1
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Dong H, Li L, Feng HH, Wang DC. Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci 2023; 16:138-147. [PMID: 37964861 PMCID: PMC10641249 DOI: 10.1016/j.sopen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Background Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.
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Affiliation(s)
- Hui Dong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Li Li
- Department of Pediatric Surgery, Zigong First People's Hospital, Zigong 643000, Sichuan, China
| | - Hui-He Feng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
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2
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Zhang H, Cao Z, Cao J, Chen J, Liu Y, Wang M. Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study. Asian J Surg 2023; 46:4222-4228. [PMID: 36642546 DOI: 10.1016/j.asjsur.2022.12.040] [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: 08/25/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. MATERIALS AND METHODS The study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. RESULTS There were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). CONCLUSION The hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.
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Affiliation(s)
- Hongming Zhang
- Department of General Surgery, No.1 Hospital of Zhangjiakou, Hebei, Zhangjiakou, PR China
| | - Zhen Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
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Arici S. Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP). Surg Laparosc Endosc Percutan Tech 2023; 33:511-514. [PMID: 37725830 DOI: 10.1097/sle.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair has gained popularity due to its advantages over open procedures. However, technical challenges and anatomical variations can affect surgical outcomes. The umbilicus-symphysis pubis (USP) distance has been identified as a potential factor impacting laparoscopic operations. This study aims to investigate the association between USP distance, technical difficulties, and operative time in the transabdominal preperitoneal (TAPP) surgery. METHODS A retrospective analysis was conducted on 122 patients who underwent elective TAPP surgery. USP distance was measured, and surgical data were collected. Statistical analysis was performed to evaluate the relationship between USP distance and operative time. RESULTS Among the patients, 80 underwent unilateral hernia repair, and 42 underwent bilateral hernia repair. In unilateral repair, USP distance did not significantly affect operative time. However, in bilateral repair, there was a significant association between USP distance and operation time prolongation ( P =0.039). DISCUSSION TAPP surgery presents challenges due to limited visualization and anatomical variations. Factors like USP distance can impact surgical outcomes. A shorter distance increases complexity, while a longer distance facilitates smoother procedures. Surgeons should consider USP distance during surgical planning to optimize outcomes. CONCLUSION The study findings indicate that USP distance is associated with prolonged operative time in TAPP bilateral hernia repair. Surgeons, especially those in the learning phase, can benefit from considering this relationship to optimize surgical outcomes and resource allocation. Further research is needed to validate these findings and explore additional factors influencing operative time in hernia repair surgeries.
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Affiliation(s)
- Sinan Arici
- Department of General Surgery, T.C. Bursa Yüksek İhtisas Training and Research Hospital, Yildirim, Bursa, Turkey
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4
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Hu N, Xie H, Wang DC, Lei YH, Wei J, Yu M, Li YJ. Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A meta-analysis of randomized controlled trials. Asian J Surg 2023; 46:3417-3425. [PMID: 37037745 DOI: 10.1016/j.asjsur.2023.03.146] [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: 11/29/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = -1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future.
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Affiliation(s)
- Nan Hu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Hong Xie
- Department of General Medicine, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Yue-Hua Lei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Jian Wei
- 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
| | - Yue-Juan Li
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
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5
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Towards automatic verification of the critical view of the myopectineal orifice with artificial intelligence. Surg Endosc 2023:10.1007/s00464-023-09934-7. [PMID: 36828887 DOI: 10.1007/s00464-023-09934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos. METHODS Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data. RESULTS Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%. CONCLUSION This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity.
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A new approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair. BMC Surg 2023; 23:26. [PMID: 36710336 PMCID: PMC9885556 DOI: 10.1186/s12893-023-01917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To investigate the feasibility, safety and efficacy of the right-side approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair. METHODS Retrospective analysis was performed on 189 patients who were diagnosed with bilateral inguinal hernia preoperatively or intraoperatively and underwent selective TAPP in the General Surgery I Section of Shaanxi Provincial People's Hospital from January 2015 to September 2020. 94 cases were performed using the right-side approach (research group), and 95 cases with conventional approach (control group). Intraoperative and postoperative conditions of the two groups were observed and compared. RESULTS All operation were completed successfully. The operative time of research group was significantly shorter than that of control group (128.8 ± 35.4 vs 144.1 ± 40.9 min, P = 0.006). There were no significant differences in postoperative hospital stay, VAS score on first postoperative day, incidence of seroma and hematoma, urinary retention and other complications (P > 0.05). None of the patients occured hernia recurrence, mesh infection, intestinal obstruction and other complications. CONCLUSIONS The right-side approach to enter Retzius space is safe and feasible in TAPP surgery of bilateral inguinal hernia. Compared with the conventional approach, it can shorten the operative time and has certain advantages.
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7
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Arici S. Evaluation of the Factors Influencing on Intraoperative Difficulty Scores of Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2022; 32:1097-1101. [PMID: 36040346 DOI: 10.1089/lap.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inguinal hernias are the leading surgical diseases in the world. There are different surgical procedures reported for the treatment. Some problems are thought to be encountered when performing laparoscopic surgery in these patients, such as risk of severe complications and the prolonged operative duration. Aim: The objective of this study was to specify the complexity of the transabdominal preperitoneal (TAPP) procedure by using an intraoperative scoring system and examine the scores with these patients' predictive factors. Materials and Methods: A prospective study was conducted in patients who underwent inguinal hernia surgery with TAPP. Previous lower abdominal surgery, previous (open) hernia surgery, body mass index (BMI), type of hernia, duration of the surgery, scoring the difficulty of the operation in five various stages using the visual analog scale (VAS) score (1. Mobilizing the peritoneum/dissection of the inferior peritoneal flap. 2. Dissection of internal ring or vas deference or hernia sac. 3. Visualization of Cooper's ligament. 4. Mesh placement. 5. Peritoneal closure.) and the time of discharge were recorded. Results: In this study, 137 patients were included. "BMI" and "previous lower abdominal surgery" have significantly higher scores, time of surgery, and hospital stay compared with other risk factors (P < .005). Conclusion: This study showed that patient's BMI and previous lower abdominal surgery could create technical difficulty with the TAPP procedure, but it is not necessary to avoid this laparoscopic technique because of these situations and can be performed safely.
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Affiliation(s)
- Sinan Arici
- Department of General Surgery, T.C. Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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8
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Hayakawa S, Hayakawa T, Watanabe K, Saito K, Miyai H, Ogawa R, Yamamoto M, Kobayashi K, Takiguchi S, Tanaka M. Evaluation of long‐term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair. Ann Gastroenterol Surg 2022; 6:577-586. [PMID: 35847434 PMCID: PMC9271018 DOI: 10.1002/ags3.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
Aim This study has two aims: to evaluate long‐term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C‐TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases. Methods A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C‐TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10‐point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long‐term chronic pain and complications. Results The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate‐to‐severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest (P = .726), at movement (P = .712), or mesh discomfort (P = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post‐match comparison, no differences in complications with Clavian‐Dindo classification ≥III (U Group 0.7%, B Group 2.1%, P = .622) were detected. Conclusion C‐TAPP, which focuses on the layered structure, showed acceptable results for long‐term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.
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Affiliation(s)
- Shunsuke Hayakawa
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Tetsushi Hayakawa
- Department of Laparoscopic Hernia Surgery CenterKariya Toyota General HospitalKariyaJapan
| | - Kaori Watanabe
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Kenta Saito
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hirotaka Miyai
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Ryo Ogawa
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Minoru Yamamoto
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Kenji Kobayashi
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Shuji Takiguchi
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Moritsugu Tanaka
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
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9
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Ramanathan S, Krishnamoorthy V, Ratnakar K, Thangavel P, Sundarraj R. Colovesical fistula secondary to hernia mesh migration: an unusual incident. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractWe evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.
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Affiliation(s)
| | | | - Kini Ratnakar
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | | | - Raju Sundarraj
- Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
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10
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Cano-Valderrama O, Sanz-López R, Sanz-Ortega G, Anula R, Romera JL, Rojo M, Catalán V, Mugüerza J, Torres AJ. Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort. Surg Endosc 2020; 35:2907-2913. [PMID: 32556772 DOI: 10.1007/s00464-020-07729-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. METHODS A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. RESULTS 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. CONCLUSIONS Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain. .,Department of Surgery, Universidad Complutense, Madrid, Spain. .,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | - Rodrigo Sanz-López
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Gonzalo Sanz-Ortega
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Rocío Anula
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - José L Romera
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Mikel Rojo
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Vanesa Catalán
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - José Mugüerza
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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11
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Coratti F, Trafeli M, Barbato G, Maggioni C, Manetti A, Cianchi F. The Gauze technique: a simple method of dissection in laparoscopic inguinal hernia repair. MINERVA CHIR 2020; 75:426-429. [PMID: 32456400 DOI: 10.23736/s0026-4733.20.08335-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hernia repair is one of the most frequent operation in general surgery. The aim of this is study is to present a new preperitoneal atraumatic dissection of peritoneal flap during laparoscopic transabdominal preperitoneal inguinal hernia repair. METHODS From January 2019 to December 2019, 30 patients (19 male, 11 female) attended TAPP inguinal hernia repairs. The inclusion's criteria were: patients from 32 to 88 years; male and woman; bilateral inguinal hernia. RESULTS The median age of patients was 46,46 (32-88). The median time of operation was 63,8 (45-100) minutes. All procedures were performed without complications and convertions. CONCLUSIONS Based on our experience the soft technique is a safe and feasible way to create a preperitoneal flap. Operating time is drastically reduced and the learning curve is reduced even for less experienced surgeons.
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Affiliation(s)
- Francesco Coratti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy -
| | - Martina Trafeli
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Giuseppe Barbato
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Andrea Manetti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
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12
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Gavrilov SG, Son DA, Churikov DA, Efremova OI, Shulyak GD. [Ultrasonic geometry of synthetic endoprostheses after transabdominal preperitoneal hernioplasty of inguinal hernias]. Khirurgiia (Mosk) 2020:53-60. [PMID: 31994500 DOI: 10.17116/hirurgia202001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess position of mesh endoprosthesis in retroperitoneal space after TARR hernioplasty using ultrasound in early and long-term postoperative period. MATERIAL AND METHODS There were 30 patients with inguinal hernias after TARR procedure. Standard technology of laparoscopic transabdominal preperitoneal hernioplasty was used in all patients. In all cases, a large-pore monofilament polypropylene mesh 10x15 cm was used. Control examination and ultrasound of the mesh implant were performed the next day, in 1, 3, 6, 12 months after surgery. Correct position of the implant was determined by its placement at the level of pubic bone with complete overlap of posterior wall of the inguinal canal and inner ring. RESULTS US-image of the implant is present in two geometric forms - linear and sinusoid. The shape of prosthesis varies depending on postoperative period and the use of fixing elements. Thus, sinusoidal shape of prosthesis was observed in patients without fixation of prosthesis the next day and in 1 month after TARR. Geometry of the implant acquired the form of a straight line after 3 months and became almost a straight line in 12 months after surgery. Linear shape of prosthesis in early postoperative period was found after intraoperative fixation of endoprosthesis. Sinusoidal shape is noted after 3 months. Ultrasonic pattern of endoprosthesis looked as a thin hyperechoic band with thickness of 1.2-3.9 mm. Mean thickness of prosthesis was 2.2±0.1 mm the next day after surgery, 2.8±0.2 mm after 1 month and 1.6±0.05 mm after 12 months. CONCLUSION Geometry of synthetic implants after TARR hernioplasty undergoes significant changes and depends on duration of postoperative period and fixation of the prosthesis.
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Affiliation(s)
- S G Gavrilov
- Savelyev University's Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - D A Son
- Savelyev University's Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - D A Churikov
- Savelyev University's Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - O I Efremova
- Savelyev University's Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - G D Shulyak
- Savelyev University's Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
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Gavrilov SG, Son DA, Churikov DA, Shuliak GD. Ultrasound Appearance of Mesh After Transabdominal Preperitoneal Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2020; 30:395-401. [PMID: 31930930 DOI: 10.1089/lap.2019.0689] [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: 11/12/2022] Open
Abstract
Background: The linear geometry of the meshes undergoes significant changes after the transabdominal preperitoneal (TAPP) inguinal hernia repair, caused not only by the presence or absence of mesh fixation but also by reparative processes occurring in the area of surgical intervention. Objective: To assess the position of mesh in the preperitoneal space after the TAPP inguinal hernia repair using ultrasonography in the immediate and late postoperative periods. Materials and Methods: A total of 65 patients who underwent inguinal hernia repair with TAPP were examined. In all cases, a lightweight large-pore monofilament polypropylene mesh (size 10 × 15 cm) was used as a prosthesis. Follow-up examinations and ultrasonography of the mesh were carried out on the first postoperative day and at 1, 3, 6, and 12 months of the follow-up period. Results: Ultrasonography demonstrated mesh in two distinctly different appearances. Although it was seen as an echogenic structure with mild acoustic shadowing, the shape was either wavy or straight linear depending on the method and time elapsed from surgery. Thus, in patients without mesh fixation, it has a wavy appearance on the first day and at 1 month after TAPP, whereas at 3 months it took the appearance of a straight line, and at 12 months the implant has retained the shape of a straight line. Among patients who underwent mesh fixation in the immediate postoperative period, implant appeared as a straight line, and starting from the third month it began to acquire a wavy outline. Conclusion: Geometry of mesh used for TAPP inguinal hernia repair undergoes significantly different changes depending on the method of mesh fixation and time of postoperative period.
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Affiliation(s)
- Sergey G Gavrilov
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Denis A Son
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Dmitry A Churikov
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Grigory D Shuliak
- Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moscow, Russia
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Sanna A, Felicioni L, Cecconi C, Cola R. Retromuscular Mesh Repair Using Extended Totally Extraperitoneal Repair Minimal Access: Early Outcomes of an Evolving Technique-A Single Institution Experience. J Laparoendosc Adv Surg Tech A 2019; 30:246-250. [PMID: 31895628 DOI: 10.1089/lap.2019.0661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Enhanced-view extended totally extraperitoneal repair (eTEP) technique for laparoscopic retromuscular ventral hernia (VHR) repair is a novel application recently described by some authors. We present our early single institution experience on this technique. Methods: Retrospective review of the eTEP technique for laparoscopic retromuscular VHR repair cases at our institution from October 2018 to June 2019 with 1 month follow-up was evaluated. Data analyses include patients characteristics, operative details, and complications. Results: A total of 18 patients were treated with eTEP. One patient was reoperated using the same procedure and hospital stay was 6 days. The same patient who had undergone transversus abdominis release developed a seroma that could be observed 20 days after surgery. Conclusion: Our short-term experience with eTEP access suggests feasibility of this approach in accordance with results from other authors. We do not think the technique is challenging, but it is necessary for it to be performed by surgeons with skills in laparoscopic abdominal wall reconstruction.
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Affiliation(s)
- Andrea Sanna
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Luca Felicioni
- Division of General and Minivasive Surgery, Misericordia Hospital della Misericordia, Grosseto, Italy
| | - Claudia Cecconi
- Division of General Surgery, resident of Padova University School of Medicine, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Roberto Cola
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
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Hu D, Huang B, Gao L. Lightweight Versus Heavyweight Mesh in Laparoscopic Inguinal Hernia Repair: An Updated Systematic Review and Meta-Analysis of Randomized Trials. J Laparoendosc Adv Surg Tech A 2019; 29:1152-1162. [PMID: 31373875 DOI: 10.1089/lap.2019.0363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: There is no consensus on whether lightweight mesh (LWM) is better than heavyweight mesh (HWM) in laparoscopic inguinal hernia repair (LIHR). This study aims to update the previous reviews and to analyze present randomized controlled studies comparing LWM versus HWM in LIHR systematically. Methods: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs), which compared LWM with HWM in adults with LIHR. All eligible data of outcomes were quantitatively analyzed using Revman 5.3 software or qualitatively described. The outcomes included chronic pain, moderate-severe chronic pain, recurrence, foreign body sensation, influence on sexual life and male fertility (pain with ejaculation, testicular pain, etc.). Results: We included 12 RCTs that analyzed 3092 hernias. The difference between LWM and HWM groups at any follow-up time was not significant in chronic pain and foreign body sensation. Compared with HWM group, patients in LWM group had a similar risk of postoperative moderate-severe chronic pain at 3 and 12 months follow-up, a slightly increased risk of developing moderate-severe chronic pain at >12 months follow-up (risk ratio [RR] = 3.20, 95% confidence interval [CI] 1.05-9.75, P = .04), and a higher risk of recurrence rate (RR = 2.28, 95% CI 1.17-4.44, P = .02). At long-term follow-up, the influences of LWM and HWM on sexual life and male fertility were comparable. Conclusion: LWMs do not show advantages in chronic pain, foreign body sensation as well as the influence on sexual life and male fertility, and may increase hernia recurrence rates for LIHR. In addition, a higher incremental cost and lower incremental effect of LWMs make conventional HWMs preferred choice for LIHR.
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Affiliation(s)
- Dan Hu
- Department of Hepatobiliary Surgery, The First People's Hospital of Nantong, Nantong, China
| | - Bin Huang
- Department of General Surgery, Haimen Traditional Chinese Medicine Hospital, Haimen, China
| | - Lili Gao
- Department of Gynaecology, The First People's Hospital of Nantong, Nantong, China
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Primary unilateral not complicated inguinal hernia: our choice of TAPP, why, results and review of literature. Hernia 2019; 23:417-428. [PMID: 31069580 DOI: 10.1007/s10029-019-01959-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/21/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Currently, three different techniques are favored for repair of an inguinal hernia: (1) The suture repair described by Shouldice. (2) An open mesh repair according to Lichtenstein. (3) Laparo-endoscopic techniques TAPP and TEP. The aim of the presented paper was to describe the ranking of the Transabdominal Preperitoneal Patch Plasty (TAPP) in comparison to the other techniques for inguinal hernia repair. METHODS The manuscript is based on the experiences gained in more than 15,000 TAPPs and numerous own studies as well. The technique of TAPP is described in detail and also the results which can be achieved with special reference to primary unilateral inguinal hernias in male patients. Moreover, a systematic review of the literature is done for the comparison with the other techniques. RESULTS According to own experiences, 98% of all patients with an inguinal hernia admitted for surgery to Marienhospital Stuttgart could be operated on using the TAPP technique. The recurrence rate and the rate of severe chronic pain in this setting were below 1%. Due to the limited quality of most of the published studies an evidence-based comparison which is the best of the currently most recommended techniques is questionable. Therefore, when comparing TAPP with TEP, no definite conclusion about superiority of one technique over the other is possible. Both techniques are safe and effective if properly performed. The guidelines recommend that the surgeon should use the technique he had learned best and is familiar with. The comparison between TAPP and the Shouldice repair shows less pain and a higher effectivity after TAPP. The recurrence rate after Lichtenstein repair and after TAPP is similar, but pain and recovery time are significantly less after TAPP. CONCLUSION Analyzing the own abundant experiences and the reports in the literature, the TAPP technique has the potential to become the standard operative technique for repair of inguinal hernias in future. However, due to the low level of evidence of most of the studies definite conclusions are difficult to draw at this point of time.
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Egawa N, Nakamura J, Manabe T, Iwasaki H, Noshiro H. Incidence of postoperative complications in transabdominal preperitoneal repair for groin hernia is influenced by poor performance status rather than by old age. Ann Gastroenterol Surg 2019; 3:318-324. [PMID: 31131361 PMCID: PMC6524104 DOI: 10.1002/ags3.12247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/18/2019] [Accepted: 03/10/2019] [Indexed: 11/16/2022] Open
Abstract
AIM The present study was designed to evaluate the safety and feasibility of transabdominal preperitoneal (TAPP) repair for very old patients with groin hernia and to identify the risk factors predicting perioperative complications. METHODS A total of 140 patients treated by TAPP were reviewed retrospectively. They were divided into two groups: patients ≥80 years of age (≥80 years group; n = 26) and those <80 years of age (<80 years group; n = 114). Patient characteristics and surgical outcomes were then statistically compared between the two groups. RESULTS Number of patients with any comorbidities was significantly higher in the ≥80 years group than in the <80 years group (96.2% vs 61.4%, P = 0.003). There were no significant differences in surgical outcomes between the two groups. In the univariate analysis of perioperative complications, poor performance status (PS) (P = 0.014), lower hemoglobin level (P = 0.038) and lower albumin level (P = 0.016) were significantly associated with the occurrence of postoperative complications, and multivariate analysis showed that only poor PS was an independent factor (PS 0-2 vs 3-4: P = 0.034, OR 5.192 [95% CI; 1.137 to 23.71]). CONCLUSIONS This is the first report to show that the incidence of postoperative complications in TAPP repair for groin hernia is influenced by poor PS rather than old age. TAPP can be a safe surgical procedure for very old patients with a good PS, with benefits that are equal to those in young patients.
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Affiliation(s)
- Noriyuki Egawa
- Department of SurgeryFaculty of MedicineSaga UniversitySagaJapan
| | - Jun Nakamura
- Department of SurgeryFaculty of MedicineSaga UniversitySagaJapan
| | - Tatsuya Manabe
- Department of SurgeryFaculty of MedicineSaga UniversitySagaJapan
| | - Hironori Iwasaki
- Department of SurgeryFaculty of MedicineSaga UniversitySagaJapan
| | - Hirokazu Noshiro
- Department of SurgeryFaculty of MedicineSaga UniversitySagaJapan
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18
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Wirth U, Saller ML, von Ahnen T, Köckerling F, Schardey HM, Schopf S. [Inguinal hernia repair in TAPP technique in a day-case surgery setting - at what price?]. Chirurg 2018; 88:792-798. [PMID: 28451730 DOI: 10.1007/s00104-017-0429-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND TAPP surgery can be considered as a gold standard in inguinal hernia repair. Patients benefit of a faster reconvalescence and less pain compared to other techniques. TAPP surgery in Germany is performed in an in-patient setting routinely. However, according to European guidelines, inguinal hernia surgery should be considered as day-case surgery whenever possible. OBJECTIVES The safety of day-case surgery was examined in relation to postoperative pain, complications, comorbidities, recurrent inguinal hernia and bilateral procedures. MATERIAL AND METHODS In a retrospective, monocentric study we analyzed 522 elective inguinal hernia repairs using TAPP technique in a specialized hernia center. Supplemental data from Herniamed registry is analyzed. RESULTS Parts of the procedures should be performed in an in-patient setting, whereas a much larger number of cases should be carried out as day-case surgeries. Logistic regression analyses show that "age", "bilateral procedures" and "comorbidities" affect the complication rate. "Age" and "recurrent inguinal hernia" are risk factors for an increased need for analgetic medication. Furthermore, we present an actual distribution of day-case vs. in-patient surgeries in inguinal hernia repair based on data from the Herniamed registry. CONCLUSION A much larger part of procedures could safely be carried out as day-case surgeries. Based on a false incentive there is an incorrect steering in the German health system. These procedures cannot be carried out covering the costs as day-surgery cases. If there is no reevaluation of the proceeds of these procedures in a day-case surgery setting, the reasonable quality in treatment is compromised especially in inguinal hernia surgery.
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Affiliation(s)
- U Wirth
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland. .,Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.
| | - M-L Saller
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Klinik für Rehabilitation und Innere Medizin, International Medical Center, Schön Klinik Vogtareuth, Vogtareuth, Deutschland
| | - T von Ahnen
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - F Köckerling
- Klinik für Chirurgie-, Viszeral- und Gefäßchirurgie, Vivantes-Klinikum Spandau, Berlin, Deutschland
| | - H M Schardey
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - S Schopf
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
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Mitura K, Garnysz K, Wyrzykowska D, Michałek I. The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon's experience. Surg Endosc 2018; 32:4284-4289. [PMID: 29603008 PMCID: PMC6132881 DOI: 10.1007/s00464-018-6178-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/21/2018] [Indexed: 11/15/2022]
Abstract
Background Although inguinal hernia is one of the most common conditions requiring surgical treatment, no reliable information is available on the quality of life of patients with inguinal hernias before surgery. Additionally, patients with intense inguinal pain prior to surgery are more susceptible to postoperative chronic pain. In such cases, less invasive laparoscopic techniques can be used, allowing atraumatic mesh fixation to reduce postoperative pain. The aim of the study was to determine, whether these treatments for patients with preoperative pain would minimize upsetting experiences after surgery. Materials and methods Data were gathered prospectively from the National Hernia Repair Register for 146 patients who underwent TAPP repairs in the general surgery department (2013–2016). The demographic data were recorded, the pain intensity was determined and patients described the occurrence of pain during ten everyday activities. Results The average surgery time was 56.4 min. The follow-up was 23.4 months. The pain before surgery was 4.28 and 12 months after surgery 0.38 (p < 0.001). Pain intensity before surgery was scored as 4.1, 4.3, and 4.9 among patients who had a hernia < 12 months, > 1 year, and > 5 years, respectively (p = 0.028). Twelve months after surgery, the pain was 0.26, 0.34, and 0.40 (p = 0.037), respectively. Patients < 40 years experienced pain before the surgery more often. The intensity of pre-/postoperative pain was significantly higher < 40 years (4.9/0.63) than > 60 years (3.8/0.29). Conclusions TAPP inguinal hernia repair with glue fixation significantly decreased the frequency and intensity of the pain compared to that experienced preoperatively. After TAPP repair, the influence of pain on basic everyday activities is substantially lower. Patients under 40 years of age experience frequent and intense pre- and postoperative pain. A longer hernia duration prior to surgery causes increased pre- and postoperative pain.
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Affiliation(s)
- Kryspin Mitura
- General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland. .,Department of Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland.
| | - Karolina Garnysz
- General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland
| | - Dorota Wyrzykowska
- General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland.,Department of Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Irmina Michałek
- General Surgery Department, Siedlce Hospital, ul. Narutowicza 25, 08-110, Siedlce, Poland
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20
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Uemura A, Fukayama T, Tanaka T, Hasegawa-Baba Y, Shibutani M, Tanaka R. Development of an Anti-Adhesive Membrane for Use in Video-Assisted Thoracic Surgery. Int J Med Sci 2018; 15:689-695. [PMID: 29910673 PMCID: PMC6001413 DOI: 10.7150/ijms.24050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 01/21/2023] Open
Abstract
Background: The need to prevent postoperative adhesions after surgery has been considered a significant challenge in thoracic surgery, especially with the advent of video-assisted thoracic surgery (VATS). While preventive materials for postoperative adhesions have been studied for many years, they are all still in the development phases. Methods: In this animal study, an insoluble hyaluronic acid membrane was used in VATS for wedge resection to test its operability and to examine the body's response to the membrane. Ten beagles were divided into two groups, an experimental group and a negative control group. In the experimental group, an insoluble hyaluronic acid membrane containing glycerol was used as the test membrane (10 x 10 x 0.1 cm3). The test membrane was implanted in the left thoracic cavity of the animal under VATS following wedge resection. The animals were observed for two weeks and then euthanized for examination. Results: Macroscopically, the median adhesion score was lower in the experimental group (0) than in the control group (2.5). On histopathological examination, the test membrane elicited only a minor inflammatory response and foreign body reaction. Conclusion: The test membrane showed satisfactory operability and appears to be a practical material to prevent postoperative adhesions after thoracic surgery in VATS.
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Affiliation(s)
- Akiko Uemura
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Toshiharu Fukayama
- National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Takashi Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Yasuko Hasegawa-Baba
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Makoto Shibutani
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Ryou Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
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Luz S, Rechner J, Widmann B, Zollinger T, De Lorenzi D. [Lower right abdominal pain and anal bleeding : A rare cause for nonspecific complaints]. Chirurg 2017; 89:306-309. [PMID: 29038821 DOI: 10.1007/s00104-017-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Luz
- Department für Chirurgie, Spital Grabs, Spitalstraße 44, 9472, Grabs, Schweiz.
| | - J Rechner
- Department für Chirurgie, Spital Altstätten, Altstätten, Schweiz
| | - B Widmann
- Klinik für Allgemein‑, Viszeral‑, Endokrin- und Transplantationschirurgie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - T Zollinger
- Institut für Pathologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - D De Lorenzi
- Department für Chirurgie, Spital Grabs, Spitalstraße 44, 9472, Grabs, Schweiz
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22
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Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 2017; 10:119-127. [PMID: 28547932 DOI: 10.1111/ases.12388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed.
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Langenbach MR, Berengolts A. Chronic Pain after Laparoscopic Inguinal Hernia Repair Depends on Mesh Implant Features: A Clinical Randomised Trial. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/ojpm.000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Transabdominal preperitoneal patch plasty (TAPP) is the most frequently used surgical technique for repair of an inguinal hernia in German hospitals (Federal Statistical Office, Wiesbaden). Since its initial description in 1992 by Arregui the technique has been further developed and completely standardized, so that TAPP is now suitable as an operation performed by trainee surgeons despite the complex technique. The individual operation stages have been described by many experts mainly based on their own experiences, training with other experts, participation in meetings with live or video demonstrations and reports in the literature. A scientific explanation for the individual operation steps, i.e. why a certain technique is given preference in comparison to other techniques, is not usually communicated. In this article for the first time not only the operation steps of TAPP are described in detail but also the scientific reasons (evidence) are given.
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25
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Fan JKM, Yip J, Foo DCC, Lo OSH, Law WL. Randomized trial comparing self gripping semi re-absorbable mesh (PROGRIP) with polypropylene mesh in open inguinal hernioplasty: the 6 years result. Hernia 2016; 21:9-16. [PMID: 27889845 DOI: 10.1007/s10029-016-1545-z] [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: 08/25/2016] [Accepted: 11/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The use of absorbable polylactic acid hook self-gripping polypropylene mesh in open inguinal hernia may potentially reduce operative time and enhance patient recovery. The objective of this randomized trial is to compare the outcomes following self-gripping mesh repair to polypropylene mesh secured with sutures in open inguinal hernioplasty. METHOD Eligible patients aged 18-80 years old, who had primary unilateral uncomplicated inguinal hernia, were randomized into either Polypropylene (PL) group or PROGRIP (PG) group just before the placement of mesh intra-operatively by computer generated code. The primary outcome was the time from mesh placement to end of operation, whereas secondary outcomes included the total operative time, amount of analgesic used, length of post-operative stay, seroma formation, chronic discomfort, chronic pain score and recurrence. The study has been registered in http://www.clinicaltrial.gov carrying an ID of NCT00960011. Patients were followed-up in outpatient clinic for up to 6 years after operation. RESULTS From March 2009 to April 2016, 45 patients were included. The mean age of PG group (n = 22) was 62.0 ± 15.7 years old while that of the PL group was 62.6 ± 4.9 years old (n = 23). There was no significant difference regarding the smoking habit, drinking habit, comorbidities, previous hernia operation and Nyhus type of hernia between the two groups. The size of defects, the time of groin dissection and the size of incision were similar. In the PG group, there was significant reduction in the time for mesh placement (11.8 ± 3.1 vs. 21.0 ± 6.2 min, p < 0.001) and total operative time (39.2 ± 9.8 vs. 47.7 ± 8.0 min, p = 0.003). There was one recurrence in PL group and nil in PG group. Although there was a significant difference in paresthesia between 2 groups after operation, the difference disappears with time and comparable from post-operative 1 year onwards. There was no difference in chronic pain, chronic discomfort, affect daily activities, palpable mesh demonstrated throughout the whole study period till 6 years after operation. CONCLUSIONS The use of polylactic acid self-gripping mesh in open inguinal hernia repair effectively reduces the operating time with comparable long-term surgical outcome with traditional polypropylene mesh.
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Affiliation(s)
- J K M Fan
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - J Yip
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - D C C Foo
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - O S H Lo
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - W L Law
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong.
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