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Li X, Hu X, Hu Y, Jie Y. Single-port versus traditional three-port laparoscopic total extraperitoneal inguinal hernia repair: A single-centre, prospective, randomised study. J Int Med Res 2024; 52:3000605241257418. [PMID: 38844780 PMCID: PMC11159553 DOI: 10.1177/03000605241257418] [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: 01/23/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE To explore the efficacy and safety of single-incision laparoscopic (SIL) technique compared with the traditional three-port total extraperitoneal (TEP) technique for inguinal hernia repair. METHODS This prospective, randomised study involved patients who underwent surgery for inguinal hernia at our hospital from December 2021 to July 2023. Patients were randomly assigned to SIL-TEP or TEP groups based on a computer-generated random number table. Perioperative clinical indicators for the surgical approaches were evaluated. RESULTS Of the 127 patients eligible for study, 66 were randomised to the SIL-TEP group and 61 to the TEP group. The operation time for SIL-TEP was significantly longer than for TEP but the time to return to normal activities was significantly shorter and short-term pain score was significantly lower. There were no differences between groups in intraoperative blood loss, postoperative hospital stays, pain relief time, hospitalization costs or cosmetic satisfaction scores. CONCLUSION While SIL-TEP is more challenging than TEP for hernia repair, we found that at our centre it is comparable with regard to overall safety and feasibility. Further studies are needed to validate our findings.
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Affiliation(s)
- Xuen Li
- Longshan Central Hospital, Cixi, Zhejiang, China, 315300
| | - Xufeng Hu
- Longshan Central Hospital, Cixi, Zhejiang, China, 315300
| | - Yue Hu
- The First People's Hospital of Ningbo, Zhejiang, China, 315000
| | - Yuan Jie
- Longshan Central Hospital, Cixi, Zhejiang, China, 315300
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Huang Q, Wang X, Xiang X, Qi C, Fei T, Zhou E. TPP (totally preperitoneal) making single incision laparoscopic inguinal hernia repair more feasible: a comparison with single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP). BMC Surg 2024; 24:81. [PMID: 38443886 PMCID: PMC10913552 DOI: 10.1186/s12893-024-02372-9] [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: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Totally preperitoneal hernioplasty (TPP) is a concept which was introduced for distinguishing with totally extraperitoneal (TEP). There is few evidence reflecting the single incision laparoscopic totally preperitoneal (SIL-TPP) characteristic. The aim of study is to demonstrate the feasibility of single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) and compare the outcomes with the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) technique. METHODS During August 2018 and July 2022, 200 inguinal hernia patients received SIL-TPP and 56 patients received SIL-TEP in the First hospital of Ningbo university. The demographics, clinical characteristics, intraoperative and postoperative parameters were retrospectively analysed. RESULTS SIL-TPP and SIL-TEP hernia repair were successfully conducted in all patients. There was no conversation happened in two group. Patients' demographics were comparable when compared between the two groups adding the comparison initial 52 cases analysis (P > 0.05). The mean unilateral hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (unilateral: 81.38 ± 25.32 vs. 95.96 ± 28.54, P: 0.001). Further study of unilateral hernia operative time revealed the mean indirect hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (indirect: 81.38 ± 25.33 vs. 95.87 ± 28.54, P: 0.001). The unilateral hernia operation time trend of initial 52 cases of two group analysis revealed the operation time of SIL-TPP reduced faster than SIL-TEP along with treating number increasing (Figs. 2 and 3). The comparison of initial equal quantity unilateral hernia patient mean operative time revealed the SIL-TPP group was significant shorter than SIL-TEP group (85.77 ± 22.76 vs. 95.87 ± 28.54, P: 0.049). The rate of peritoneum tearing of SIL-TPP group was significant high than SIL-TEP (P = 0.005). CONCLUSION SIL-TPP hernia repair is a superior procedure and possess its own distinguished advantages. We recommend it rather than SIL-TEP for treating inguinal hernia, especially for indirect hernia. However, large-scale randomized controlled trials comparing SIL-TPP and SIL-TEP are needed to confirm these results.
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Affiliation(s)
- Qing Huang
- Emergency Department of The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Xiaojun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Xionghua Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Changlei Qi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Ting Fei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China
| | - Encheng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, China.
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Wang DC, Fu JW, Jiang T, Chen WX, Yu M. Meta‑analysis of single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair. Updates Surg 2023; 75:2133-2145. [PMID: 37640967 DOI: 10.1007/s13304-023-01634-0] [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: 11/25/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
Whether single-incision laparoscopic totally extraperitoneal (SIL-TEP) inguinal hernia repair is similar or superior to multi-trocar laparoscopic totally extraperitoneal (MTL-TEP) inguinal hernia repair is controversial. We conducted this meta-analysis to compare the safety, efficacy and cosmetic effect of the two surgical methods. We systematically searched the Cochrane Library, Embase database and PubMed database for published studies on SIL-TEP and MTL-TEP inguinal hernia repair. The studies were screened and evaluated for quality according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for meta-analysis. Twenty studies were included, including 7 randomized controlled studies and 13 nonrandomized controlled studies. Meta-analysis revealed no significant difference between SIL-TEP and MTL-TEP inguinal hernia repair in terms of unilateral operation time (P = 0.12), bilateral operation time (P = 0.72), pain score on the first day after operation (P = 0.61], chronic pain rate (P = 0.61), total complication rate (P = 0.26), hospital stay (P = 0.72), and recurrence rate (P = 0.83), but the cosmetic effect score (P = 0.002) was higher in the former. These findings demonstrate that SIL-TEP inguinal hernia repair is safe, reliable and feasible. In addition, it can result in a better cosmetic effect of the incision than MTL-TEP inguinal hernia repair. SIL-TEP inguinal hernia repair should be considered for patients with stricter cosmetic requirements.Clinical trial registration: INPLASY2022110085.
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Affiliation(s)
- Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Jun-Wen Fu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Tao Jiang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Wen-Xing Chen
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Miao Yu
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, Sichuan, China
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4
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Prassas D, Rolfs TM, Vaghiri S, Kounnamas A, Knoefel WT, Krieg A. Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30820. [PMID: 36397342 PMCID: PMC10662824 DOI: 10.1097/md.0000000000030820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques. METHODS A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated. RESULTS Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = -0.23; 95% CI [-0.41, -0.06]; P = .01; 4 studies; I2 = 9). For the remaining primary and secondary endpoints, intra- and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. CONCLUSIONS Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.
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Affiliation(s)
- Dimitrios Prassas
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Thomas Marten Rolfs
- Catholic Hospital Essen Philippusstift, Teaching Hospital of Duisburg-Essen University, Department of Surgery, Essen, Germany
| | - Sascha Vaghiri
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Aristodemos Kounnamas
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
| | - Andreas Krieg
- Heinrich-Heine-University and University Hospital Duesseldorf, Department of Surgery, Duesseldorf, Germany
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Zhou E, Qi C, Wang X, Fei T, Huang Q. Single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP): Lessons learned from 102 procedures and initial experience. Medicine (Baltimore) 2022; 101:e30882. [PMID: 36181025 PMCID: PMC9524943 DOI: 10.1097/md.0000000000030882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The abdominal wall in groin area is conventionally considered that it was comprised by 9 layers. Single incision laparoscopy totally extraperitoneal hernioplasty (SIL-TEP) reported before were operated through the front of the posterior rectus sheath. METHOD 102 SIL-TPP were conducted from October 2018 to October 2020 at The Affiliated Hospital of Medical School of Ningbo University using a self-made single-port device and standard laparoscopic instruments. Clinical data, demographic and intraoperative findings, and short-term postoperative outcomes were analyzed. RESULTS Of the 102 hernias treated, 46 were right inguinal hernias, 33 were left inguinal hernias and 23 were double-side inguinal hernias. All patients received the SIL-TPP and no conversion happened. The mean left-side and right-side hernia operative time was almost same. The left-side and right-side operative time were 75.48 ± 26.95 and 76.24 ± 26.09 minutes, respectively. The mean operative time was 75.92 ± 26.45 (range, 29-170 minutes) in unilateral inguinal hernia. Mean operative time was 104.17 ± 28.58 minutes (range, 67-180 minutes) in double-side inguinal hernia. The intraoperative complications rate was 21.57 (22/102) and all the complications were Peritoneum or sac tearing. Postoperative complications occurred in 3 cases (1 case wound seroma, 1 case urinary retension and 1 case upper respiratory infection) and were successfully treated conservatively. The mean hospital stay was 2.8646 ± 1.38 days. The 24 hours Visual analogue scale score was 2.28 ± 0.77. During follow-up to June 2022, no recurrence case occurred. CONCLUSION SIL-TPP is safe and feasible. SIL-TPP has its unique skills and advantages to treat inguinal hernia. Large-scale randomized controlled trials comparing SIL-TPP inguinal hernia repair with conventional single port and conventional three port laparoscopic totally extraperitoneal hernioplasty with short-term outcome and long-term recurrence rate are needed to confirm these results.
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Affiliation(s)
- Encheng Zhou
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Changlei Qi
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Xiaojun Wang
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Ting Fei
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Qing Huang
- Emergency Department of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Qing Huang, Emergency Department of The Affiliated Hospital of Medical School, Ningbo University, 247 Renmin Road, Ningbo, Zhejiang 315000, China (e-mail: )
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Suzuki Y, Wakasugi M, Mikamori M, Tamaoka K, Nakahara Y, Tei M, Furukawa K, Ohtsuka M, Masuzawa T, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic totally extra-peritoneal inguinal hernia repair: a single-institution experience of 186 consecutive cases. Surg Today 2021; 52:114-119. [PMID: 34115209 DOI: 10.1007/s00595-021-02323-4] [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: 02/23/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This retrospective study was conducted to compare the long-term outcomes of single-incision totally extraperitoneal (S-TEP) inguinal hernia repair and conventional multiport totally extraperitoneal (M-TEP) inguinal hernia repair. METHODS The study population included 186 consecutive patients (S-TEP, n = 149; M-TEP, n = 37) who underwent elective surgery for inguinal hernia at Osaka Police Hospital between 2011 and 2013. RESULTS No significant between-group difference was found in patient or hernia characteristics or in perioperative outcomes, with the exception of age (S-TEP group vs. M-TEP group: median 69 [IQR 60-75] years vs. 64 [55-69] years, respectively; P = 0.019). Furthermore, no significant between-group difference was found in follow-up time (5.5 [3.0-5.8] vs. 5.4 [3.1-5.7] years, P = 0.839), recurrence rate (0.6 vs. 2.4%, P = 0.358), chronic pain (1.2 vs. 0%, P = 1.000), feeling the mesh (2.3 vs. 7.1%, P = 0.142), or movement limitation (0.6 vs. 0%, P = 1.000). All chronic symptoms were "mild but not bothersome." A metachronous contralateral inguinal hernia developed in 8.1% of patients. CONCLUSION The long-term outcomes of S-TEP repair were comparable to those of M-TEP, with rates of recurrence, chronic pain, feeling the mesh, and movement limitation falling within acceptable limits.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Shibaharacho 4-14-1, Toyonaka, Osaka, 560-8565, Japan.
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Kohei Tamaoka
- Department of Endoscopic Diagnosis and Therapeutics, Kanto Central Hospital of the Mutual Aid and Association of Public School Teachers, Setagaya-ku Kamiyoga 6-25-1, Tokyo, 158-8531, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Toru Masuzawa
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
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Fang CW, Chiu AW, Huang SKH. Comparison of Single-Port Laparoscopic Totally Extraperitoneal Hernioplasty Versus Conventional Laparoscopic Totally Extraperitoneal Hernioplasty : A Single-Center Study. Am Surg 2020; 87:608-615. [PMID: 33136428 DOI: 10.1177/0003134820949999] [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: 11/15/2022]
Abstract
BACKGROUND To evaluate the safety and outcomes of single-port laparoscopic totally extraperitoneal (SPLTEP) and conventional laparoscopic totally extraperitoneal (CLTEP) hernioplasty. METHODS Retrospectively, we collected patients who underwent a laparoscopic totally extraperitoneal approach. The inclusion criteria were as follows: (1) male patients aged >20 years, (2) untreated hernia, and (3) American Society of Anesthesiologists (ASA) score ≤3. The exclusion criteria included: (1) additional procedures received during surgery, (2) inguinoscrotal hernia, (3) ASA score >3, (4) previous lower abdominal surgery, (5) bleeding disorders, and (6) incarcerated, obstructed, strangulated, or recurrent inguinal hernias. Patients were classified into SPLTEP and CLTEP groups. The demographics, body mass index (BMI), ASA score, comorbidities, blood loss, operation time, postoperative length of stay (LOS)/complications, hernia recurrence, visual analog scale (VAS), and postoperative analgesic requirements were collected for analysis. RESULTS A total of 246 patients were enrolled. There were 103 patients in the SPLTEP group and 143 patients in the CLTEP group. The mean age was 56.1 ± 16.2 years versus 57.9 ± 15.1 years. There were no significances in demographics, BMI, ASA score, comorbidities, blood loss, operation time, postoperative LOS/complications, and hernia recurrence. The SPLTEP group had a shorter postoperative LOS, lower VAS at 18 hours postoperation, and a reduced amount of 24-hour postoperative analgesics. CONCLUSION SPLTEP hernioplasty is as safe as the CLTEP procedure. In addition, the SPLTEP group had a shorter LOS and a lower VAS score and required less postoperative analgesics. Further studies may focus on long-term complications, hernia recurrence, and chronic pain in these 2 groups.
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Affiliation(s)
- Chu-Wen Fang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Allen W Chiu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Urology, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
| | - Steven Kuan-Hua Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Yu CC, Chen YT, Huang CS, Chueh SCJ, Lo CW, Tsai YC. A comprehensive study comparing tack and glue mesh fixation in laparoscopic total extraperitoneal repair for adult groin hernias. Surg Endosc 2020; 34:4486-4493. [PMID: 31741160 DOI: 10.1007/s00464-019-07234-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Glue mesh fixation is thought to cause less pain compared to tack mesh fixation during laparoscopic total extraperitoneal inguinal hernia repair (TEP). However, the clinical benefits of glue mesh fixation are still controversial. This study aimed to evaluate the acute pain, chronic pain, and recurrence rate between these two fixation methods. METHODS After reviewing all patients in our prospective hernia repair database from February 2008 to December 2017, we identified 583 patients who underwent TEP with tack mesh fixation and 70 patients with glue fixation by a single surgeon. Acute post-operative pain and activity level were evaluated using a Visual Analog Score (VAS) and the modified Medical Outcome Study (MOS) score. The primary endpoint was chronic pain 6 months after TEP. The secondary endpoints were acute pain, activity level, complications, and recurrence. RESULTS After adjustment for potential confounding factors, the glue mesh fixation had significant lower VAS at 2 h post operation during rest and coughing and on the first day after surgery during coughing (p = 0.005, p < 0.001, and p = 0.011). The modified MOS on the first day was higher in the glue group (p < 0.001). There were no reduced risk of chronic pain or increased risk of recurrence for the glue group compared to the tack group [Odds ratio (OR) = 0.237, p = 0.169; OR = 2.498, p = 0.299]. In the sub-group analysis for recurrent hernia repair, glue fixation is associated with better modified MOS (p = 0.031) on first day and lower VAS on the operative day and first day at rest (p = 0.003 and p = 0.024) after surgery. CONCLUSIONS Glue fixation method was superior to tack fixation method in acute post-operative pain and early post-operative activity level after laparoscopic TEP repair. However, both fixation methods had similar incidence of chronic pain-, recurrence-, and procedure-related complications after laparoscopic TEP repair.
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Affiliation(s)
- Chih-Chin Yu
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Urology, Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Ching-Shui Huang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Chieh J Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chi-Wen Lo
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan. .,Department of Urology, Tzu Chi University, Hualien, Taiwan.
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9
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Patient-Reported Outcomes and Long-Term Results of a Randomized Controlled Trial Comparing Single-Port Versus Conventional Laparoscopic Inguinal Hernia Repair. World J Surg 2020; 44:2191-2198. [PMID: 32123978 DOI: 10.1007/s00268-020-05443-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgical techniques for inguinal hernia repair have evolved rapidly from open methods to conventional laparoscopic totally extra-peritoneal (CTEP) and recently single-port TEP (STEP). As there is currently no randomized controlled trial (RCT) reporting long-term patient-reported outcomes between CTEP and STEP, we reviewed patients who were randomized to CTEP or STEP 5 years after surgery. METHODS Telephone interviews were administered to patients with primary unilateral inguinal hernia recruited for the RCT comparing CTEP and STEP in 2011. The modified Body Image Questionnaire was used to measure long-term patient-reported outcomes. RESULTS Forty-two out of forty-nine of the STEP group and forty-one out of fifty of the CTEP group responded to phone interviews. Median follow-up time, demographic data and clinical outcomes were comparable between both groups. The Body Image Score (5-20: 5-least dissatisfied, 20-most dissatisfied; BIS score ± SD, STEP vs. CTEP, 5.33 ± 0.90 vs. 7.17 ± 1.87, p < 0.001) and Cosmetic Score (2-20: 2-least satisfied, 20-most satisfied; CS score ± SD, STEP vs. CTEP, 19.05 ± 1.31 vs. 15.87 ± 1.57, p < 0.001) were superior in the STEP group. Similarly, self-reported scar perception (1-cannot be seen, 2-can barely be seen, 3-visible; scar perception score ± SD, STEP vs. CTEP, 1.29 ± 0.51 vs. 2.55 ± 0.64, p < 0.001) and overall experience score (1-least satisfied, 10-most satisfied; overall satisfaction score ± SD, STEP vs. CTEP, 9.57 ± 0.67 vs. 8.22 ± 0.94, p < 0.001) were superior in the STEP group. CONCLUSION Patients who underwent STEP reported superior cosmetic and satisfaction scores and comparable surgical outcomes 5 years after surgery compared to the CTEP group. STEP should be strongly considered in patients who are concerned about long-term cosmetic outcomes and should be offered if surgical expertise is available. Trial registration NCT02302937.
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10
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Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, Arolfo S, Yehuda AB, Boni L, Cassinotti E, Dapri G, Yang T, Fransen S, Forgione A, Hajibandeh S, Hajibandeh S, Mazzola M, Migliore M, Mittermair C, Mittermair D, Morandeira-Rivas A, Moreno-Sanz C, Morlacchi A, Nizri E, Nuijts M, Raakow J, Sánchez-Margallo FM, Sánchez-Margallo JA, Szold A, Weiss H, Weiss M, Zorron R, Bouvy ND. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 2019; 33:996-1019. [PMID: 30771069 PMCID: PMC6430755 DOI: 10.1007/s00464-019-06693-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. METHODS An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. RESULTS In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. CONCLUSIONS Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yannick M Meyer
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Stavros A Antoniou
- Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Isaías Alarcón Del Agua
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Amir Ben Yehuda
- Surgery division, Assaf Harofe medical center, Zeriffin, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tao Yang
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Sofie Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
| | | | | | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Marco Migliore
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | | | - Antonio Morandeira-Rivas
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Carlos Moreno-Sanz
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Eran Nizri
- Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Myrthe Nuijts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonas Raakow
- Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Helmut Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Michael Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Ricardo Zorron
- Department of Surgery, University of Insubria, Varese, Italy
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis. Hernia 2019; 23:217-233. [PMID: 30617931 DOI: 10.1007/s10029-018-01876-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022]
Abstract
A meta-analysis was conducted to provide an up-to-date comparison of single-port and multi-port approach, in laparoscopic inguinal hernia mesh repair. This meta-analysis was performed on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases (MEDLINE, Web of Science and Cochrane Central Register of Controlled Clinical Trials) were systematically screened. Fixed Effects or Random Effects model was used, according to the Cochran Q test. In total 16 eligible studies were found. There was no statistically significant difference, regarding unilateral operation duration, between the two approaches, in TEP (OR - 4.61; 95% CI - 9.70, 0.47, p = 0.08) or TAPP (OR - 1.96; 95% CI - 4.89, 0.97, p = 0.19) procedures. Similarly, in both operative modalities, no superiority of either approach was proven, in terms of conversion rate (TEP OR 0.69, p = 0.48; TAPP OR 5.46, p = 0.31), length of hospital stay (TEP WMD 0.00, p = 0.76; TAPP WMD - 0.11, p = 0.42) and overall complication rate (TEP OR 1.10, p = 0.51; TAPP OR 0.74, p = 0.43). Overall, single-port and the established multi-port approach in inguinal hernia mesh repair, are equivalent, regarding the postoperative outcomes. Given several limitations, further RCTs, of higher methodological and quality level are required.
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12
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Choi BJ, Jeong WJ, Lee SC. Fibrin glue versus staple mesh fixation in single-port laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score-matched analysis. Int J Surg 2018; 53:32-37. [DOI: 10.1016/j.ijsu.2018.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 01/18/2023]
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13
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Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc 2018; 32:3262-3272. [DOI: 10.1007/s00464-018-6045-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/03/2018] [Indexed: 01/08/2023]
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14
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Rajapandian S, Bhushan C, Sabnis SC, Jain M, Raj PP, Parathasarthi R, Senthilnathan P, Palanivelu C. Single incision multiport versus conventional laparoscopic inguinal hernia repair: A matched comparison. J Minim Access Surg 2018; 14:44-51. [PMID: 28695883 PMCID: PMC5749197 DOI: 10.4103/jmas.jmas_30_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis. Materials and Methods: This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015. Results: Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups. Conclusion: S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month.
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Affiliation(s)
- Subbiah Rajapandian
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Chittawadagi Bhushan
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sandeep C Sabnis
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Manish Jain
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Praveen Raj
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Ramakrishnan Parathasarthi
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanisamy Senthilnathan
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- Department of Surgical Gastroenterology and Laparoscopic Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Broder MS, Cai B, Chang E, Neary MP. Epidemiology of Gastrointestinal Neuroendocrine Tumors in a U.S. Commercially Insured Population. Endocr Pract 2017; 23:1210-1216. [DOI: 10.4158/ep171879.or] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Systemic inflammatory response after hernia repair: a systematic review. Langenbecks Arch Surg 2017; 402:1023-1037. [DOI: 10.1007/s00423-017-1618-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022]
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17
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Ng MWV, Ng KC. Gasless single-incision laparoscopic inguinal hernia repair: initial experience. Hernia 2017; 21:803-808. [PMID: 28808824 DOI: 10.1007/s10029-017-1637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/06/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Laparoscopic hernioplasty has been gaining its popularity in the past decade for its rapid recovery. Single-incision surgery, as its possible advancement, has also received more attention. Traditional laparoscopic surgery with carbon dioxide insufflation precluded patients with underlying cardiovascular or pulmonary disease from minimal invasive surgery. We report our early experience with gasless single-incision laparoscopic inguinal hernia repair via totally extraperitoneal (TEP) approach. METHODS Between 2010 and 2012, 15 consecutive patients underwent gasless laparoscopic inguinal hernia repair by the same surgeon, using abdominal wall lifting technique with a self-tailored device. Patient demographics, hernia characteristics, operative findings and postoperative outcomes were analyzed prospectively. RESULTS Of the 15 patients, all had unilateral hernia. Two presented with acute incarceration, in which one required bowel resection. There was no conversion to open surgery or insertion of additional ports. The median operating time was 80 min (range 51-130) for elective repair and 178 min (range 135-220) for emergency repair. The median hospital stay was 1 day (range 1-6) with minimal requirement of analgesics. Median time taken to resume normal activity was 2 days (range 1-6). No major medical complications or mesh infection was encountered. One patient developed hematoma and was successfully managed by salvage laparoscopic reoperation. During a median follow-up of 54 months (range 38-60), none experienced recurrence. CONCLUSION Gasless single-incision TEP is feasible with favorable results, even in high-risk patients with compromised cardiorespiratory status. This technique can also be applied to emergency setting in patients with incarcerated inguinal hernia requiring bowel resection. Future large scale randomized study is needed to verify the effectiveness of this technique.
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Affiliation(s)
- M W V Ng
- Department of Surgery, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po, Kowloon, Hong Kong, People's Republic of China
| | - K C Ng
- Department of Surgery, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po, Kowloon, Hong Kong, People's Republic of China.
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18
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Buenafe AAE, Lee-Ong AC. Laparoendoscopic single-site surgery in inguinal hernia repair. Asian J Endosc Surg 2017; 10:244-251. [PMID: 28703439 DOI: 10.1111/ases.12401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
Laparoendoscopic single-site surgery (LESS) for laparoscopic inguinal hernia repair (IHR) offers the potential for excellent cosmetic outcomes and maximization of the inherent advantages of minimally invasive surgery. LESS IHR is associated with a steep learning curve, which is attributable to both the IHR technique itself and the single-site technique. The technical obstacles in the single-site technique may be mitigated by employing certain maneuvers and strategies that minimize clashing between instruments and improve freedom of movement. The current literature consistently points out the inherent challenges in LESS IHR, with its longer operative time compared to that of conventional laparoscopic IHR. LESS IHR performed by capable operators has comparable complication rates, duration of hospital stay, and incidence of recurrence as conventional laparoscopic IHR. LESS IHR is both feasible and safe. Given its excellent cosmetic outcome, it is likely to be sought by younger patients who are concerned with scar formation. The use of robotics may bypass the technical challenges in LESS, but cost considerations in their usage will likely persist.
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Affiliation(s)
- Alfred Allen E Buenafe
- Philippine Center for Advanced Surgery, Cardinal Santos Medical Center, San Juan, Philippines
| | - Alembert C Lee-Ong
- Philippine Center for Advanced Surgery, Cardinal Santos Medical Center, San Juan, Philippines.,Manila Doctors Hospital, Manila, Philippines
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Usefulness of a Long Forceps Technique in Single-Incision Laparoscopic Surgery for Totally Extraperitoneal Repair of Inguinal Hernia. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00123.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Collisions between the laparoscope and the forceps remain a specific problem for single-incision laparoscopic surgery (SILS). We considered that the use of a long forceps would resolve this problem and use the long forceps in SILS for totally extraperitoneal repair (TEP). SILS for TEP (S-TEP) was performed to treat 34 inguinal hernias in 27 patients from November 2013 to February 2015. Among them, unilateral inguinal hernia repair was performed in 5 patients (median age: 71 years; range: 40–88 years) using a laparosonic coagulating shears (LCS) device and a straight long (43 cm) forceps. A 1-cm umbilical incision was made, a 5-mm flexible laparoscope was moved into the peritoneal cavity, and the type of inguinal hernia was diagnosed. Next, preperitoneal space was made using a finger or gauze. The single-port device was applied at preperitoneal space and insufflation was initiated with CO2 gas. The preperitoneal space was more easily created using a long straight forceps rather than standard ones. The hernia sac was then freed from the spermatic cord and a mesh was rolled, inserted, and deployed. Absorbable spiral tackers were used for fixation over the Cooper's ligament, lateral to the inferior epigastric vessels. The use of a long forceps was considered to be associated with reduction of the difficulty for dissection in S-TEP. We considered the use of a long forceps to be useful to the S-TEP operation.
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20
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Luo S, Wu S, Lai H, Mo X, Chen J. Single-Incision Laparoscopic Inguinal Hernioplasty Versus Conventional Laparoscopic Inguinal Hernioplasty. Surg Innov 2017; 24:171-182. [PMID: 28164741 DOI: 10.1177/1553350617690308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Additional studies comparing single-incision laparoscopic inguinal hernioplasty (SILH) and conventional laparoscopic inguinal hernioplasty (CLH) have been published, and this study updates the meta-analysis of this subject. METHODS Two reviewers independently searched the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases to locate original articles that compared SILH and CLH for inguinal hernia that were published until October 2015. Operative time, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were compared using Stata software, version 12.0. RESULTS Sixteen studies were selected for this analysis, which included a total of 1672 patients (907 in SILH and 765 in CLH). SILH showed a longer operative time; however, conversions, complications, length of hospital stay, recurrence, postoperative pain at 24 hours, and postoperative pain at 7 days were similar between the 2 groups. CONCLUSIONS Our meta-analysis has shown that inguinal hernia repair using SILH is as safe as CLH. However, based on our evidence, we currently believe that SILH is not an efficacious surgical alternative to CLH for inguinal hernias due to the fact that it does not provide significant benefit in postoperative pain and cosmetic outcomes. However, large-scale, well-designed, and multicenter studies will be needed to further confirm the results of this study.
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Affiliation(s)
- Shanshan Luo
- 1 Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
| | - Shike Wu
- 1 Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
| | - Hao Lai
- 1 Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
| | - Xianwei Mo
- 1 Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
| | - Jiansi Chen
- 1 Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
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DiLorenzo M, Pillai Riddell R, Holsti L. Beyond Acute Pain: Understanding Chronic Pain in Infancy. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E26. [PMID: 27834860 PMCID: PMC5184801 DOI: 10.3390/children3040026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
Abstract
This topical review presents the current challenges in defining chronic pain in infants, summarizes evidence from animal and human infant studies regarding the biological processes necessary for chronic pain signaling, and presents observational/experiential evidence from clinical experts. A literature search of four databases (CINAHL, EMBASE, PsycINFO, and MEDLINE) was conducted, along with hand searches of reference lists. Evidence from animal studies suggest that important neurophysiological mechanisms, such as the availability of key neurotransmitters needed for maintenance of chronic pain, may be immature or absent in the developing neonate. In some cases, human infants may be significantly less likely to develop chronic pain. However, evidence also points to altered pain perception, such as allodynia and hyperalgesia, with significant injury. Moreover, clinicians and parents in pediatric intensive care settings describe groups of infants with altered behavioral responses to repeated or prolonged painful stimuli, yet agreement on a working definition of chronic pain in infancy remains elusive. While our understanding of infant chronic pain is still in the rudimentary stages, a promising avenue for the future assessment of chronic pain in infancy would be to develop a clinical tool that uses both neurophysiological approaches and clinical perceptions already presented in the literature.
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Affiliation(s)
- Miranda DiLorenzo
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada.
| | - Rebecca Pillai Riddell
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada.
- Department of Psychiatry, The Hospital for Sick Children and the Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, B.C. Children's Hospital Research, Vancouver, BC, V5Z 4H4, Canada.
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada.
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Choi BJ, Jeong WJ, Lee IK, Lee SC. Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial. Hernia 2016; 20:789-795. [PMID: 27142209 DOI: 10.1007/s10029-016-1499-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. Clinically, however, the benefits of single-port TEP (SP TEP) are unclear. This study aimed to compare short-term surgical outcomes between SP TEP and conventional laparoscopic TEP(CL TEP) inguinal hernia repair. METHODS Between January 2013 and February 2015, 99 men with primary unilateral inguinal hernia were randomized to the single-port or conventional 3-port TEP procedures. The primary end point was postoperative pain. Secondary end points were complications, postoperative hospital stay, days to return to daily normal activities, cosmesis, and quality of life (QOL). RESULTS We randomized 50 patients to SP TEP and 49 to CL TEP repair. The SP TEP group patients had significantly lower pain scores (visual analog scale) 7 days postoperation (p = 0.017). However, there were no significant differences between the two groups in postoperative pain scores 24 h (p = 0.44) and 4 weeks (p = 0.677) after operation and analgesic requirements on the operation day (p = 0.303) and 7 days after the operation (p = 0.204). Operation time, postoperative hospital stay, and complications were comparable between the two groups. The days to return to daily normal activities, QOL, and cosmetic satisfaction were not different between the two groups. CONCLUSION The outcomes of SP TEP hernia repair for operation time and morbidities were comparable to CL TEP, and postoperative pain was lower at 7 days than in CL TEP hernia repair. The SP TEP technique can be recommended as an alternative treatment for inguinal hernia repair in experienced hands.
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Affiliation(s)
- B J Choi
- Department of Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-ro 64, Jung-gu, Daejeon, 301-723, Republic of Korea
| | - W J Jeong
- Department of Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-ro 64, Jung-gu, Daejeon, 301-723, Republic of Korea
| | - I K Lee
- Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - S C Lee
- Department of Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-ro 64, Jung-gu, Daejeon, 301-723, Republic of Korea.
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Tran H, Tran K, Zajkowska M, Lam V, Hawthorne WJ. Single-incision laparoscopic repair of Spigelian hernia. JSLS 2016; 19:e2015.001644. [PMID: 25722629 PMCID: PMC4325554 DOI: 10.4293/jsls.2015.001644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.
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Affiliation(s)
- Hanh Tran
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
| | - Kim Tran
- Sydney Hernia Specialists Clinic, Sydney, Australia
| | | | - Vincent Lam
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
| | - Wayne J Hawthorne
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
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Sajid MS, Khawaja AH, Sayegh M, Baig MK. A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg 2016; 29:25-35. [PMID: 26975426 DOI: 10.1016/j.ijsu.2016.02.088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this article is to evaluate whether the surgical outcomes differ between single incision laparoscopic surgery (SILS) versus multi-incision laparoscopic surgery (MILS) for the repair of inguinal hernia. METHODS A systematic review of the literature on published studies reporting the surgical outcomes following SILS versus MILS for inguinal hernia repair was undertaken using the principles of meta-analysis. RESULTS Fifteen comparative studies on 1651 patients evaluating the surgical outcomes in patients undergoing SILS versus MILS for inguinal hernia repair were systematically analysed. The post-operative recovery time was significantly quicker [odds ratio, -0.35 (CI, -0.57 - 0.14), p = 0.001] following SILS compared to MILS procedure. However, the statistical equivalence was seen in outcomes of length of hospital stay, operative time both for unilateral and bilateral hernias, post-operative pain score, one-week pain score, hernia recurrence [odds ratio, 1.24 (CI, 0.47-3.23), p = 0.66], conversion [odds ratio, 1.07 (CI, 0.37-3.12), p = 0.90], and post-operative complications [odds ratio, 0.95 (CI, 0.66-1.36, p = 0.78] between two approaches. The sub-group analysis of four included randomized, controlled trials showed similarities between outcomes following SILS and MILS except slightly higher postoperative pain score in MILS group. CONCLUSIONS Both SILS and MILS approaches of inguinal hernia repair are feasible, safe and can be offered to patients depending upon the availability of expertise and resources.
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Affiliation(s)
- M S Sajid
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK.
| | - A H Khawaja
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - M Sayegh
- Department of General, Upper Gastrointestinal & Hepato-pancreatico-biliary Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital Worthing, West Sussex, BN11 2DH, UK
| | - M K Baig
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
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Tran HM, Tran K, Zajkowska M, Lam V, Hawthorne W. Single-incision laparoscopic intraperitoneal onlay mesh repair for the treatment of multiple recurrent inguinal hernias. JSLS 2016; 18:JSLS-D-13-00354. [PMID: 25392643 PMCID: PMC4154433 DOI: 10.4293/jsls.2014.00354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias. Materials and methods: All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months. Conclusions: Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.
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Affiliation(s)
- Hanh Minh Tran
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Tran
- The Sydney Hernia Specialists Clinic, Sydney, New South Wales, Australia
| | - Marta Zajkowska
- The Sydney Hernia Specialists Clinic, Sydney, New South Wales, Australia
| | - Vincent Lam
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Wayne Hawthorne
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Lo CW, Yang SSD, Tsai YC, Hsieh CH, Chang SJ. Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia 2016; 20:21-32. [PMID: 26645961 DOI: 10.1007/s10029-015-1443-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/06/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE We systemically reviewed published literatures and performed meta-analysis to compare the surgical outcomes between laparoendoscopic single-site over the multiple-port total extraperitoneal approach in hernia repair. METHODS We did a systemic search of PubMed and Cochrane review for all randomized controlled trials and comparative trials that compared the efficacy and safety between LESS-TEP and MP-TEP. The evaluated outcomes included perioperative parameters (operative time, conversion rate), hospital stay and complications (seroma, delayed return of bladder function, postoperative pain and recurrence). The Cochrane Collaboration Review Manager software (RevMan, version 5.2.6) was used for statistical analysis. RESULTS There were 10 trials met the inclusion criteria and included for meta-analysis. Totally, there were 595 and 514 patients underwent LESS-TEP and MP-TEP, respectively. The LESS-TEP took significantly longer-operative time than the MP-TEP in unilateral hernia repair (weighted mean difference (WMD) 4.11 min, 95% CI 0.76-7.46, p = 0.02) while not in bilateral hernia repair (WMD 3.87 min, 95% of CI -2.59-10.33, z = 1.17, p = 0.24). There were no significant differences in surgical outcomes with regard to postoperative pain scale, conversion rate, hospital stay, recurrence rate and complication rate between two groups. The length of the sub-umbilical wound was the same in both groups. The result of cosmesis was not compared because of the limited data. CONCLUSION In experienced hands, LESS-TEP is a feasible alternative to MP-TEP with comparable surgical efficacy and morbidity, but with longer operation time in unilateral hernia repair. Potential advantages of LESS-TEP including better cosmesis, less postoperative pain and less trocar-associated complications were not clearly shown.
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Affiliation(s)
- Chi-Wen Lo
- Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan.
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
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Lin CD, Wu CH, Liu YB, Tsai YC. Feasibility and safety of laparoendoscopic single-site surgery of total extraperitoneal inguinal hernia repair after previous open groin hernia repair: a comparative study. Surg Endosc 2015; 30:2086-9. [DOI: 10.1007/s00464-015-4461-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/12/2015] [Indexed: 01/03/2023]
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Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial. Surg Endosc 2015; 30:1356-63. [PMID: 26162422 DOI: 10.1007/s00464-015-4378-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The advantage of single-port total extra-peritoneal (TEP) inguinal hernia repair over the conventional technique is still debatable. Our objective was to compare the outcomes of TEP inguinal hernia repair using either a single-port or conventional surgical technique, in two blind randomized groups of patients. METHODS In this prospective, randomized, double-blind, controlled clinical trial, 100 patients undergoing surgery for unilateral inguinal hernia were randomized into two groups: One group underwent conventional laparoscopic TEP inguinal hernia repair, while the other was selected for single-port TEP repair. Primary endpoint is postoperative pain (VAS), while secondary endpoints are recurrence, chronic pain and complications. RESULTS From 100 patients, 49 underwent single-port hernia TEP repair, 50 had conventional three-port TEP hernia repair, and one patient declined to participate after randomization. The two groups were comparable in terms of patient demographics and operative findings. Mean operative time was 49.1(±13.8) min in the conventional group and 54.1(±14.4) min in the single-port group (p = 0.08). Mean hospital stay was 19.7(±5.8) h in the conventional group and 20.5(±6.4) h in the single-port group (p = 0.489). No major complications and no recurrence reported at 11-month follow-up. No statistically significant difference noted in postoperative pain between the two groups at regular intervals. CONCLUSIONS The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are similar but not superior to the conventional technique.
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Tran H, Tran K, Zajkowska M, Lam V, Hawthorne WJ. Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs. JSLS 2015; 19:e2014.00212. [PMID: 25848186 PMCID: PMC4376219 DOI: 10.4293/jsls.2014.00212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.
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Affiliation(s)
- Hanh Tran
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Kim Tran
- Sydney Hernia Specialists Clinic, Sydney, NSW, Australia
| | | | - Vincent Lam
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Wayne J Hawthorne
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia
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Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia 2015; 19:407-16. [DOI: 10.1007/s10029-015-1349-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/17/2015] [Indexed: 01/08/2023]
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Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia 2014; 19:417-22. [PMID: 25537571 DOI: 10.1007/s10029-014-1337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Reports have been issued recently on single incision laparoscopic hernioplasty, but no large-scale study has been conducted as yet. This study aimed to assess the safety and feasibility of the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) on a large number of cases. METHODS 512 SIL-TEPs in 471 patients were performed from June 2010 to January 2014 at Incheon St. Mary's Hospital, The Catholic University of Korea. SIL-TEP was performed using a glove single port device and standard laparoscopic instruments. Short-term outcomes were reviewed. RESULTS Of the 512 hernias, 329 (64.3 %) were indirect, 144 (28.1 %) were direct, 9 (1.8 %) were femoral, and 30 (5.9 %) were combined. There were 3 (0.6 %) conversions to single or three-port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 41.6 min for unilateral hernias and 65.3 min for bilateral hernias. Postoperative complications occurred in 45 cases (9.6 %); 21 were wound seromas, 5 were hematomas, and 18 were urinary retentions. All were successfully treated conservatively. Mean hospital stay was 1.8 days. CONCLUSION The SIL-TEP is safe and technically feasible. Additional studies on long-term recurrence rates are needed to confirm the safety of SIL-TEP.
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Single-incision totally extraperitoneal inguinal hernia repair: our initial 100 cases and comparison with conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair. Surg Today 2014; 45:606-10. [PMID: 24973058 DOI: 10.1007/s00595-014-0967-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/25/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE To compare the outcomes of single-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair (SILS-TEP) and conventional three-port totally extraperitoneal (TEP) repair. METHODS We performed a retrospective analysis of 137 patients (SILS-TEP, 100; conventional TEP, 37) scheduled to undergo elective inguinal hernia from January 2011 to July 2013 at Osaka Police Hospital. RESULTS There were no significant differences in the patient demographics. There were no significant differences in the length of the operation between the two groups (SILS-TEP group, 93 min vs. conventional TEP group, 92 min for unilateral hernias, p = 0.8; SILS-TEP group, 142 min vs. conventional TEP, 128 min for bilateral hernias, p = 0.4). The postoperative hospital stay, total medical charge for the hospital stay and the numerical rating scale before and 3 months after surgery were comparable in both groups. Two cases treated by SILS-TEP repair were converted to conventional three-port TEP repair (one case) and mesh-plug method (one case). The postoperative complications were comparable in both groups, and these were managed conservatively. One recurrence (2 %, 1/37) developed in the conventional TEP group, compared with 0 recurrences (0/100) in the SILS-TEP group. CONCLUSIONS SILS-TEP repair seems to be safe and feasible, with no significant differences in the total medical charges for the hospital stay or the postoperative pain score 3 months after surgery compared with conventional three-port TEP repair.
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A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc 2014; 28:3053-8. [DOI: 10.1007/s00464-014-3578-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
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Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 2014; 18:731-44. [DOI: 10.1007/s10029-014-1261-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
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