendations in the literature subdivided on the Lichtenstein and laparoscopic inguinal hernia repairs. METHODS In this systematic review, three databases were searched in August 2021 to identify studies on inguinal hernia repairs with a statement about postoperative convalescence recommendations. The outcome was convalescence recommendations subdivided on daily activities, light work, heavy lifting, and sport. RESULTS In total, 91 studies fulfilled the eligibility criteria, and 50 and 58 studies reported about convalescence recommendations after Lichtenstein and laparoscopic repairs, respectively. Patients were instructed with a wide range of convalescence recommendations. A total of 34 Lichtenstein studies and 35 laparoscopic studies recommended resumption of daily activities as soon as possible. Following Lichtenstein repairs, the patients were instructed to resume light work after median 0 days (interquartile range (IQR) 0-0), heavy lifting after 42 days (IQR 14-42), and sport after 7 days (IQR 0-29). Following laparoscopic procedures, the patients were instructed to resume light work after median 0 days (IQR 0-0), heavy lifting after 14 days (IQR 10-28), and sport after 12 days (IQR 7-23). CONCLUSION This study revealed a broad spectrum of convalescence recommendations depending on activity level following inguinal hernia repair, which likely reflects a lack of high-quality evidence within this field.
Collapse
|
14
|
Gram-Hanssen A, Christophersen C, Rosenberg J. Results from patient-reported outcome measures are inconsistently reported in inguinal hernia trials: a systematic review. Hernia 2022; 26:687-699. [PMID: 34480660 DOI: 10.1007/s10029-021-02492-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the use, results, and reporting of patient-reported outcome measures specific to patients undergoing inguinal hernia repair. METHODS A systematic review was performed and reported according to the PRISMA 2020 statement. A protocol was registered at PROSPERO (CRD42021243468). Systematic searches were performed in PubMed and EMBASE. We only included randomized controlled trials that involved postoperative administration of a hernia-specific patient-reported outcome measure. Risk of bias was evaluated with the Cochrane risk of bias-tool 2.0. RESULTS Twenty trials and four different instruments were included: the Carolinas Comfort Scale (nine studies), Activities Assessment Scale (six studies), Inguinal Pain Questionnaire (seven studies), and Surgical Pain Scales (one study). Included trials used patient-reported outcome measures and compared either different surgical approaches (11 studies), types of mesh/fixation (seven studies), or types of anesthesia/analgesia (two studies). Results were reported using several different methods including means, medians, or proportions of either overall results, results from subscales, or results from single questionnaire items. Seven of the 20 included studies specified a patient-reported outcome measure as a primary outcome and provided clear reporting of sample size calculation. CONCLUSION Reporting of results from patient-reported outcome measures in inguinal hernia research was characterized by heterogeneity. The results were reported using several different methods, which impedes proper evidence synthesis. Only half of the included studies applied a patient-reported outcome measure as primary outcome. Ultimately, the heterogeneity in outcome reporting is an important methodological problem obstructing the full utilization of patient-reported outcome measures in inguinal hernia research.
Collapse
Affiliation(s)
- A Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - C Christophersen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
15
|
Sekhon Inderjit Singh HK, Massey LH, Arulampalam T, Motson RW, Pawa N. Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis. Am J Surg 2022; 224:1135-1149. [DOI: 10.1016/j.amjsurg.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
|
16
|
Takeuchi Y, Etoh T, Suzuki K, Ohyama T, Hiratsuka T, Ishio T, Kugimiya M, Matsumoto T, Kai S, Bandoh T, Shibata K, Iwaki K, Tahara K, Shigemitsu Y, Inomata M. Surgical outcomes of totally extraperitoneal repair for inguinal hernia: A retrospective multicenter propensity score-matched study. Ann Gastroenterol Surg 2021; 5:502-509. [PMID: 34337299 PMCID: PMC8316736 DOI: 10.1002/ags3.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers. METHODS This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 1:1 (total: 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery. RESULTS The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP: 0.5% vs open mesh repair: 1.0%, P = .375). However, the TEP group had significantly longer operating times (median: 70.2 min vs 65.0 min, P < .001), significantly less blood loss (0-5.1 mL vs 0-20.4 mL, P < .001), and significantly shorter postoperative hospital stays (median: 5.0 days vs 6.4 days, P < .001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P = .535). CONCLUSION This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.
Collapse
Affiliation(s)
- Yu Takeuchi
- Department of SurgeryJCHO Nankai Medical CenterOitaJapan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Kosuke Suzuki
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | | | | | - Tetsuya Ishio
- Department of SurgeryKitsuki City Yamaga HospitalOitaJapan
| | | | - Toshifumi Matsumoto
- Department of SurgeryNational Hospital Organization Beppu Medical CenterOitaJapan
| | - Seiichiro Kai
- Department of SurgeryNakatsu Municipal HospitalOitaJapan
| | - Toshio Bandoh
- Department of SurgeryOita Prefectural HospitalOitaJapan
| | - Kohei Shibata
- Department of Gastrointestinal SurgeryOitaken Kouseiren Tsurumi HospitalOitaJapan
| | - Kentaro Iwaki
- Department of SurgeryOita Red Cross HospitalOitaJapan
| | | | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | | |
Collapse
|
17
|
Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials. Ann Surg 2021; 274:954-961. [PMID: 33427757 DOI: 10.1097/sla.0000000000004735] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS Systematic review and network meta-analyses of Randomized Controlled Trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk Ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% Credible Intervals (CrI) were used to assess relative inference. RESULTS Thirty-five RCTs (7,777 patients) were included. Overall, 3,496 (44.9%) underwent Lichtenstein, 1,269 (16.3%) TAPP, and 3,012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12-hour, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs. Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs. Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs. Lichtenstein (WMD = -3.3; 95% CrI -4.9; -1.8) and TEP vs. Lichtenstein (WMD = -3.6; 95% CrI -4.9; -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches while no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
Collapse
Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Sarakatsianou C, Baloyiannis I, Perivoliotis K, Georgopoulou S, Tzovaras G. Quality of life after laparoscopic trans-abdominal pre-peritoneal inguinal hernia repair: spinal vs general anesthesia. Hernia 2020; 25:789-796. [PMID: 33000326 DOI: 10.1007/s10029-020-02313-4] [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: 05/17/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effect of the anesthesia type on the postoperative quality of life in patients who underwent trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair. METHODS In this study, 70 patients submitted to TAPP for inguinal hernia repair, were randomized between spinal and general anesthesia. Overall, 58 patients completed the follow-up process and were, therefore, included. The quality of life evaluation was based on the SF-36 questionnaire. Significance was considered at the level of P < 0.05 RESULTS: General anesthesia was applied to 31 patients, whereas 27 operations were performed under spinal anesthesia. Except gender, the two study subgroups were similar in terms of demographics. Although spinal anesthesia displayed higher energy, emotional health, and general health scores these findings were not statistically significant. A positive correlation was identified between age and physical and emotional role. Operative time was associated with the estimated energy and general health. CONCLUSION Our study could not identify a difference between spinal and general anesthesia on the postoperative quality of life. Spinal anesthesia is as effective as general anesthesia and remains an attractive anesthetic alternative for TAPP inguinal hernia repair. Given several study limitations, further high-quality trials are required.
Collapse
Affiliation(s)
- C Sarakatsianou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - I Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - K Perivoliotis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - S Georgopoulou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - G Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| |
Collapse
|
19
|
Holzheimer RG, Gaschütz N. Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)—association of pain with compression neuropathy†. J Surg Case Rep 2020; 2020:rjaa143. [PMID: 32699595 PMCID: PMC7365039 DOI: 10.1093/jscr/rjaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2–5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1, n = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2, n = 22), OIHR (group 3, n = 37), LIHR followed by OIHR/LIHR (group 4, n = 5) and OIHR followed by LIHR/OIHR (group 5, n = 9). The results were as follows: preoperative pain: 33–100%, recurrence rate 0–11% (II, groups 2–5), nerve damage 92–100% and persistent CPIP: n = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.
Collapse
Affiliation(s)
- René Gordon Holzheimer
- Surgeon/Sportsmedicine - Chirurgische Tagesklinik Sauerlach/München – Ludwig-Maximilians-Universität München Germany – Sant Anna Klinik Meran Italy
| | | |
Collapse
|
20
|
Gavriilidis P, Davies RJ, Wheeler J, de'Angelis N, Di Saverio S. Numbers speak louder and communicate a clearer message than words: author's reply. Hernia 2020; 24:1131-1133. [PMID: 32036546 DOI: 10.1007/s10029-020-02125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022]
Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010, Créteil, France
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
21
|
Comment on: Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomized-controlled trials. Hernia 2020; 24:907-908. [PMID: 31993826 DOI: 10.1007/s10029-019-02110-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
|
22
|
Li W, Li Y, Ding L, Xu Q, Chen X, Li S, Lin Y, Xu P, Sun D, Sun Y. A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction. Surg Endosc 2019; 34:1882-1886. [PMID: 31820158 DOI: 10.1007/s00464-019-07303-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The management of the hernia sac is the core step of laparoscopic indirect inguinal hernioplasty. In this study, a randomized controlled trial was conducted to evaluate the clinical effect of laparoscopic total extraperitoneal inguinal herniorrhaphy (TEP) with hernia sac transection and complete sac reduction. METHOD From May 2017 to May 2018, 70 patients aged 18-75 with primary indirect inguinal hernia in our hospital were randomly divided into a transected sac group (TS) and a completely reduced sac group (RS). The primary outcomes compared between the two groups were the hernia sac treatment time, operation time, and the incidence of seroma formation after operation. Secondary outcomes included acute pain, chronic pain (pain which lasted for at least 3 months), hospital stay, recurrence rate, and other complications. RESULT There were no significant differences in baseline demographic characteristics including age, sex, hernia type, size of hernia defect, and follow-up time between the two groups. The times required for hernia sac separation and operation in the TS group were significantly shorter than in the control group (6.1 ± 2.3 vs. 25 ± 5.8 min for hernia sac separation, p < 0.01; and 35.10 ± 3.50 vs. 54.40 ± 4.20 min for operation, p < 0.01). There was no significant difference in hospitalization time, incidence of acute pain, seroma formation, or urinary retention between the two groups. During the 12-month follow-up period, chronic pain, early recurrence, and other complications were not found in either group. CONCLUSION Both the hernia sac transection technique and the complete sac reduction technique are safe and reliable. The hernia sac transection technique is a simple and effective hernia sac treatment method. It reduces the operation time and does not increase seroma or acute or chronic pain. It is valuable and likely to be popularly applied.
Collapse
Affiliation(s)
- Weiming Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Yijun Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Lili Ding
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Qingwen Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Xiongzhi Chen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Shumin Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Yueying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Pengyuan Xu
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China
| | - Dali Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China.
| | - Yanbo Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China.
| |
Collapse
|
23
|
[Demographic perspective on the concept of the tailored approach in surgery : Analysis of the quality of life exemplified by inguinal hernia repair]. Chirurg 2019; 91:60-66. [PMID: 31664471 DOI: 10.1007/s00104-019-01049-x] [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: 10/25/2022]
Abstract
INTRODUCTION The constant increase in life expectancy for over 170 years is one of the biggest achievements of modern society. In Germany the probability of an 80-year-old person becoming 100 years old has increased by a factor of 20 since the 1950s. This fact has various implications for the clinical routine and therapeutic guidelines. In addition to the quantitative factors (e.g. complications, recurrence rate), the quality of life (QoL) as a patient-centered subjective factor should be taken into consideration in the treatment options for hernia repair. To compare heterogeneous cohorts of patients regarding the QoL, a standardization based on representative reference values is absolutely essential. MATERIAL AND METHODS The study was based on data from the follow-up of 310 patients who underwent inguinal hernia repair at the surgery department of the University Hospital Rostock. The preoperative clinical examination of the patients and a questionnaire were supplemented by a postal follow-up survey postoperatively at a median of 20 months (follow-up rate 66%). Patient pain level was assessed by a visual analogue scale (VAS) and health-unspecific QoL by the EQ-5D questionnaire. Standardization of the EQ-5D was based on a survey on a normative German reference population. RESULTS Analysis of the patients in the various treatment arms showed significant differences in age composition and health states (American Society of Anesthesologists, ASA scores) of the patient cohorts. A comparison of the QoL between the two mesh-based procedures, the transabdominal preperitoneal (TAPP) procedure and the Lichtenstein procedure, showed that complete recovery is possible after 6 months. A slight decrease in the QoL of the Lichtenstein cohort patients was ascertainable, which can be explained by the method and the higher age of the group. Taking the differences in age of the two groups into account led to a change of the QoL outcome. CONCLUSION The concept of QoL is currently becoming increasingly more important in the assessment of treatment procedures. When comparing several therapeutic procedures, a standardization must be undertaken to take the heterogeneity of patient cohorts into consideration. Analogous to the relative survival in cancer epidemiology, the measured QoL scores should be put in the relationship to the age and sex-specific reference of the general population in order to demonstrate the actual effect of the disease in question and its treatment.
Collapse
|
24
|
Gavriilidis P, Davies RJ, Wheeler J, de'Angelis N, Di Saverio S. Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials. Hernia 2019; 23:1093-1103. [PMID: 31602585 PMCID: PMC6938473 DOI: 10.1007/s10029-019-02049-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/04/2019] [Indexed: 01/17/2023]
Abstract
Background–purpose Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. Methods Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. Results The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = − 6.32 (− 8.17, − 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. Conclusions This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic. Electronic supplementary material The online version of this article (10.1007/s10029-019-02049-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- P Gavriilidis
- Division of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - N de'Angelis
- Department of Digestive Surgery, Henri Mondor University Hospital, 94010, Créteil, France
| | - S Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| |
Collapse
|