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Hitman T, Bartlett ASR, Bowker A, McLay J. Comparison of bilateral to unilateral total extra-peritoneal (TEP) inguinal hernia repair: a systematic review and meta-analysis. Hernia 2023; 27:1047-1057. [PMID: 37010657 PMCID: PMC10533595 DOI: 10.1007/s10029-023-02785-0] [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: 01/07/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk. METHODS Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots. RESULTS Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair. CONCLUSION Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
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Affiliation(s)
- T Hitman
- School of Medicine, University of Auckland, Auckland, New Zealand.
| | - A S R Bartlett
- Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand
- Department of General Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand
- Laparoscopy Auckland, Epsom, Auckland, New Zealand
| | - A Bowker
- Laparoscopy Auckland, Epsom, Auckland, New Zealand
| | - J McLay
- Faculty of Science, Statistics, University of Auckland, Auckland, New Zealand
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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.
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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
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [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: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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Moreton ML, Truter A. Evaluation of inguinal hernia repair using post-operative pain and quality of life metrics. Hernia 2023; 27:71-76. [PMID: 36334162 DOI: 10.1007/s10029-022-02701-y] [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: 07/26/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Elective inguinal hernia repair is a ubiquitous procedure that carries risks; chronic pain and impacts on quality of life (QoL) must be considered when advising patients around repair. The length of time from surgery date and impacts on quality of life are often limited to only a few years of follow-up and despite hernia repair being quite common, long-term outcomes are not often reported. METHODS A cohort of patients who had received Lichtenstein inguinal hernia repair over the previous 10 years were contacted and surveyed using the Brief Pain Inventory Short Form (BPI) to assess chronic pain and its effects on their QoL. Patient and operative factors were correlated with pain through linear regression and t-test analysis provided statistical significance for mean comparisons (P < 0.05). RESULTS The rate of chronic pain was 17.2% with recurrence of 3.1% at an average post-operative interval of 5.84 years. Of the various metrics compared between groups, age was one of the only significant predictors of chronic pain with younger patients reporting higher pain. Further time from surgery also translated to significantly less pain with a difference of 1.3 years. BPI respondents identified pain that interfered to varying degrees in different aspects of life but had relatively low average magnitudes (range: 1.82/10-2.91/10). CONCLUSIONS These long-term considerations of post-surgical impact should be considered alongside potential benefits when advising patients about surgery and may help moderate post-operative expectations to optimize the outcome of common inguinal hernia repairs.
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Affiliation(s)
- Michael L Moreton
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - André Truter
- Faculty of Medicine, The University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
- Department of Surgery, Saanich Peninsula Hospital, 2166 Mt Newton X Rd, Saanichton, BC, V8M 2B2, Canada
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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.
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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
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Sultan AAEA, Abo Elazm HA, Omran H. Lichtenstein versus transabdominal preperitoneal (TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes. Ann Med Surg (Lond) 2022. [DOI: https://doi.org/10.1016/j.amsu.2022.103428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sultan AAEA, Abo Elazm HA, Omran H. Lichtenstein versus transabdominal preperitoneal (TAPP) inguinal hernia repair for unilateral non recurrent hernia: A multicenter short term randomized comparative study of clinical outcomes. Ann Med Surg (Lond) 2022; 76:103428. [PMID: 35345792 PMCID: PMC8957018 DOI: 10.1016/j.amsu.2022.103428] [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: 12/25/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background The repair of inguinal hernia is still one of the most prevalent surgical procedures done worldwide. Among all repair techniques, open Lichtenstein repair is the most globally conducted. In the past few decades, laparoscopic technique for inguinal hernia repair has increased technical demand. Trans-abdominal pre-peritoneal (TAPP) technique is the main approach, which is featured by less postoperative pain and early recovery. Objective The current work is a short-term study to make a comparison between open Lichtenstein repair of inguinal hernia as well as laparoscopic trans-abdominal preperitoneal repair of inguinal hernia (TAPP) for unilateral non recurrent hernia regarding intraoperative, postoperative complications and hospital stay. Patients and methods The present prospective randomized study recruited 100 male subjects from General Surgery Department of Al-Azhar University Hospitals and Ain Shams university hospitals suffering from oblique inguinal hernia (unilateral non recurrent hernia) with an age above 18 years and good overall health, who were randomized into two groups: Group A: 49 cases were subjected to laparoscopic trans-abdominal pre-peritoneal repair (TAPP). Group B: 51 cases were subjected to open Lichtenstein repair. Results This study detected less post-operative pain day 0, day 1, day 7 and 1 month postoperatively. There was no significant difference at 6 months post-operatively. Conclusion Finally, we concluded that TAPP repair for inguinal hernia (unilateral non recurrent hernia) safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time. Inguinal hernia can be treated with either open surgical technique (Lichtenstein) or laparoscopic technique (transabdominal preperitoneal repair). TAPP repair for inguinal hernia safer with less early post-operative pain. There is no statistical difference as regard to surgical complications and post-operative recurrence.
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Affiliation(s)
| | | | - Hisham Omran
- General Surgery, Faculty of Medicine - Ain Shams University, Egypt
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Castro GRA, Zilles A, Gazzola LD, Barros RB, Sadowski JA, Guetter CR. LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1695. [DOI: 10.1590/0102-672020220002e1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022]
Abstract
ABSTRACT BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.
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Jan Z, Ali S, Ahmed N, Sarwar MA. Comparison of Common Postoperative Complications Between Lichtenstein Open Repair and Laparoscopic Transabdominal Pre-peritoneal (TAPP) Repair for Unilateral Inguinal Hernia. Cureus 2021; 13:e17863. [PMID: 34660065 PMCID: PMC8502236 DOI: 10.7759/cureus.17863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Laparoscopic transabdominal pre-peritoneal (TAPP) repair is a minimally invasive technique that is becoming the procedure of choice among surgeons for inguinal hernia repair and research work is still going on comparing TAPP repair with Lichtenstein open mesh repair. The objective of our study is to compare common postoperative complications in Lichtenstein mesh repair and laparoscopic TAPP repair for unilateral inguinal hernia in our unit. Methods Between August 2016 and August 2018, patients with unilateral inguinal hernia and ASA grade I/II were selected in the surgical outpatient department (OPD) and prospectively randomized into two equal groups. Lichtenstein open mesh repair was done in Group-I and laparoscopic TAPP repair in Group-II. The visual analog scale (VAS) was used for the assessment of the intensity of pain. Results A total of 100 patients with a diagnosis of unilateral inguinal hernia were included in the study. Overall, our study showed that there was less postoperative pain in those patients who underwent TAPP repair as compared to patients with Lichtenstein mesh repair (p= <0.05). There were more postoperative complications in Group-I as compared to Group-II. Conclusion Laparoscopic TAPP repair for inguinal hernia is associated with less postoperative pain and other postoperative complications in addition to a shorter hospital stay as compared to Lichtenstein mesh repair. Thus, this is helping in the early return of patients to daily life activities.
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Affiliation(s)
- ZakaUllah Jan
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Sajid Ali
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Nisar Ahmed
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
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Corthals S, van Cleven S, Uyttebroek O, Abreu de Carvalho L, Vanlander A, Berrevoet F. Quality of life after open versus laparoscopic preperitoneal mesh repair for unilateral inguinal hernias. Asian J Surg 2021; 44:1266-1273. [PMID: 33888373 DOI: 10.1016/j.asjsur.2021.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Both the open transinguinal preperitoneal repair (TIPP) and the laparoscopic total extraperitoneal mesh repair (TEP) show excellent outcomes. Direct comparative data between these 2 preperitoneal techniques is lacking. The aim of this study was to assess postoperative outcomes and quality of life (QoL) for these open and laparoscopic preperitoneal repair techniques. METHODS Between 2014 and 2016, 204 male patients underwent unilateral inguinal hernia repair through TIPP (n = 135) or TEP (n = 69). Data recorded include demographic profile, preoperative and intraoperative variables, postoperative complications and postoperative quality of life. Two validated hernia-specific QoL questionnaires, the Carolinas Comfort Scale (CCS) and the European Registry for Abdominal Wall Hernias Quality of Life score (EuraHS QoL) were used to assess postoperative QoL. RESULTS The TIPP group consisted of 135 patients, the TEP group of 69 patients. The mean age of patients was significantly higher in TIPP (64.07 ± 17.10 years) than in TEP (59.0 ± 15.53 years) (p = 0.022). A total of 96 patients (47.1%) responded to our invitation for longterm follow-up: 58 in the TIPP group (43%) and 38 in the TEP group (55.1%). There was no difference in mean follow-up time between the surgical procedure and filling in the questionnaires: 37.4 ± 12.8 months for TIPP and 33.5 ± 11.3 months for TEP group (p = 0.13). No significant differences in quality of life were found between TIPP and TEP for all explored domains. CONCLUSION TIPP and TEP show equivalent results considering postoperative quality of life. Compared to existing literature on mesh repair for unilateral inguinal hernias, we may conclude that the preperitoneal location of the mesh probably is a more decisive factor for quality of life than the surgical approach used.
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Affiliation(s)
- Simon Corthals
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn van Cleven
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Belgium
| | - Ortwin Uyttebroek
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Belgium
| | - Luis Abreu de Carvalho
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Belgium
| | - Aude Vanlander
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Belgium.
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Forester B, Attaar M, Lach M, Chirayil S, Kuchta K, Denham W, Linn JG, Haggerty SP, Carbray J, Ujiki M. Inguinal hernia mesh is safe in 1720 patients. Surg Endosc 2021; 36:1609-1618. [PMID: 33763744 DOI: 10.1007/s00464-021-08442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is substantial media and patient interest in the safety of mesh for hernia repair. However, there is a lack of data regarding health-related quality of life (HRQOL) outcomes in patients who undergo inguinal hernia repair (IHR) with mesh. The purpose of this study is report short and long-term postoperative quality of life outcomes in patients following IHR with mesh. METHODS We analyzed outcomes of 1720 patients who underwent IHR with mesh between 2008 and 2019 at a single institution from a prospectively maintained quality database. All surgeries were performed by four board-certified surgeons. HRQOL outcomes were measured using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys that were administered preoperatively, 3 weeks, 6 months, 1, 2, and 5 years postoperatively. Survey responses were summarized as mean with standard deviation or frequency with percentage. Postoperative SOMS scores were compared to preoperative scores using the two-tailed paired t test with a significance level of p < 0.05. RESULTS One (0.1%) patient experienced a mesh infection postoperatively. In terms of complications, 159 (9.2%) developed a seroma, 31 (1.8%) a hematoma, and 36 (2.1%) patients experienced a recurrence. SOMS Pain Impact, SOMS Pain Quality, and SOMS Pain visual analog scale at 3 weeks, 6 months, 1 year, 2 years, and 5 years were all improved from preoperative (all p < 0.05). At 5 years postoperatively, only 3.9%, 3.2%, and 3.1% of patients reported severe or disabling sensation of mesh, pain, and movement limitations, respectively. CONCLUSION Inguinal hernia repair with mesh results in a low rate of complications. A minority of patients had severe or disabling symptoms at 5-year follow-up and generally reported improvements in pain impact and quality in long-term follow-up.
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Affiliation(s)
- Beau Forester
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Mikhail Attaar
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Maya Lach
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Sebastian Chirayil
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Kristine Kuchta
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Woody Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John G Linn
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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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.
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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
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Gram-Hanssen A, Tolstrup A, Zetner D, Rosenberg J. Patient-Reported Outcome Measures for Patients Undergoing Inguinal Hernia Repair. Front Surg 2020; 7:17. [PMID: 32373624 PMCID: PMC7177003 DOI: 10.3389/fsurg.2020.00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
There are many ways to determine the success of an inguinal hernia operation. Traditional measures are hernia recurrence, neuralgia, mesh infection, or rather the absence of these complications. While these traditional measures obviously have their merits, alternative outcomes are emerging, and researchers and clinicians are gaining an increasing interest in patient-reported outcomes and patient reported outcome measures (PROMs). PROMs are patient questionnaires concerning quality of life, chronic pain, disability, or other subjects that are best assessed by the patients. PROMs come in two different forms: generic and condition specific. The generic PROMs concern general symptoms and issues, while the condition-specific PROMs target patients with a certain condition. Inguinal hernia-specific PROMs typically address issues like mesh-related symptoms, groin pain, sexual dysfunction, etc. Clinical measurement instruments such as PROMs should be carefully validated according to standardized guidelines to ensure their psychometric measurement properties. Unfortunately, this type of evidence is often lacking when it comes to inguinal hernia-specific PROMs. In this review, we explain why PROMs are useful for patients with inguinal hernia and why one should use inguinal hernia-specific PROMs as opposed to the generic ones. We address the importance of population-specific validation and explain what type of evidence is lacking. Last, we discuss the future prospects of using PROMs for patients with inguinal hernia.
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Affiliation(s)
- Anders Gram-Hanssen
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Anders Tolstrup
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Dennis Zetner
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Min L, Yong P, Yun L, Balde AI, Chang Z, Qian G, He L, Fang P. Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience. Surg Endosc 2020; 34:5338-5345. [PMID: 32157406 DOI: 10.1007/s00464-019-07324-6] [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: 04/23/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution. METHODS A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score. RESULTS A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients' age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3 months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3 months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3 months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI - 8.524, - 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI - 5.400, - 1.489; P = 0.001) were independently associated with chronic pain. CONCLUSION These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.
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Affiliation(s)
- Liuwei Min
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Pengzhi Yong
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liuying Yun
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Alpha I Balde
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Zhanghuan Chang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Gao Qian
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liangzheng He
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Panyan Fang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
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Bittner Iv JG, Cesnik LW, Kirwan T, Wolf L, Guo D. Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg 2018; 12:625-632. [PMID: 29453731 PMCID: PMC6223756 DOI: 10.1007/s11701-018-0790-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 11/28/2022]
Abstract
Few publications describe the potential benefit of robotic-assisted inguinal hernia repair on acute postoperative groin pain (APGP). This study compared patients’ perceptions of APGP, activity limitation, and overall satisfaction after robotic-assisted- (R), laparoscopic (L), or open (O) inguinal hernia repair (IHR). Random samples of patients from two web-based research panels and surgical practices were screened for patients who underwent IHR between October 28, 2015 and November 1, 2016. Qualified patients were surveyed to assess perceived APGP at 1 week postoperatively, activity disruption, and overall satisfaction. Three cohorts based on operative approach were compared after propensity matching. Propensity scoring resulted in 83 R-IHR matched to 83 L-IHR respondents, while 85 R-IHR matched with 85 O-IHR respondents. R-IHR respondents recalled less APGP compared to respondents who had O-IHR (4.1 ± 0.3 vs 5.6 ± 0.3, p < 0.01) but similar APGP compared to L-IHR (4.0 ± 0.3 vs 4.4 ± 0.3, p = 0.37). Respondents recalled less activity disruption 1 week postoperatively after R-IHR versus O-IHR (6.1 ± 0.3 vs. 7.3 ± 0.2, p < 0.01) but similar levels of activity disruption after R-IHR and L-IHR (6.0 ± 0.3 vs. 6.6 ± 0.27, p = 0.32). At the time of the survey, respondents perceived less physical activity disruption after R-IHR compared to O-IHR (1.4 ± 0.2 vs. 2.8 ± 0.4, p < 0.01) but similar between R-IHR and L-IHR (1.3 ± 0.2 vs 1.2 ± 0.2, p = 0.94). Most respondents felt satisfied with their outcome regardless of operative approach. Patient perceptions of pain and activity disruption differ by approach, suggesting a potential advantage of a minimally invasive technique over open for IHR. Further studies are warranted to determine long-term outcomes regarding pain and quality of life after IHR.
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Affiliation(s)
- James G Bittner Iv
- Department of Surgery, Virginia Commonwealth University School of Medicine, PO Box 980519, Richmond, VA, 23298, USA.
| | - Lawrence W Cesnik
- Market Research Department, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | - Thomas Kirwan
- Bruno and Ridgway Research Associates, Lawrenceville, NJ, USA
| | - Laurie Wolf
- Bruno and Ridgway Research Associates, Lawrenceville, NJ, USA
| | - Dongjing Guo
- Department of Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, CA, USA
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A Prospective Randomized Controlled Trial Comparing Quality of Life Following Endoscopic Totally Extraperitoneal (TEP) Versus Open Stoppa Inguinal Hernioplasty. Surg Laparosc Endosc Percutan Tech 2017; 27:257-261. [DOI: 10.1097/sle.0000000000000450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malavé L, Ferri V, Lazzaro S, Kalivaci D, Quijano Y, Vicente E. A prospective randomized study comparing laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein repair for bilateral inguinal hernias. Am J Surg 2017; 216:78-83. [PMID: 28751063 DOI: 10.1016/j.amjsurg.2017.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/28/2017] [Accepted: 07/14/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia. METHODS Patients were prospectively randomized between March 2013 and March 2015. Outcome parameters included hospital stay, operation time, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. RESULTS Sixty-one patients underwent TAPP repair and 73 underwent OLR. TAPP procedure had less early post-operative pain up to 7 days from surgery (p = 0.003), a shorter length of hospital stay (p = 0.001), less postoperative complications (p = 0.012) and less chronic pain (0.04) when compared with the OLR approach. CONCLUSIONS TAPP procedure for bilateral inguinal hernia effectively reduces early postoperative pain, hospital stay and postoperative complications.
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Affiliation(s)
- Benedetto Ielpo
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain.
| | - Hipolito Duran
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Eduardo Diaz
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Isabel Fabra
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Riccardo Caruso
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Luis Malavé
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Valentina Ferri
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Sara Lazzaro
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Denis Kalivaci
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Yolanda Quijano
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
| | - Emilio Vicente
- General Surgery Department, Sanchinarro Hospital, San Pablo University of Madrid, Spain
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Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis. Surg Endosc 2016; 31:2109-2121. [PMID: 27585467 DOI: 10.1007/s00464-016-5207-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. METHODS Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. RESULTS From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors. CONCLUSIONS Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.
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Light D, Bawa S. Trans-fascial closure in laparoscopic ventral hernia repair. Surg Endosc 2016; 30:5228-5231. [PMID: 27005285 DOI: 10.1007/s00464-016-4868-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Laparoscopic incisional hernia repair has become widely accepted in the management of incisional hernias. There has been recent interest in combining fascial closure along with mesh placement to improve outcomes. We report our experience with this technique. METHODS Cases were evaluated retrospectively from 2012 to 2015. There were no exclusions. Cases were included which involved laparoscopic ventral hernia repair with fascial closure and mesh placement. Fascial closure was performed using non-absorbable sutures passed with a suture passage device percutaneously. A 5-cm overlap was performed using intra-peritoneal mesh. Fixation was performed using absorbable tacks in a double crown technique. RESULTS One hundred and twelve cases were included. The mean age was 57 years old (range 33-81 years). Fifty-nine were females and 53 were males. The median post-operative stay for the non-fascial closure group was 0 days (range 0-12 days). The median post-operative stay for the fascial closure group was 0 days (range 0-12 days). All cases were followed up clinically at 6 weeks. In the non-fascial closure group, five patients developed a seroma (12 %). One patient developed a wound infection (3 %). Six patients presented with a recurrence over the study period (15 %). In the fascial closure group, four patients had a seroma, which was managed conservatively (5 %). One patient developed a wound infection (1 %). Five patients developed a recurrence over the study period (7 %). CONCLUSION We have shown comparable rates for seroma and recurrence to other series. Laparoscopic incisional hernia repair with defect closure is feasible and reduces seroma rate and recurrence.
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Affiliation(s)
- Duncan Light
- Northumbria NHS Trust, Rake Lane, North Shields, NE29 8NH, UK.
| | - Sadiq Bawa
- Northumbria NHS Trust, Rake Lane, North Shields, NE29 8NH, UK
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