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Chi Q, Shi Z, Zhang Z, Lin C, Liu G, Weng S. Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible? BMC Surg 2020; 20:310. [PMID: 33267814 PMCID: PMC7709271 DOI: 10.1186/s12893-020-00979-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 04/21/2024] Open
Abstract
Background Continuous ambulatory peritoneal dialysis (CAPD), which often causes a common complication such as abdominal wall hernia, is a prevalent alternative therapy for end-stage renal failure patients. However, relevant studies are somewhat rare, and the peritoneal dialysis (PD) protocol during the perioperative period is still controversial. The aim of this study was to evaluate the effectiveness and perioperative management of tension-free mesh repair for inguinal hernias in CAPD patients. Methods Between January 2013 and December 2019, 18 CAPD patients with 20 inguinal hernias who underwent tension-free mesh repair were retrospectively analyzed. Data on demographics, perioperative features, the perioperative dialysis protocol and surgical complications were collected and assessed. Results All hernias were diagnosed after the start of CAPD, and the median duration from PD onset to hernia formation was 16 months (2–61 months). All patients underwent successful tension-free mesh repair, including 17 Lichtenstein and 3 anterior Kugel procedures. The median operation time was 62.5 min, and the median postoperative hospital stay was 3 days. Fifteen patients received low-exchange volumes and high-frequency exchanges from 1 to 3 days after surgery for 2 weeks with gradual resumption of the original CAPD regimen within 4 weeks. Complications included seroma (n = 2) and hematoma (n = 1). No wound or mesh infection or recurrence occurred during the follow-up period. Conclusions Tension-free mesh repair is safe and feasible for inguinal hernias in CAPD patients, The Lichtenstein mesh repair should be the first choice, and anterior Kugel repair may be considered an effective procedure. Bridging hemodialysis seems unnecessary except for emergency surgery.
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Affiliation(s)
- Qiyu Chi
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Zheng Shi
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Zhibo Zhang
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Chunzhong Lin
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Guozhong Liu
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Shangeng Weng
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou, 350005, Fujian, China.
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A 12-year experience of using the Kugel procedure for adult inguinal hernias via the internal ring approach. Hernia 2018; 22:863-870. [DOI: 10.1007/s10029-018-1783-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022]
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Andresen K, Rosenberg J. Open preperitoneal groin hernia repair with mesh: A qualitative systematic review. Am J Surg 2017; 213:1153-1159. [PMID: 28095985 DOI: 10.1016/j.amjsurg.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/07/2016] [Accepted: 01/08/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique. DATA SOURCES A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh technique. CONCLUSIONS A total of 67 articles were included, describing nine different methods: Kugel, TREPP, TIPP, Onstep, Horton/Florence, Nyhus, Ugahary, Read, and Stoppa. In general, results regarding pain, recurrences and complications seem promising. It was not possible to conduct a meta-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes.
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Affiliation(s)
- Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Chen PH, Chiang HC, Chen YL, Lin J, Wang BF, Yan MY, Chen CC, Shih HJ, Chen JT. Initial experience with application of single layer modified Kugel mesh for inguinal hernia repair: Case series of 72 consecutive patients. Asian J Surg 2016; 40:152-157. [PMID: 26971818 DOI: 10.1016/j.asjsur.2015.08.001] [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: 04/28/2015] [Revised: 06/25/2015] [Accepted: 08/05/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This is an initial review of the safety and efficacy of anterior preperitoneal modified Kugel (MK) mesh herniorrhaphy application without using optional onlay mesh. METHODS We retrospectively reviewed patients who underwent herniorrhaphy by a single surgeon from July 1st, 2009 to December 31st, 2010. During these 18 months, a total of 72 patients underwent single-layer MK mesh herniorrhaphy. Anterior preperitoneal approach was used to place the mesh. If the patient's inguinal hernia defect did not exceed the memory ring of MK mesh, the onlay mesh was omitted. Postoperative results (wound infection, recurrence, and chronic pain/discomfort) were recorded and analyzed. RESULTS A total of 72 patients underwent anterior preperitoneal single layer MK mesh herniorrhaphy. One patient had recurrent hernia after 1 year and was treated with a laparoscopic transabdominal preperitoneal operation. The most common postoperative complaint was mild soreness which was self-resolving after 1 month. Mean total operative time (skin to skin) was 73 minutes. The average hospital stay was 2 days. Most of the postoperative complications including soreness (14%), pain for > 3 months (1.4%), and scrotal hematoma (1.4%) were self-resolving. One patient experienced wound infection, which was treated with oral antibiotics. One patient had recurrence 1 year after the operation. CONCLUSION The postoperative complication and recurrence rates of single-layer MK mesh herniorrhaphy was comparable with previously reported tension-free repair. Single-layer application is safe and feasible. A longer follow-up period and larger study group with a control group are needed to verify our method.
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Affiliation(s)
- Pao-Hwa Chen
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Heng-Chieh Chiang
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Yao-Li Chen
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Jesen Lin
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Bai-Fu Wang
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Meng-Yi Yan
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun-Chi Chen
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Jen Shih
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Jian-Ting Chen
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Chyung JW, Shin DG, Kwon Y, Cho DH, Lee KB, Park SS, Yoon J, Jang YS. Tumescent local anesthetic technique for inguinal hernia repairs. Ann Surg Treat Res 2014; 87:325-30. [PMID: 25485241 PMCID: PMC4255543 DOI: 10.4174/astr.2014.87.6.325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. Methods The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. Results The mean operation time (±standard deviation) and hospital stay were 64.5 ± 17.6 minutes and 2.7 ± 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 ± 14 months. Conclusion Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.
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Affiliation(s)
- Ju Won Chyung
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Gue Shin
- Department of Surgery, Seoul Red Cross Hospital, Seoul, Korea
| | - Yujin Kwon
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Hui Cho
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Sang Soo Park
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Jin Yoon
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yong Seog Jang
- Department of Surgery, Seoul Medical Center, Seoul, Korea
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Arslan K, Erenoglu B, Turan E, Koksal H, Dogru O. Minimally invasive preperitoneal single-layer mesh repair versus standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial. Hernia 2014; 19:373-81. [DOI: 10.1007/s10029-014-1306-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Jiang ZP, Wang DY, Lai DM, Zhou QB, Zhang YC, Yang B, Chen S. Variations of Urinary Bladder and the Urogenital Fatty Fascial Compartment with Different Filling of the Bladder are Notable Factors Relevant to Hernia Repair-Related Bladder Injury. Am Surg 2013. [DOI: 10.1177/000313481307900227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study investigated bladder and urogenital fatty fascial compartment (UFFC) variations during bladder filling in an attempt to identify other possible causes of hernia repair-related bladder injury besides mesh migration. The study included 30 patients scheduled for abdominal computed tomography (CT) scan for nonhernia diseases. Sixty-four-slice CT scan was performed immediately after urination and no more than 30 minutes later. Three-dimensional images were constructed by two independent experienced readers. The empty bladder was triangular in shape, narrow in the front and broad in the rear. Its vertex deviated from midline of the abdominal wall in 11 cases (36.7%). With normal filling, it appeared as an irregular oval shape. Only two cases (6.7%) of empty bladder extended inside Hesselbach's triangle. However, this area was occupied to some extent in all cases during bladder filling ( P = 0.003). The UFFC formed a molar-like structure in cross-section. In three dimensions, it appeared as an inverted V-shaped structure from the front. In the lateral view it appeared as a spoon that contained the bladder. UFFC volume increased from 61.85 ± 6.23 to 139.23 ± 5.29 cm3with bladder filling ( P < 0.0001). The UFFC can be clearly identified by CT scanning or three-dimensional reconstruction. The considerable spatial variation of the UFFC and movement and deformation of the mesh within this area may be related to bladder injury.
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Affiliation(s)
- Zhi-Peng Jiang
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong-Ye Wang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong-Ming Lai
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Quan-Bo Zhou
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Chao Zhang
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Yang
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuang Chen
- Department of Surgical Disciplines, South China Training Center for Hernia Therapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Barreto SG, Schoemaker D, Siddins M, Wattchow D. Colovesical fistula following an open preperitoneal "Kugel" mesh repair of an inguinal hernia. Hernia 2011; 13:647-9. [PMID: 19337773 DOI: 10.1007/s10029-009-0496-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 03/08/2009] [Indexed: 11/26/2022]
Abstract
Erosion of the "Kugel" mesh into intraperitoneal organs has not been previously reported in the medical literature. We report such an occurrence in a 54-year-old male, 4 years following a "Kugel" preperitoneal repair of a left-sided inguinal hernia. The patient presented with septicaemia, pneumaturia and left iliac fossa pain. His computed tomography (CT) scan indicated the presence of gas in the bladder and a thickened loop of sigmoid colon attached to the region of the dome of the bladder. Colonoscopy showed some scattered diverticula in the sigmoid colon but no tumour. On surgical exploration, the "Kugel" mesh was found to erode the sigmoid colon and the bladder wall, leading to a colovesical fistula. An anterior resection of the rectum with removal of the mesh with closure of the bladder wall defect was performed.
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Affiliation(s)
- S G Barreto
- Division of Colorectal Surgery, Department of General and Digestive Surgery, Flinders Medical Centre & Flinders Private Hospital, Bedford Park, Adelaide, SA, Australia
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Chen J, Lv Y, Shen Y, Liu S, Wang M. A prospective comparison of preperitoneal tension-free open herniorrhaphy with mesh plug herniorrhaphy for the treatment of femoral hernias. Surgery 2010; 148:976-81. [DOI: 10.1016/j.surg.2010.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 02/12/2010] [Indexed: 11/25/2022]
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10
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Bender Ö, Balcı FL, Yüney E, Sağlam F, Özdenkaya Y, Sarı YS. Systemic inflammatory response after Kugel versus laparoscopic groin hernia repair: a prospective randomized trial. Surg Endosc 2009; 23:2657-61. [DOI: 10.1007/s00464-009-0495-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/15/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
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11
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Ramadan SU, Gokharman D, Tuncbilek I, Ozer H, Kosar P, Kacar M, Temel S, Kosar U. Does the presence of a mesh have an effect on the testicular blood flow after surgical repair of indirect inguinal hernia? JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:78-81. [PMID: 18642364 DOI: 10.1002/jcu.20516] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Modern treatment of inguinal hernias includes prosthetic mesh repairs. However, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. The aim of this prospective study was to evaluate the effect of mesh implantation/perimesh fibrosis on testicular flow after repair of indirect inguinal hernias (IIHs). METHOD Forty-eight male patients with unilateral IIH were included. Both testicular parenchyma were assessed using gray-scale sonography, and color/spectral Doppler sonography was performed to evaluate testicular arterial impedance, perfusion, and venous flow. Measurements were made bilaterally at the level of the inguinal canal 1 day before and at the end of the 2nd month after the operation. RESULTS There was no difference in testicular and echotexture perfusion between the hernia and the control sides pre- and postoperatively. No venous thrombosis was found. In all groups, resistance index and pulsatility index, measured at 4 levels, were highest in the proximal inguinal canal and lowest at the extratesticular-intrascrotal level (p < 0.05). For all Doppler parameters there was no significant difference between the pre- and postoperative measurements on both the hernia and the control sides. CONCLUSION Mesh implantation/perimesh fibrosis does not adversely affect ipsilateral testicular flow. Mesh application is still a safe procedure in male patients in whom testicular function is important.
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Affiliation(s)
- Selma Uysal Ramadan
- Department of Radiology, Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey
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Nienhuijs SW, Rosman C, Strobbe LJA, Wolff A, Bleichrodt RP. An overview of the features influencing pain after inguinal hernia repair. Int J Surg 2008; 6:351-6. [PMID: 18450528 DOI: 10.1016/j.ijsu.2008.02.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 01/25/2008] [Accepted: 02/26/2008] [Indexed: 11/25/2022]
Abstract
Pain is a prominent issue in inguinal hernia repair research as its persisting appearance is a severe complication. The interest is also urged by the combination of a high number of repairs with an estimated risk for chronic postoperative pain of 11%. Almost every healthcare provider could encounter this complication. Pain is a complex study subject, mostly defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Various explanatory factors for pain following hernia repair have been reported. Most investigators, however, discuss only a few aspects. In the present review, these factors are collected to provide a more holistic synopsis of pain following hernia repair. It may be a resource for understanding this and other postsurgical pain.
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Affiliation(s)
- S W Nienhuijs
- Catharina Hospital, Department of Surgery, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
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Karatepe O, Adas G, Battal M, Gulcicek OB, Polat Y, Altıok M, Karahan S. The comparison of preperitoneal and Lichtenstein repair for incarcerated groin hernias: A randomised controlled trial. Int J Surg 2008; 6:189-92. [DOI: 10.1016/j.ijsu.2008.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 01/29/2008] [Accepted: 02/29/2008] [Indexed: 11/25/2022]
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Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 2007; 31:1751-1757. [PMID: 17510766 DOI: 10.1007/s00268-007-9090-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 02/28/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The open preperitoneal approach in inguinal hernia repair might have the benefit of a mesh in the preferred space without the disadvantages of an endoscopic procedure. METHODS A total of 172 patients with primary inguinal hernia were randomized to undergo the open preperitoneal Kugel or the standard open anterior Lichtenstein procedure in a teaching hospital. The main outcome measures were operating variables, visual analog scale (VAS) pain scores, and consumed analgesics during the first 2 weeks postoperatively and at 3 months, neurological examination, and complications. RESULTS In the Lichtenstein group the operation took longer (54 min versus 41 min; p < .001). There were no clinically important differences in VAS pain score or number of analgesics during the first 2 weeks postoperatively. In the Kugel group the mean VAS pain score at 3 months was less (0.3 versus 0.9; p = .002), as was the proportion of patients reporting pain (21 versus 40%; p = .007). Pain was merely described as neuropathic, especially in the Lichtenstein group. With the anterior repair significantly more nerves were encountered, numbness reported, and cutaneous sensory changes found with neurological examination (all p < .001). CONCLUSIONS For those surgeons preferring an open approach, the Kugel procedure is a feasible alternative for the standard Lichtenstein procedure and is associated with less chronic pain at three months. Most likely the neuropathic pain and numbness with the Lichtenstein technique are results of more nerves at risk with the anterior approach.
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Affiliation(s)
- Simon Nienhuijs
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
| | - Erik Staal
- University Medical Centre St. Radboud, PO Box 9015, 6500, GS, Nijmegen, The Netherlands
| | - Mariël Keemers-Gels
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Luc Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Van Nieuwenhove Y, Vansteenkiste F, Vierendeels T, Coenye K. Open, preperitoneal hernia repair with the Kugel patch: a prospective, multicentre study of 450 repairs. Hernia 2006; 11:9-13. [PMID: 16943997 DOI: 10.1007/s10029-006-0137-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Kugel patch inguinal hernia repair is a relatively new, open, minimally invasive procedure using a preperitoneal approach. METHOD Prospective multicentre case series of 450 consecutive Kugel patch repairs. Recurrence rates and persistent inguinal pain after at least 1 year as well as short-term outcomes were studied. RESULTS After a follow-up of 18 months, eight recurrences (1.9%) were found, and persisting inguinal pain was reported in 15 patients (3.5%). The mean operation time and hospital stay were 20 +/- 9 min and 19 +/- 1.3 h respectively. Less than 1% of patients planned for an ambulatory treatment needed prolonged hospitalisation. Analgesics were used for 3 +/- 2 days. Paracetamol was the only painkiller used in 69% of patients, and 13% did not take any painkiller at all. Half of all patients returned to their daily activities after 9 days and half of the employed patients returned to work after 14 days. CONCLUSION The Kugel patch repair is a quick technique with a low recurrence rate and good patient comfort. It offers the advantages of a preperitoneal inguinal hernia repair without the need for general anaesthesia or expensive laparoscopic equipment.
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Affiliation(s)
- Y Van Nieuwenhove
- Department of Surgery, Academisch Ziekenhuis-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
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Peiper C, Junge K, Klinge U, Strehlau E, Ottinger A, Schumpelick V. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia 2005; 10:7-12. [PMID: 16362230 DOI: 10.1007/s10029-005-0055-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 11/13/2005] [Indexed: 12/13/2022]
Abstract
The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion. We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig, we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall. The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of a prosthetic mesh during inguinal hernia repair is recommended.
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Affiliation(s)
- Christian Peiper
- Surgical Clinic, Evangelisches Krankenhaus, Pferdebachstr. 27, 58455, Witten, Germany.
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