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Mainprize M, Svendrovski A, Spencer Netto FAC, Katz J. Matching males and females undergoing non mesh primary unilateral inguinal hernia repair: evaluating sex differences in preoperative and acute postoperative pain. Updates Surg 2024; 76:1983-1990. [PMID: 38480641 DOI: 10.1007/s13304-024-01792-9] [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: 09/15/2023] [Accepted: 02/24/2024] [Indexed: 10/06/2024]
Abstract
PURPOSE The objective was to compare pain and related psychological factors during the preoperative and acute postoperative period between male and female patients, who underwent non mesh primary unilateral inguinal hernia repair. METHODS After ethics approval, informed consent was obtained, and data were collected. Male and female participants were compared by manually matching one-to-one on 10 variables. Descriptive statistics (mean ± standard deviation and frequency) as well as numerical rating scales from 0 to 10 were used. Comparison tests were performed using Chi-square or Fisher's Exact test for categorical data and independent samples t-test or non-parametric equivalent tests for numerical scores. p < 0.05 is reported as statistically significant. To control type I error, Bonferroni correction was used. RESULTS 72 participants with 36 matched pairs were included. Sex differences were found for operation length (p = .006), side of operation (p = .002), and hernia type (p = .013). Significant differences between the sexes were not found at the preoperative or postoperative time for resilience, pain interference or pain severity related measures, postoperative hernia pain incidence, pain catastrophizing, depression and anxiety symptoms, or return to normal activities. CONCLUSION When controlling for known confounders and using a conservative Type I error rate, pain and related factors between the sexes did not differ significantly.
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Affiliation(s)
- Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 7N2, Canada.
| | | | | | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
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van Hout L, Harker MJR, Vriens PWHE, Bökkerink WJV. Identifying postoperative complications after inguinal hernia repair with a smartphone application: a comparative cohort study. Hernia 2024; 28:1265-1274. [PMID: 38506944 PMCID: PMC11296961 DOI: 10.1007/s10029-024-03019-7] [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: 11/16/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The Q1.6 Inguinal Hernia application continuously measures patient-reported outcomes (PROs) by sampling experiences through brief, digital and condition-specific questions, utilising micro-moments. This can overcome the limitations of current paper questionnaires and give real-time insight into patient recovery. This exploratory study compares data from the application with retrospective data from electronic medical records (EMRs) to provide information on its accuracy in detecting postoperative complications after inguinal hernia repair. METHODS Patients were asked to use the application in addition to their usual care. The application employs twitch crowdsourcing to gather PROs. Questions from validated and frequently used questionnaires were integrated. A retrospective assessment of EMRs was combined with an additional telephone interview. The primary endpoints were the sensitivity and specificity of the application in detecting chronic postoperative inguinal pain, recurrence and surgical-site infection (SSI). RESULTS A total of 215 patients were analysed. The sensitivity and specificity for detecting chronic postoperative inguinal pain were 100% (95% CI [47.8%, 100%]) and 93.7% (95% CI [88.3%, 97.1%]), respectively. For recurrence, the sensitivity was 77.8% (95% CI [40.0%, 97.2%]), and the specificity was 81.3% (95% CI [75.0%, 86.5%]). For SSI, the sensitivity and specificity were 75.0% (95% CI [19.4%, 99.4%]) and 89.8% (95% CI [84.8%, 93.6%]), respectively. CONCLUSION This study demonstrates satisfactory measurement capabilities of the Q1.6 Inguinal Hernia application for identifying postoperative complications following inguinal hernia repair. However, certain aspects require further improvement, such as addressing error-prone questions, enhancing long-term compliance, and validating (pain) measurements through prospective control data. TRAIL REGISTRATION NUMBER NL7813 (Dutch Trial Registry), 19 May 2019.
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Affiliation(s)
- L van Hout
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
| | - M J R Harker
- Department of Surgery, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Department of Surgery, Hernia Centre Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
| | - W J V Bökkerink
- Department of Surgery, Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
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Messias BA, Nicastro RG, Mocchetti ER, Waisberg J, Roll S, Junior MAFR. Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes. Hernia 2024; 28:1467-1476. [PMID: 38900355 PMCID: PMC11297121 DOI: 10.1007/s10029-024-03094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. METHODS PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. RESULTS Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. CONCLUSION The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique.
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Affiliation(s)
- Bruno Amantini Messias
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil.
- Department of Surgery, São Camilo University Center, São Paulo, SP, Brazil.
| | | | - Erica Rossi Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil
| | - Jaques Waisberg
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil
- Department of Surgery, ABC Medical School, Santo Andre, SP, Brazil
| | - Sergio Roll
- Abdominal Wall Surgery Unit, Santa Casa de São Paulo, São Paulo, SP, Brazil
- Hernia Center, Oswaldo Cruz German Hospital, Sao Paulo, SP, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro Junior
- Division Chair Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
- Department of Surgery, Catholic University of São Paulo, Sorocaba, SP, Brazil
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Chu Z, Zheng B, Yan L. Incidence and predictors of chronic pain after inguinal hernia surgery: a systematic review and meta-analysis. Hernia 2024; 28:967-987. [PMID: 38538812 DOI: 10.1007/s10029-024-02980-7] [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: 09/20/2023] [Accepted: 01/25/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE The mesh is currently the preferred treatment option for hernia repair surgery. Chronic postoperative inguinal pain (CPIP), lasting more than 3 months after surgery, is a complication that significantly impacts patients' quality of life. Currently, there is a lack of evidence-based information describing the incidence and independent predictive factors of chronic pain, posing a serious challenge in clinical practice for devising personalized prevention strategies. Hence, we conducted this systematic review and meta-analysis to investigate the incidence and predictive factors, aiming to provide a reference for developing plans to prevent chronic pain. METHODS We conducted a systematic search of PubMed, Cochrane, Embase, and Web of Science, with the retrieval cutoff date set at December 17, 2022. The included studies underwent assessment using the NOS scale, and subgroup analysis for the incidence was carried out based on different regions. RESULTS Ultimately, 18 studies were included, involving 29,466 patients. Meta-analysis showed that the pooled incidence of chronic pain was 17.01% (95%CI 12.78% ~ 21.71%). The incidence was 18.65% (95%CI 13.59% ~ 24.29%) in Europe, 14.70% (95%CI 7.87% ~ 23.17%) in Asia, and 6.04%(95%CI 4.62 ~ 7.64) in North America. Furthermore, We also found that the risk factors for CPIP are younger age [OR = 2.261 (95%CI 1.126 ~ 4.549)], presence of other postoperative complications [OR = 1.849 (95%CI 1.034 ~ 3.305)], hernial sac defect < 3 cm [OR = 1.370 (95%CI 1.012 ~ 1.853)], being female [OR = 1.885 (95%CI 1.024 ~ 3.472)], postoperative pain [OR = 1.553 (95%CI 1.276 ~ 1.889)], preoperative pain [OR = 2.321 (95%CI 1.354 ~ 3.979)], and having a history of ipsilateral inguinal hernia repair [OR = 2.706 (95% CI 1.445 ~ 5.069)]. CONCLUSIONS The incidence of persistent pain following hernia repair surgery is high in current clinical practice, a concern that should not be overlooked. Stratified assessment tools need to be established for patients experiencing early chronic pain, and personalized follow-up strategies and preventive interventions should be developed for those with potentially high risks. These measures aim to enhance the quality of life for patients after hernia repair.
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Affiliation(s)
- Z Chu
- Yan'an University, Yan'an, 716000, Shaanxi, China
| | - B Zheng
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Huangyan Village, Beilin District, No. 256 Youyi West Road, Xi'an City, 710000, Shaanxi Province, China
| | - L Yan
- First Department of General Surgery, Shaanxi Provincial People's Hospital, Huangyan Village, Beilin District, No. 256 Youyi West Road, Xi'an City, 710000, Shaanxi Province, China.
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Wang SH, Lee CY, Hsieh WC, Yen JB, Tseng IM, Wong CH, Ho DR. Tailored treatment of female indirect inguinal hernias by using single-port laparoscopic percutaneous internal ring suture: a comparison between children and adults. Hernia 2024; 28:1365-1372. [PMID: 38775981 PMCID: PMC11297084 DOI: 10.1007/s10029-024-03055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/18/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE To compare the outcome of indirect inguinal hernias repaired by using single-port laparoscopic percutaneous internal ring suture (SPIRS) between the pediatric and adult females. METHODS The medical records of females who were clinically assessed to have inguinal hernia from Oct. 2016 to May 2022 were reviewed. Patients who received laparoscopy for the diagnosis of the hernia type and customized treatment according to their hernia type were included, while those who chose other operation methods initially were excluded. The patients were divided into the adult and pediatric groups based on their age. The demographic characteristics, hernia types, operation durations, and outcomes were analyzed between these two groups. RESULTS A total of 65 adults and 60 children were included in this study. The median age was 38 years. (range: 23-88) for group A and 3 years (range: 0.1-16) for group P. Indirect hernias were present in 85% of adults and 100% of children. All the indirect hernias were repaired by SPIRS uneventfully. Incidence of contralateral patent processus vaginalis was 24% in adults and 50% in children (p = 0.016). The average operation time was 22/46 min (one/two sides) for the adults and 9/15 min (one/two sides) for the pediatrics (p < 0.010 for both). The overall complication rates were 5.4% and 3.3% for the adult and pediatric group respectively (p = 0.106). No recurrence was observed in the pediatric group, but two adults experienced recurrence and another had chronic postoperative inguinal pain, necessitating reoperation. The mean follow-up period was 38.6 ± 15.4 months for adults and 42.8 ± 18.9 months for children (p = 0.198). CONCLUSION Our results support that the pathogenesis of indirect inguinal hernia for the female adults is due to the non-obliteration of a congenital processus vaginalis. Tailored treatment of the female IIH by using single-port laparoscopic percutaneous internal ring suture may be an alternative for the management of female IHs.
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Affiliation(s)
- S-H Wang
- Department of Pediatric Surgery, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, 333, Taoyuan, Taiwan
| | - C-Y Lee
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan
- Department of Nursing, Chang-Gung University of Science and Technology, Chiayi Campus, Chiayi, 61363, Taiwan
| | - W-C Hsieh
- Department of Rehabilitation, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan
| | - J-B Yen
- Department of Pediatrics, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan
| | - I-M Tseng
- Department of Surgery, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan
| | - C-H Wong
- Department of Anesthesiology, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan.
| | - D-R Ho
- School of Medicine, College of Medicine, Chang-Gung University, 333, Taoyuan, Taiwan.
- School of Medicine, National Tsing Hua University, Hsinchu, 300044, Taiwan.
- Department of Urology, Chang-Gung Memorial Hospital, Chiayi, 61363, Taiwan.
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Moseholm VB, Baker JJ, Rosenberg J. Identification of the ilioinguinal and iliohypogastric nerves during open inguinal hernia repair: a nationwide register-based study. Hernia 2024; 28:1181-1186. [PMID: 38502369 PMCID: PMC11297051 DOI: 10.1007/s10029-024-03002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Chronic pain remains prevalent after open inguinal hernia repair and nerve-handling strategies are debated. Some guidelines suggest sparing nerves that are encountered; however, the nerve identification rates are unclear. This study aimed to investigate the nerve identification rates in a register-based nationwide cohort. METHODS This study was reported according to the RECORD guideline and used prospective, routinely collected data from the Danish Hernia Database, which was linked with the National Patient Registry. We included patients ≥ 18 years old, undergoing Lichtenstein hernia repair with information on nerve handling of the iliohypogastric and ilioinguinal nerves. RESULTS We included 30,911 open hernia repairs performed between 2012 and 2022. The ilioinguinal nerve was identified in 73% of the repairs and the iliohypogastric nerve in 66% of repairs. Both nerves were spared in more than 94% of cases where they were identified. Female patient sex, emergency and recurrence surgery, general anesthesia, medial and saddle hernias, and large defect size all result in lower nerve identification rates for both nerves. CONCLUSION The Ilioinguinal nerve was recognized in 73% of cases, while the iliohypogastric nerve was recognized in 66% with almost all identified nerves being spared during surgery. Several pre- and intraoperative factors influenced identification rates of the ilioinguinal and iliohypogastric nerve.
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Affiliation(s)
- V B Moseholm
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - J J Baker
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Andresen K, Rosenberg J. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2024; 7:CD004703. [PMID: 38963034 PMCID: PMC11223180 DOI: 10.1002/14651858.cd004703.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND An inguinal hernia occurs when part of the intestine protrudes through the abdominal muscles. In adults, this common condition is much more likely in men than in women. Inguinal hernia can be monitored by 'watchful waiting', but if symptoms persist or worsen, surgery is usually required, which can be open or laparoscopic. Laparoscopic (keyhole) repair of inguinal hernias in adults is generally performed using either the transabdominal preperitoneal (TAPP) or the totally extraperitoneal (TEP) method. Both methods include the use of mesh placed in front of the peritoneal lining of the abdominal wall, but for the TAPP technique, the abdominal cavity needs to be entered to place the mesh, and for the TEP technique, the whole procedure is done on the outside of the peritoneal lining of the abdominall wall. Whether one method is superior to the other has not been established, and there is debate about their relative benefits and harms. An advantage of TEP is its avoidance of the abdominal cavity; the downside is that it requires a steeper learning curve for clinicians. TAPP is considered simpler and makes it possible to inspect the contralateral side, but TAPP may have a higher risk of visceral injury compared to TEP. This is an update of a Cochrane review first published in 2005. OBJECTIVES To compare the benefits and harms of laparoscopic TAPP technique versus laparoscopic TEP technique for inguinal hernia repair in adults. SEARCH METHODS On 25 October 2022, the authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); and Ovid Embase, for published randomised controlled trials. To identify studies in progress, we searched ClinicalTrials.gov and the WHO International Clinical Trial Registry Platform (ICTRP). SELECTION CRITERIA All prospective randomised, quasi-randomised, and cluster-randomised trials that compared the laparoscopic TAPP technique with the laparoscopic TEP technique for inguinal hernia repair in adults were eligible for inclusion. We included studies that involved a mix of different types of groin hernia if we could extract data for the inguinal hernias. Studies may have also included a group of participants receiving hernia repair by open surgery, but these groups were not included in our review. DATA COLLECTION AND ANALYSIS Both review authors independently evaluated trial eligibility, extracted data from included studies, and assessed the risk of bias in the included studies. The review's primary outcomes were serious adverse events, chronic pain (persisting for at least six months after surgery), and hernia recurrence. We also assessed a variety of secondary outcomes at perioperative, early postoperative, and late postoperative time points. We performed statistical analyses using the random-effects model, and expressed the results as odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for key outcomes as high, moderate, low or very low. MAIN RESULTS We included 23 studies in this review update, which randomised 1156 people to TAPP and 1110 people to TEP, all requiring repair of inguinal hernias. Study sample sizes varied from 40 to 316 participants. The vast majority of study participants were male. We judged most studies to be at 'high' or 'unclear' risk of bias. Our judgements of the certainty of the evidence were low or very low for all outcomes we assessed. There may be little to no difference between TAPP and TEP laparoscopic techniques for serious adverse events (0.4% versus 0.7%; OR 0.58, 95% CI 0.15 to 2.32, P = 0.45, I2 = 0%; 19 studies, 1735 participants; low certainty of evidence); and hernia recurrence (1.2% versus 1.1%; OR 1.14, 95% CI 0.49 to 2.62, P = 0.97, I2 = 0%; 17 studies, 1712 participants; low certainty of evidence). The evidence is very uncertain about the effects of TAPP versus TEP techniques on chronic pain (OR 0.62, 95% CI 0.20 to 1.97, P = 0.68, I2 = 0%; 6 studies, 860 participants; very low certainty of evidence). In terms of secondary outcomes, the evidence is very uncertain for TAPP versus TEP techniques for perioperative visceral and vascular injury (15 studies, 1523 participants; very low certainty of evidence), and for haematoma or seroma during the early (≤ 30 days) postoperative phase (OR 0.86, 95% CI 0.54 to 1.37, P = 0.3861, I2 = 0%; 15 studies, 1423 participants; very low certainty of evidence). TEP technique may carry a higher risk of conversion to another hernia repair method (either TAPP technique or open surgery) when compared to TAPP (2.5% versus 0.7%; OR 0.28, 95% CI 0.09 to 0.84, P = 0.02, I2 = 0%; 13 studies, 1178 participants; low certainty of evidence). Only two studies (474 participants) reported quality of life in the late (> 30 days) postoperative phase; overall, there was an improvement in quality of life from the pre- to post-operative assessment, but the evidence suggests little to no difference between the techniques (low certainty of evidence). AUTHORS' CONCLUSIONS This review update found that there may be little to no difference between the TAPP and TEP techniques for serious adverse events, hernia recurrence, or chronic pain (low- to very-low-certainty evidence). Decisions about which method to use will most likely reflect surgeon and patient preference until high-certainty evidence becomes available. There may be a higher risk of needing to convert from TEP to TAPP or open surgery when compared to the risk of needing to convert from TAPP to open surgery (low-certainty evidence). If surgeons opt for TEP as their standard laparoscopic method, they could consider having a strategy for how to handle the potential need for conversion. This might include proficiency in the TAPP approach or having informed the patient about the risk of conversion to open surgery. For surgeons or surgical departments, the choice of a laparoscopic technique should involve shared decision-making with patients and their families or carers. Future research could focus on patient-reported outcomes, such as quality of life.
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Affiliation(s)
- Kristoffer Andresen
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
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Rey Chaves CE, Ramírez-Giraldo C, Isaza-Restrepo A, Conde Monroy D, González-Tamayo J, Ayala D, Moreno Matson MC, Navarro-Alean J. Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh. Heliyon 2024; 10:e30033. [PMID: 38707324 PMCID: PMC11066375 DOI: 10.1016/j.heliyon.2024.e30033] [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: 10/04/2023] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. Methods We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. Results The evaluated patients' median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. Conclusions Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.
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Affiliation(s)
| | - Camilo Ramírez-Giraldo
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | - Danny Conde Monroy
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
| | | | | | | | - Jorge Navarro-Alean
- Hospital Universitario Mayor - Méderi. Bogotá, Colombia
- Universidad del Rosario. Bogotá, Colombia
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Kwee E, Langeveld M, Duraku LS, Hundepool CA, Zuidam M. Surgical Treatment of Neuropathic Chronic Postherniorrhaphy Inguinal Pain: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:2812. [PMID: 38792355 PMCID: PMC11122157 DOI: 10.3390/jcm13102812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/14/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Neuropathic chronic postherniorrhaphy inguinal pain (CPIP) is a serious adverse outcome following inguinal hernia repair surgery. The optimal surgical treatment for neuropathic CPIP remains controversial in the current literature. This systematic review aims to evaluate the effectiveness of various surgical techniques utilized to manage neuropathic CPIP. Methods: The electronic databases Medline, Embase, Web of Science, Cochrane Central, and Google Scholar were searched. Inclusion criteria were defined to select studies reporting on the efficacy of surgical interventions in patients with neuropathic CPIP. The primary outcome was postoperative pain relief, as determined by postoperative numerical or nonnumerical pain scores. Results: Ten studies met the inclusion criteria. Three surgical techniques were identified: selective neurectomy, triple neurectomy, and targeted muscle reinnervation. Proportions of good postoperative results of the surgical techniques ranged between 46 and 88 percent. Overall, the surgical treatment of neuropathic CPIP achieved a good postoperative result in 68 percent (95% CI, 49 to 82%) of neuropathic CPIP patients (n = 244), with targeted muscle reinnervation yielding the highest proportion of good postoperative results. Conclusions: The surgical treatment of neuropathic CPIP is generally considered safe and has demonstrated effective pain relief across various surgical techniques. Targeted muscle reinnervation exhibits considerable potential for surpassing current success rates in inguinal hernia repair surgery.
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Affiliation(s)
- Esmee Kwee
- Department of Plastic, Reconstructive Surgery and Handsurgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (E.K.)
| | - Mirte Langeveld
- Department of Plastic, Reconstructive Surgery and Handsurgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (E.K.)
| | - Liron S. Duraku
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam University Medical Center, 1105AZ Amsterdam, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic, Reconstructive Surgery and Handsurgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (E.K.)
| | - Michiel Zuidam
- Department of Plastic, Reconstructive Surgery and Handsurgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (E.K.)
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10
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Reistrup H, Andresen K, Öberg S, Rosenberg J. Higher rate of chronic pain in young men after open mesh vs nonmesh repair of elective primary unilateral indirect inguinal hernia: A nationwide questionnaire study. Curr Probl Surg 2024; 61:101459. [PMID: 38548427 DOI: 10.1016/j.cpsurg.2024.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Hugin Reistrup
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stina Öberg
- 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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Zhang X, Zhang J, Gu W, Wu D, Shi C, Ma Z. Dexmedetomidine adjunct to ropivacaine for ultrasound-guided transversus abdominis plane block for open inguinal hernia repair in the older adults: A randomised clinical trial. J Minim Access Surg 2024; 20:187-195. [PMID: 36695243 PMCID: PMC11095806 DOI: 10.4103/jmas.jmas_189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 10/01/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of adding dexmedetomidine to ropivacaine on pain relief and quality of recovery in older patients undergoing open inguinal hernia repair surgeries. METHODS This was a prospective and randomised clinical trial of 102 patients aged over 65 years who received an ultrasound-guided transversus open mesh herniorrhaphy abdominis plane (TAP) block with either 0.375% ropivacaine 20 ml (Group R, n = 47) or 0.375% ropivacaine combined with 1 μg/kg dexmedetomidine 20 ml (Group RD, n = 45) in the pre-anaesthesia care unit before elective open inguinal hernia surgeries. The primary outcome measure was Visual Analogue Scale (VAS) pain scores at rest and on movement at 2, 4, 8, 12 and 24 h and at 1 and 3 months' postoperatively. The secondary outcome measures were the incidence of post-operative delirium (POD), nausea and vomiting and the occurrence of side effects or complications on post-operative day 1. RESULTS Group RD had lower VAS scores at rest and on movement at 8 and 12 h postoperatively and a lower incidence of POD on the post-operative day 1 than Group R. Transient bradycardia was more frequent in Group RD than in Group R, and side effects or post-operative complications were reported in either group. CONCLUSION The addition of dexmedetomidine to ropivacaine in a TAP block enhances postoperative analgesia during hospitalisation and improves the quality of recovery without affecting chronic pain in older patients undergoing open inguinal hernia repair surgery.
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Affiliation(s)
- Xiaokun Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinwei Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Di Wu
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changxi Shi
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
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Baldini E, Lori E, Morini C, Palla L, Coletta D, De Luca GM, Giraudo G, Intini SG, Perotti B, Sorge A, Sozio G, Arganini M, Beltrami E, Pironi D, Ranalli M, Saviano C, Patriti A, Usai S, Vernaccini N, Vittore F, D’Andrea V, Nardi P, Sorrenti S, Palumbo P. Sutureless Repair for Open Treatment of Inguinal Hernia: Three Techniques in Comparison. J Clin Med 2024; 13:589. [PMID: 38276095 PMCID: PMC10816828 DOI: 10.3390/jcm13020589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Currently, groin hernia repair is mostly performed with application of mesh prostheses fixed with or without suture. However, views on safety and efficacy of different surgical approaches are still partly discordant. In this multicentre retrospective study, three sutureless procedures, i.e., mesh fixation with glue, application of self-gripping mesh, and Trabucco's technique, were compared in 1034 patients with primary unilateral non-complicated inguinal hernia subjected to open anterior surgery. Patient-related features, comorbidities, and drugs potentially affecting the intervention outcomes were also examined. The incidence of postoperative complications, acute and chronic pain, and time until discharge were assessed. A multivariate logistic regression was used to compare the odds ratio of the surgical techniques adjusting for other risk factors. The application of standard/heavy mesh, performed in the Trabucco's technique, was found to significantly increase the odds ratio of hematomas (p = 0.014) and, most notably, of acute postoperative pain (p < 0.001). Among the clinical parameters, antithrombotic therapy and large hernia size were independent risk factors for hematomas and longer hospital stay, whilst small hernias were an independent predictor of pain. Overall, our findings suggest that the Trabucco's technique should not be preferred in patients with a large hernia and on antithrombotic therapy.
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Affiliation(s)
- Enke Baldini
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Eleonora Lori
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Carola Morini
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Luigi Palla
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Diego Coletta
- United Hospitals of Northern Marche (AOORMN)—Pesaro, 61121 Pesaro, Italy; (D.C.); (A.P.)
| | - Giuseppe M. De Luca
- Unit of Academic General Surgery “V. Bonomo”, University of Bari, 70124 Bari, Italy; (G.M.D.L.); (F.V.)
| | - Giorgio Giraudo
- Department of Surgery, Santa Croce e Carle Hospital (ASO) of Cuneo, 12100 Cuneo, Italy; (G.G.); (E.B.)
| | - Sergio G. Intini
- Department of Surgery, S. Maria Della Misericordia Hospital, ASUFC of Udine, 33100 Udine, Italy; (S.G.I.); (N.V.)
| | - Bruno Perotti
- Department of Surgery, Versilia Hospital of Viareggio, 55049 Camaiore, Italy; (B.P.); (M.A.)
| | - Angelo Sorge
- Day Surgery P.O.S. Giovanni Bosco, 80144 Naples, Italy; (A.S.); (C.S.)
| | - Giampaolo Sozio
- Department of Surgery, Alta Val D’Elsa Hospital of Poggibonsi—Siena, 53036 Poggibonsi, Italy; (G.S.); (M.R.)
| | - Marco Arganini
- Department of Surgery, Versilia Hospital of Viareggio, 55049 Camaiore, Italy; (B.P.); (M.A.)
| | - Elsa Beltrami
- Department of Surgery, Santa Croce e Carle Hospital (ASO) of Cuneo, 12100 Cuneo, Italy; (G.G.); (E.B.)
| | - Daniele Pironi
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Massimo Ranalli
- Department of Surgery, Alta Val D’Elsa Hospital of Poggibonsi—Siena, 53036 Poggibonsi, Italy; (G.S.); (M.R.)
| | - Cecilia Saviano
- Day Surgery P.O.S. Giovanni Bosco, 80144 Naples, Italy; (A.S.); (C.S.)
| | - Alberto Patriti
- United Hospitals of Northern Marche (AOORMN)—Pesaro, 61121 Pesaro, Italy; (D.C.); (A.P.)
| | - Sofia Usai
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Nicola Vernaccini
- Department of Surgery, S. Maria Della Misericordia Hospital, ASUFC of Udine, 33100 Udine, Italy; (S.G.I.); (N.V.)
| | - Francesco Vittore
- Unit of Academic General Surgery “V. Bonomo”, University of Bari, 70124 Bari, Italy; (G.M.D.L.); (F.V.)
| | - Vito D’Andrea
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Priscilla Nardi
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Salvatore Sorrenti
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Piergaspare Palumbo
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
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Ahmadinejad I, Jalali A, Ahmadinejad M, Soltanian A, Ahamdinejad Y, Shirzadi A, Chaghamirzayi P. Inguinal hernia: Lichtenstein VS Shouldice technique repair: A randomized controlled trial. Surg Open Sci 2024; 17:70-74. [PMID: 38298435 PMCID: PMC10828570 DOI: 10.1016/j.sopen.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/17/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Background Inguinal hernia repair is the most frequent operation in general surgery. The chance of a person having to undergo an inguinal hernia operation during his/her life is quite high, 27 % in men and 3 % in women. European Hernia Society guidelines state that the Lichtenstein technique (mesh-based repair) is the standard treatment of elective inguinal hernia in adults. Some authors consider the Shouldice technique (tissue-based repair) the best conventional method for open hernia repair. In this study, we compared these two methods. Methods In This randomized study, 452 patients were randomly allocated into 2 groups. 51 patients were lost during follow-up period and were excluded from further analysis in the study. Finally, the analyzed patients were 183 patients in Shouldice technique group and 218 patients in Lichtenstein technique group. All patients were examined after 1 week, 1, 3 months, 1, 2, and 3 years after the operation date. Results After 3 years follow up Recurrence of hernia in Shouldice technique group was 7.1 % and in Lichtenstein technique group was 3 % with significant differences (p-value 0.006). No statistically significant differences were found between the groups in wound infection, Seroma, hematoma, Hydrocele, Bladder damage, chronic pain in the inguinal region, and Patient Satisfaction level after surgery. Conclusion It seems that inguinal hernia treatment by the Lichtenstein technique is better than the Shouldice technique in elective patients.
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Affiliation(s)
- Izadmehr Ahmadinejad
- Medical Student, Students' Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ahmad Jalali
- General Physician, Alborz University of Medical Science, Karaj, Iran
| | - Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Yasmina Ahamdinejad
- Medical Student, Students' Scientific Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Alireza Shirzadi
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Messias BA, Almeida PLD, Ichinose TMS, Mocchetti ÉR, Barbosa CA, Waisberg J, Roll S, Ribeiro Junior MF. The Lichtenstein technique is being used adequately in inguinal hernia repair: national analysis and review of the surgical technique. Rev Col Bras Cir 2023; 50:e20233655. [PMID: 38088634 PMCID: PMC10668585 DOI: 10.1590/0100-6991e-20233655-en] [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: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. METHOD Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. RESULT 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). CONCLUSION Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
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Affiliation(s)
- Bruno Amantini Messias
- - Hospital Geral de Carapicuiba, Departamento de Cirurgia Geral - Carapicuiba - SP - Brasil
- - Centro Universitário São Camilo, Faculdade de Medicina - São Paulo - SP - Brasil
| | | | | | - Érica Rossi Mocchetti
- - Hospital Geral de Carapicuiba, Departamento de Cirurgia Geral - Carapicuiba - SP - Brasil
- - Centro Universitário São Camilo, Faculdade de Medicina - São Paulo - SP - Brasil
| | - Cirênio Almeida Barbosa
- - Universidade Federal de Ouro Preto, Departamento de Cirurgia, Ginecologia e Obstetrícia e Propedêutica - Ouro Preto - MG - Brasil
| | - Jaques Waisberg
- - Faculdade de Medicina do ABC, Departamento de Cirurgia - Santo André - SP - Brasil
| | - Sergio Roll
- - Santa Casa de São Paulo, Departamento de Parede Abdominal - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
| | - Marcelo Fontenelle Ribeiro Junior
- - Sheikh Shakhbout Medical City- Mayo Clinic, Critical Care and Acute Care Surgery - Abu Dhab - Emirados Árabes Unidos
- - Pontificia Universidade Católica de São Paulo, Departamento de Cirurgia - Sorocaba - SP - Brasil
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15
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Dams A, Vankeirsbilck J, Poelmans S, Kerschaever I, Borreman P, Berwouts L, De Mulder W, Colle J, Beunis A, Dhooghe V, Van De Winkel N, Allaeys M, Ruyssers M, Haesen D, Van der Speeten K. Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study. Surg Endosc 2023; 37:9105-9115. [PMID: 37798529 DOI: 10.1007/s00464-023-10439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond™ for mesh fixation in laparoscopic inguinal hernia repair. METHODS This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond™ (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh® SURG ST (Peters Surgical)/Biomesh® P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh® SURG LI (Peters Surgical)/Premium® Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery. RESULTS Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 ± 10.04; p < 0.0001) and 12-month (3.83 ± 11.26; p < 0.0001) follow-up compared with before surgery (26.96 ± 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 ± 0.19 preoperatively to 0.90 ± 0.15 at 5 weeks (p < 0.0001) and 0.92 ± 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 ± 12.69 preoperatively to 84.31 ± 9.97 at 5-week (p < 0.0001) and 84.16 ± 14.48 at 12-month follow-up (p < 0.0001). CONCLUSIONS Ifabond™ (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature.
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Affiliation(s)
- Anne Dams
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joost Vankeirsbilck
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Stephan Poelmans
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Ivan Kerschaever
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Philippe Borreman
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Luc Berwouts
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Wim De Mulder
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Julien Colle
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Anthony Beunis
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vicky Dhooghe
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Mathias Allaeys
- Department of Abdominal Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Kurt Van der Speeten
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
- Faculty of Medicine, Hasselt University, Diepenbeek, Belgium.
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16
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Wu Q, Zhou Y, Sun S, Li H, Cao S, Shou H. Clinical analysis of acute postoperative pain after total laparoscopic hysterectomy for adenomyosis and uterine fibroids - a prospective observational study. Ann Med 2023; 55:2281510. [PMID: 37994446 PMCID: PMC10836289 DOI: 10.1080/07853890.2023.2281510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/04/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE To investigate the outcome of total laparoscopic hysterectomy (TLH) and postoperative pain characteristics and compare the pain severity after TLH for adenomyosis or uterine fibroids. METHODS This prospective observational study collected 101 patients received TLH for adenomyosis (AD group) including 41 patients were injected goserelin (3.6 mg) 28 days before TLH, while other adenomyosis patients received TLH without preoperative treatment, and 113 patients received TLH for uterine fibroids (UF group). Pain scores were evaluated at different time sites from operation day to postoperative 72 h using the numeric rating scale. Clinical data were collected from clinical record. RESULTS Operative time and anaesthetic time were longer in the AD group than those in the UF group (66.88 ± 8.65 vs. 64.46 ± 7.21, p = 0.04; 83.95 ± 10.05 vs. 79.77 ± 6.88, p < 0.01), severe endometriosis was quite more common in AD group (23.76% vs. 2.65%, p < 0.01). Postoperative usage of Flurbiprofen in AD group were more than that of UF group (15.48 ± 38.00 vs. 4.79 ± 18.16, p = 0.02). Total pains and abdominal visceral pains of AD group were more severe compared with UF group in motion and rest pattern at several time sites, while incision pain and shoulder pain were similar. The total postoperative pains after goserelin preoperative treatment in AD group were less than that without goserelin preoperative treatment (p < 0.05). The levels of serum NPY, PGE2 and NGF after laparoscopic hysterectomy of adenomyosis reduced with GnRH agonist pretreatment. CONCLUSIONS Acute postoperative pain for adenomyosis and uterine fibroids showed considerably different severity, postoperative total pain and abdominal visceral pains of TLH for adenomyosis were more severe compared with uterine fibroids. While patients received goserelin before laparoscopic hysterectomy of adenomyosis suffered from less severity of postoperative total pain than that without goserelin preoperative treatment.
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Affiliation(s)
- Qing Wu
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yun Zhou
- Department of Obstetrics and Gynecology, Shengli Clinical Medical College of Fujian Medical University and Fujian Provincial Hospital, Fuzhou, China
| | - Saijun Sun
- Tiantai People’s Hospital of Zhejiang Province, Zhejiang, China
| | - Hui Li
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shanshan Cao
- Tiantai People’s Hospital of Zhejiang Province, Zhejiang, China
| | - Huafeng Shou
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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17
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Gutiérrez Carrillo G, Garcia Sanz M, de Arriba Alonso M, Gutiérrez Fernandez A, Alonso Prieto MÁ. Robot-assisted laparoscopic triple neurectomy for chronic inguinal pain: Description of the technique, our experience and preliminary results. Actas Urol Esp 2023; 47:605-610. [PMID: 37207986 DOI: 10.1016/j.acuroe.2023.05.001] [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: 10/25/2021] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Chronic inguinal pain or inguinodynia following hernioplasty is a relatively common complication that can be very incapacitating. Surgical treatment by triple neurectomy is a therapeutic option when previous treatments (oral/local therapy or neuromodulation) have failed. OBJECTIVE Retrospective description of the surgical technique and results of laparoscopic and robot-assisted triple neurectomy for chronic inguinodynia. MATERIAL AND METHODS We describe the inclusion/exclusion criteria as well as the surgical technique applied in 7 patients operated on at the University Health Care Complex of León (Urology Department) after failure of other treatment options. RESULTS The patients presented chronic groin pain, reporting a preoperative pain VAS of 7.43 out of 10. After surgery, this score was reduced to 3.71 on the first postoperative day and to 4.2 points one year after surgery. Hospital discharge occurred 24 h after surgery with no relevant complications being reported. CONCLUSIONS Laparoscopic or robot-assisted triple neurectomy is a safe, reproducible, and effective technique for the treatment of chronic groin pain refractory to other treatments.
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Affiliation(s)
- G Gutiérrez Carrillo
- Complejo Asistencial de León, Complejo Asistencial Universitario de León, León, Spain.
| | - M Garcia Sanz
- Complejo Asistencial de León, Complejo Asistencial Universitario de León, León, Spain
| | - M de Arriba Alonso
- Complejo Asistencial de León, Complejo Asistencial Universitario de León, León, Spain
| | - A Gutiérrez Fernandez
- Complejo Asistencial de León, Complejo Asistencial Universitario de León, León, Spain
| | - M Á Alonso Prieto
- Complejo Asistencial de León, Complejo Asistencial Universitario de León, León, Spain
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18
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Moseholm VB, Baker JJ, Rosenberg J. Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses. Langenbecks Arch Surg 2023; 408:417. [PMID: 37874414 PMCID: PMC10598160 DOI: 10.1007/s00423-023-03154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Inguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies. METHODS This review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane's RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses. RESULTS A total of 23 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76-87%) for the ilioinguinal nerve, 62% (95% CI: 54-71%) for the iliohypogastric nerve, and 41% (95% CI: 27-55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs. CONCLUSION The ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy.
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Affiliation(s)
- Viktor Bay Moseholm
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Jason Joe Baker
- 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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Hurel R, Bouazzi L, Barbe C, Kianmanesh R, Romain B, Gillion JF, Renard Y. Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry. Hernia 2023; 27:1165-1177. [PMID: 36753035 DOI: 10.1007/s10029-023-02737-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry. METHODS Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP. RESULTS After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02). CONCLUSION This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.
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Affiliation(s)
- Romane Hurel
- University of Reims Champagne-Ardenne, Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - Leila Bouazzi
- University of Reims Champagne-Ardenne, Comité Universitaire de Ressources pour la Recherche en Santé-CURRS, Reims, France
| | - Coralie Barbe
- University of Reims Champagne-Ardenne, Comité Universitaire de Ressources pour la Recherche en Santé-CURRS, Reims, France
| | - Reza Kianmanesh
- University of Reims Champagne-Ardenne, Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France
| | - Benoît Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | | | - Yohann Renard
- University of Reims Champagne-Ardenne, Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France.
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20
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Vassalou EE, Vardas K, Dimitriadis E, Perysinakis I. The Role of Imaging in the Pre- and Postoperative Evaluation of Inguinal Hernia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2425-2438. [PMID: 37087757 DOI: 10.1002/jum.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
Inguinal hernia repair is the most frequently performed surgical procedure. Imaging has a fundamental role in initial assessment and postoperative evaluation of inguinal hernias. Clinical implications of radiology in the preoperative setting include diagnosis of occult/complicated hernias and enhancement of diagnostic certainty. Postoperatively, imaging may assist the detection and characterization of complications. Familiarity with the normal appearance of the postoperative groin area and surgical techniques is required to avoid misinterpretation. This pictorial essay provides an overview of the expected postoperative imaging findings and highlights the role of imaging in the pre- and postoperative evaluation of inguinal hernias, with emphasis on ultrasonography.
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Affiliation(s)
| | | | | | - Iraklis Perysinakis
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Greece
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21
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Hu Q, Du YX, Wang DC, Yang YJ, Lei YH, Wei J. Efficacy and safety of ilioinguinal neurectomy in open tension-free inguinal hernia repair: A meta-analysis of randomized controlled trials. Am J Surg 2023; 226:531-541. [PMID: 37451939 DOI: 10.1016/j.amjsurg.2023.06.027] [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: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND There is still controversy surrounding routine ilioinguinal neurectomy in open tension-free inguinal hernia repair. METHOD PubMed, Cochrane Library and EMBASE databases were searched for randomized controlled trials of ilioinguinal neurectomy in open tension-free inguinal hernia repair. Revman 5.3 software was used for meta-analysis. RESULT Meta-analysis revealed that the incidence of severe pain on the first postoperative day was lower in the ilioinguinal neurectomy group (ING) than in the ilioinguinal nerve preservation group (INPG) [P < 0.0001]. The incidence of no pain in the first month postoperatively [P = 0.0004], the incidence of no pain in the sixth months postoperatively [P < 0.00001], and the numbness incidence in the first month postoperatively [P = 0.001] in the ING was higher than that in the INPG. There was no significant difference in the incidence of severe pain in the first month postoperatively [P = 0.20], the numbness incidence in the sixth postoperative month [P = 0.05], the hypoesthesia incidence in the first [P = 0.15] and sixth [P = 0.85] postoperative months between the two groups. CONCLUSION Ilioinguinal neurectomy in open tension-free inguinal hernia repair can better prevent postoperative pain.
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Affiliation(s)
- Qiang Hu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Ying-Xiu Du
- Department of Obstetrics and Gynecology, Zigong First People's Hospital, Zigong, 643000, Sichuan, China.
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Yong-Jun Yang
- Department of Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, 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
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22
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Sasmal PK, Sahoo A, Mishra TS, Das Poddar KK, Ali SM, Singh PK, Kumar P. Feasibility and outcomes of Desarda vs Lichtenstein hernioplasty by local anesthesia for inguinal hernia: a noninferiority randomized clinical trial. Hernia 2023; 27:1155-1163. [PMID: 37452974 DOI: 10.1007/s10029-023-02837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The Desarda autologous tissue repair is comparable to the Lichtenstein hernioplasty for inguinal hernia regarding recurrence, chronic groin pain, and return to work activities. This study was designed to establish the outcomes of Desarda's repair versus Lichtenstein's hernioplasty concerning post-operative recovery to normal gait and its feasibility under local anesthesia (LA). MATERIALS AND METHODS This study was a single-center, prospective, double-blinded, non-inferiority, randomized trial. Patients undergoing open hernia repair for primary inguinal hernia were included. Patients were randomly assigned and followed up for 2 years. The primary endpoint was the time to return to normal gait post-surgery with comfort (non-inferiority margin fixed as 0.5 days). The secondary outcomes studied were post-operative pain score, the time required to return to work (all previously performed activities), and surgical-site occurrences (SSO). RESULTS One hundred ten eligible patients were randomly assigned [56 patients (50.9%) in the Desarda group and 54 patients (49.1%) in the Lichtenstein group]. All the procedures were safely performed under LA. The median (interquartile range) time for resuming gait post-surgery with comfort was 5 days in the Desarda vs 4 days in Lichtenstein's arm (P = 0.16), thereby failing to demonstrate non-inferiority of Desarda against Lichtenstein hernioplasty. However, there were no significant differences in days to return to work, SSO, chronic groin pain, and recurrence within two years of surgery. CONCLUSIONS AND RELEVANCE This study could not demonstrate the non-inferiority of the Desarda repair versus Lichtenstein hernioplasty regarding the time taken to return to normal gait. Comparing the days to return to work, pain score, SSO, and chronic groin pain, including recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility and efficacy under LA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03512366.
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Affiliation(s)
- P K Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India.
| | - A Sahoo
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - T S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - K K Das Poddar
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - S M Ali
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - P K Singh
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
| | - P Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Sijua, Bhubaneswar, 751019, India
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23
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De la Fuente Hagopian A, Guadarrama-Sistos Vazquez S, Farhat S, Reddy NK, Trakhtenbroit MA, Echo A. The emerging role of MRI neurography in the diagnosis of chronic inguinal pain. Langenbecks Arch Surg 2023; 408:319. [PMID: 37594580 DOI: 10.1007/s00423-023-03050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Chronic pain is a frequent and notable complication after inguinal hernia repair, it has been extensively studied, but its management and diagnosis are still difficult. The cause of chronic pain following inguinal hernia surgery is usually multifactorial. This case series highlights the utility of MRI neurography (MRN) in evaluating the damage to inguinal nerves after a hernia repair, with surgical confirmation of the preoperative imaging findings. MATERIALS AND METHODS A retrospective review was performed on patients who underwent inguinal mesh removal and triple denervation of the groin. Inclusion criteria included MRI neurography. All patients underwent surgical exploration of the inguinal canal for partial or complete mesh removal and triple denervation of the groin by the same senior surgeon. RESULTS A total of nine patients who underwent triple denervation were included in this case series. MRN was then performed on 100% of patients. The postoperative mean VAS score adjusted for all patients was 1.6 (SD p), resulting in a 7.5 score difference compared to the preoperative VAS score (p). Since chronic groin pain can be a severely debilitating condition, diagnosis, and treatment become imperative. CONCLUSION MRN can detect direct and indirect signs of neuropathy even in the absence of a detectable compressive cause aids in management and diagnosis by finding the precise site of injury, and grading nerve injury to aid pre-operative assessment for the nerve surgeon. Thus, it is a valuable diagnostic tool to help with the diagnosis of nerve injuries in the setting of post-inguinal hernia groin pain.
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Affiliation(s)
- Alexa De la Fuente Hagopian
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Souha Farhat
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Michael A Trakhtenbroit
- Department of Radiology, Houston Methodist Hospital, Houston, TX, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Anthony Echo
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA.
- Texas A&M Medicine, College Station, TX, USA.
- Weill Cornell Medicine, New York, NY, USA.
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24
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George E, Olson MA, Poulose BK. Are Nerves Left In Situ Associated With Less Chronic Pain Than Manipulation During Inguinal Hernia Repair? J Surg Res 2023; 286:96-103. [PMID: 36803879 DOI: 10.1016/j.jss.2022.10.095] [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: 02/09/2022] [Revised: 09/11/2022] [Accepted: 10/16/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Nerve damage has been implicated in chronic groin pain, particularly iliohypogastric, ilioinguinal, and genital branches of genitofemoral nerves. We investigated whether three nerve identification (3N) and preservation is associated with decreased pain 6 mo after hernia repair compared to two common strategies of nerve management: ilioinguinal nerve identification (1N) and two nerve identification (2N). METHODS We identified adult inguinal hernia patients within the Abdominal Core Health Quality Collaborative national database. Six-month postoperative pain was defined using the EuraHS Quality of Life tool. A proportional odds model was used to estimate odds ratios (ORs) and expected mean differences in 6-month pain for nerve management while adjusting for confounders identified a priori. RESULTS Four thousand four hundred fifty one participants were analyzed; 358 (3N), 1731 (1N), and 2362 (2N) consisting mostly of White males (84%) over the age of 60 y old. Academic centers identified all three nerves more often than ilioinguinal or two nerve identification methods. Median 6-month postoperative pain scores were 0 [interquartile range 0-2] for all nerve management groups (P = 0.51 3N versus 1N and 3N versus 2N). There was no evidence of a difference in the odds of higher 6-month pain score in nerve management methods after adjustment (3N versus 1N OR: 0.95; 95% confidence interval 0.36-1.95, 3N versus 2N OR: 1.00; 95% confidence interval 0.50-1.85). CONCLUSIONS Although guidelines emphasize three nerve preservation, the management strategies evaluated were not associated with statistically significant differences in pain 6 mo after operation. These findings suggest that nerve manipulation may not contribute as a significant role in chronic groin pain after open inguinal hernia repair.
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Affiliation(s)
- Emily George
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Benjamin K Poulose
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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25
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Reistrup H, Andresen K, Rosenberg J. Low incidence of recurrence and chronic pain after groin hernia repair in adolescents: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:211. [PMID: 37233839 PMCID: PMC10220125 DOI: 10.1007/s00423-023-02947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The best operative management of groin hernia in adolescents is uncertain. The aim of this systematic review was to assess recurrence and chronic pain after mesh versus non-mesh repair for groin hernia in adolescents. METHODS A systematic search was done in PubMed, EMBASE, and Cochrane CENTRAL in May 2022 for studies reporting postoperative chronic pain (≥6 months) or recurrence after groin hernia repair in adolescents aged 10-17 years. We included randomized controlled trials and observational studies on primary unilateral or bilateral groin hernia repair. Risk of bias was assessed with the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Meta-analysis of the incidence of recurrence was conducted. This review is reported according to PRISMA guideline. RESULTS A total of 21 studies including 3,816 adolescents with groin hernias were included comprising two randomized controlled trials, six prospective, and 13 retrospective cohort studies. For non-mesh repairs, the weighted mean incidence proportion of recurrence was 1.6% (95% CI 0.6-2.5) after 2,167 open repairs and 1.9% (95% CI 1.1-2.8) after 1,033 laparoscopic repairs. For mesh repairs, it was 0.6% (95% CI 0.0-1.4) after 406 open repairs while there were no recurrences after 347 laparoscopic repairs (95% CI 0.0-0.6). Across all surgical techniques, the rate of chronic pain after 1,153 repairs ranged from 0 to 11%. Follow-up time varied and was reported in various ways. CONCLUSION The incidences of recurrence after groin hernia repair in adolescents were low for both open and laparoscopic mesh and non-mesh repairs. Rates of postoperative chronic pain were low. TRIAL REGISTRATION PROSPERO: CRD42022130554.
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Affiliation(s)
- Hugin Reistrup
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - 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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26
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Parkash A, Ghorayeb JH, Levy I, Upadhyay A, Srinivasan S, Chauhan G. Dorsal root ganglion stimulation for treatment of chronic postsurgical pain secondary to triple neurectomy. INTERVENTIONAL PAIN MEDICINE 2023; 2:100245. [PMID: 39239604 PMCID: PMC11372865 DOI: 10.1016/j.inpm.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 09/07/2024]
Abstract
Triple neurectomy (resection of Ilioinguinal, Iliohypogastric, and Genitofemoral nerves) is performed in cases of inguinal neuralgia, refractory to conservative management. However, this procedure comes with several adverse effects, including but not limited to ectopic afferent firing and tactile allodynia. In such a scenario, the inguinal pain can become chronic and debilitating and can be classified as chronic post-surgical pain. Spinal neuromodulation techniques have been employed for treating such refractory, intractable chronic groin, pelvic and abdominal pain. One such technique is dorsal root ganglion stimulation which is designed to manage difficult-to-treat chronic pain in specific areas of the lower body, such as the foot, knee, hip, or groin. The authors present a case in which the patient underwent a laparoscopic neurectomy of ilioinguinal, Iliohypogastric, and genitofemoral nerves that failed to resolve her pain-related symptoms. The patient presented to the authors' pain clinic with severe inguinal pain and allodynia, refractory to multiple analgesic agents. The patient underwent a successful trial and subsequent implant with ipsilateral dorsal root ganglion stimulation at L1& L2. At six months post-implant, the patient continues to report 80-90% improvement in her pain and physical function.
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Affiliation(s)
- Anishinder Parkash
- Department of Physical Medicine and Rehabilitation, Tower Health Reading Hospital/Drexel, University COM, 420 S 5th Ave, West Reading, PA, 19611, USA
| | - Joe H Ghorayeb
- University of Medicine and Health Sciences, 275 7th Ave 26th Floor, New York, NY, 10001, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Aman Upadhyay
- Department of Anesthesiology and Perioperative Medicine, McLaren Oakland Hospital 50 Perry St, Pontiac, MI, 48342, USA
| | - Suresh Srinivasan
- Department of Pain Medicine, 000 Johnson Rd, Steubenville, OH, 43952, USA
| | - Gaurav Chauhan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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van Veenendaal N, Foss NB, Miserez M, Pawlak M, Zwaans WAR, Aasvang EK. A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist. Hernia 2023; 27:5-14. [PMID: 36315351 PMCID: PMC9931782 DOI: 10.1007/s10029-022-02693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms. METHODS This narrative review presents the current knowledge of the non-surgical management of CPIP and makes suggestions for daily practice. RESULTS There is a paucity for high-level evidence of non-surgical options for CPIP. Different treatment options and algorithms have been published for chronic pain patients in the last decades. DISCUSSION AND CONCLUSION It is suggested that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive procedures upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.
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Affiliation(s)
- N van Veenendaal
- Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - N B Foss
- Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, Copenhagen, Denmark
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - W A R Zwaans
- Department of General Surgery, Máxima Medical Center, Veldhoven, Eindhoven, The Netherlands.,SolviMáx Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E K Aasvang
- Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshopitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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28
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Bökkerink WJV, van Meggelen MGM, van Dijk JP, Čadanová D, Mollen RMHG. Long-term results of the SOFTGRIP trial: TIPP versus ProGrip Lichtenstein's inguinal hernia repair. Hernia 2023; 27:139-145. [PMID: 35022864 DOI: 10.1007/s10029-021-02542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE In preventing Chronic Postoperative Inguinal Pain (CPIP) after inguinal herniorrhaphy, mesh position and mesh fixation seem important factors. The SOFTGRIP trial compared the TransInguinal PrePeritoneal (TIPP) repair to Polysoft mesh, to the Open anterior repair (Lichtenstein) using the self-gripping ProGrip mesh. Since CPIP might resolve and recurrence rate increase, this study reports the SOFTGRIP trial's long-term results (with a minimal follow-up of 5 years). METHODS All patients initially randomized in the SOFTGRIP trial were contacted if not deceased. Patients were invited for an interview and physical examination. The procedures and methodology of this randomized clinical trial have been published together with the short-term results. The main outcomes for this long-term follow-up study were chronic pain, recurrences, re-operations and numbness. RESULTS A total of 193 patients (81.4% of the initially randomized patients) were included for long-term follow-up analyses, 96 after TIPP, 97 after ProGrip Lichtenstein. After a median follow-up of 74 months (range 60-80) there were no significant differences between the two groups. Overall, chronic pain drastically decreased. Fourteen patients reported CPIP at long-term follow-up (overall 7.3%, 7 after TIPP and 7 after ProGrip Lichtenstein, any form, frequency and intensity of pain included). Recurrence rate increased from 2.6% (n = 6) at one-year follow-up, to 8.3% (n = 16) at 5-year's follow-up. CONCLUSION The SOFTGRIP trial´s long-term outcomes show that after both TIPP and ProGrip Lichtenstein, recurrence rate increases and CPIP mostly disappears. These findings aid in better informing patients on the benefits and harms of inguinal hernia repair. The findings of accumulating recurrences and fading of chronic pain, confirms the need for long-term follow-up studies. High-quality long-term data on TIPP, ProGrip Lichtenstein and other types of herniorrhaphy are scarce and complication rates vary widely. Further long-term studies are needed to reveal the true spectrum of benefits and harms of the different inguinal hernia repair techniques. TRIAL REGISTRATION Registered on August 25, 2009 at the Dutch Trial Registry ( www.trialregister.nl ) NTR1853.
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Affiliation(s)
- W J V Bökkerink
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. .,Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M G M van Meggelen
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.,Currently Working at the Emergency Department, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J P van Dijk
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - D Čadanová
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - R M H G Mollen
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
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29
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Posthuma JJ, Sandkuyl R, Sloothaak DA, Ottenhof A, van der Bilt JDW, Gooszen JAH, Verbeek PCM, In't Hof KH. Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial. Hernia 2023; 27:119-125. [PMID: 35925503 PMCID: PMC9931826 DOI: 10.1007/s10029-022-02651-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10-35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair. METHODS A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation. RESULTS A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed. CONCLUSION We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups.
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Affiliation(s)
- J J Posthuma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | - R Sandkuyl
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - D A Sloothaak
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - A Ottenhof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - J D W van der Bilt
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J A H Gooszen
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P C M Verbeek
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - K H In't Hof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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Fadaee N, Huynh D, Khanmohammed Z, Mazer L, Capati I, Towfigh S. Patients With Systemic Reaction to Their Hernia Mesh: An Introduction to Mesh Implant Illness. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10983. [PMID: 38312397 PMCID: PMC10831643 DOI: 10.3389/jaws.2023.10983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2024]
Abstract
In our practice, we have noticed an increased number of patients requiring mesh removal due to a systemic reaction to their implant. We present our experience in diagnosing and treating a subpopulation of patients who require mesh removal due to a possible mesh implant illness (MII). All patients who underwent mesh removal for indication of mesh reaction were captured from a hernia database. Data extraction focused on the patients' predisposing medical conditions, presenting symptoms suggestive of mesh implant illness, types of implants to which reaction occurred, and postoperative outcome after mesh removal. Over almost 7 years, 165 patients had mesh removed. Indication for mesh removal was probable MII in 28 (17%). Most were in females (60%), average age was 46 years, with average pre-operative pain score 5.4/10. All patients underwent complete mesh removal. Sixteen (57%) required tissue repair of their hernia; 4 (14%) had hybrid mesh implanted. Nineteen (68%) had improvement and/or resolution of their MII symptoms within the first month after removal. We present insight into a unique but rising incidence of patients who suffer from systemic reaction following mesh implantation. Predisposing factors include female sex, history of autoimmune disorder, and multiple medical and environmental allergies and sensitivities. Presenting symptoms included spontaneous rashes, erythema and edema over the area of implant, arthralgia, headaches, and chronic fatigue. Long-term follow up after mesh removal confirmed resolution of symptoms after mesh removal. We hope this provides greater attention to patients who present with vague, non-specific but debilitating symptoms after mesh implantation.
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Affiliation(s)
- Negin Fadaee
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA, United States
| | - Desmond Huynh
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zayan Khanmohammed
- Department of Surgery, University of California, Berkeley, Berkeley, CA, United States
| | - Laura Mazer
- Higher Ground Education, Lake Forest, CA, United States
| | - Isabel Capati
- Beverly Hills Hernia Center, Beverly Hills, CA, United States
| | - Shirin Towfigh
- Beverly Hills Hernia Center, Beverly Hills, CA, United States
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Gram-Hanssen A, Öberg S, Rosenberg J. A Critical Appraisal of the Chronic Pain Rate After Inguinal Hernia Repair. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10972. [PMID: 38312409 PMCID: PMC10831660 DOI: 10.3389/jaws.2023.10972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2024]
Abstract
Purpose: To critically appraise highly cited studies reporting on the rate of chronic pain after inguinal hernia repair. Methods: Google Scholar was searched on 23 May 2022. We only included publications with more than 10 citations per year since publication and more than 100 citations in total. Both reports of original data and systematic reviews were included. Risk of bias and quality of the included studies were assessed with either the Joanna Briggs Institute Checklist for Prevalence Studies or the AMSTAR 2 depending on study design. Results: Twenty studies were included and evaluated. The rate of chronic postoperative inguinal pain of any degree ranged from 10%-63%, and the rate of moderate-to-severe pain ranged from 1%-18%. All studies reported the rate of pain of any degree, and most studies reported the rate of moderate-to-severe pain influencing daily activities. Studies used different temporal definitions of chronic pain, but most studies defined it as pain persisting either three or six months postoperatively. Ten studies used unvalidated questionnaires or significantly modified versions of validated questionnaires. Eleven studies primarily included patients receiving open repair. Included studies had median 21 citations per year (range 10-39) and median 387 citations in total (range 127-788). Conclusion: The rates of chronic postoperative inguinal pain reported in the included highly cited studies are possibly inaccurate, excessive, and outdated. New prospective studies based on uniform definitions and standards of measurement are warranted to better assess a contemporary chronic pain rate after inguinal hernia repair.
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Affiliation(s)
- Anders Gram-Hanssen
- Center for Perioperative Optimization, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
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Liu J, Bittner R, Shen Y, Chen J. Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case. Surg Endosc 2022; 37:2712-2718. [PMID: 36451041 DOI: 10.1007/s00464-022-09759-w] [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: 10/26/2021] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. METHODS Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. RESULTS A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0 days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0 days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). CONCLUSIONS Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Reinhard Bittner
- Director of the Surgical Clinic, Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China.
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Phoa S, Chan KS, Lim SH, Oo AM, Shelat VG. Comparison of glue versus suture mesh fixation for primary open inguinal hernia mesh repair by Lichtenstein technique: a systematic review and meta-analysis. Hernia 2022; 26:1105-1120. [PMID: 35113292 DOI: 10.1007/s10029-022-02571-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of glue as a mesh fixator in open Lichtenstein inguinal hernia repair (IHR) has gained popularity to reduce recurrence and postoperative complications. This meta-analysis aims to provide an up-to-date review to compare glue versus suture fixation in primary open Lichtenstein IHR. METHODS PubMed, Embase, The Cochrane Library, Web of Science, and Springer were systematically searched till June 2021 for randomized controlled trials (RCTs) comparing glue versus suture fixation in open Lichtenstein IHR. Primary outcomes were early (at 1 year) and late recurrence (5 years or more). Secondary outcomes were the length of operation, postoperative haematoma and seroma, and chronic pain at 1 year. RESULTS A total of 17 RCTs with 3150 hernias (glue n = 1582, suture n = 1568) were included. Only three studies reported late recurrence. Glue fixation was associated with shorter operative duration (MD - 4.17, 95% CI - 4.82, - 3.52; p < 0.001 and a lower incidence of haematoma formation (OR 0.51, 95% CI 0.32, 0.81; p = 0.004). There was no significant difference in postoperative seroma (OR 0.72, 95% CI 0.35, 1.49; p = 0.38), chronic pain after 1 year (OR 1.10, 95% CI 0.73, 1.65; p = 0.65), early recurrence (OR 1.11, 95% CI 0.45, 2.76; p = 0.81, I2 = 0%), and late recurrence (OR 1.23, 95% CI 0.59, 2.59; p = 0.59, I2 = 0%). CONCLUSION Early and late recurrence were comparable between glue and suture fixation in open Lichtenstein IHR patients. Glue fixation had shorter operating time and lower haematoma formation than suture fixation. Chronic pain and seroma formation were comparable. More RCTs should report long-term outcomes.
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Affiliation(s)
- Shaun Phoa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
| | - Sioh Huang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Aung Myint Oo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
| | - Vishal G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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Kakizawa N, Tsujinaka S, Mizusawa Y, Tamaki S, Maemoto R, Machida E, Muto Y, Saito M, Toyama N, Rikiyama T. Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair. Cureus 2022; 14:e27117. [PMID: 36004039 PMCID: PMC9392581 DOI: 10.7759/cureus.27117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Surgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases. Methods Patients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period. Results Twenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months. Conclusion hLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.
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van Hout L, Bökkerink WJV, Vriens PWHE. Clinical feasibility of the Q1.6 Inguinal Hernia application: a prospective cohort study. Hernia 2022; 27:449-458. [PMID: 35840840 DOI: 10.1007/s10029-022-02646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential to evaluate inguinal hernia surgery. There is a need for digital and disease-specific PRO measurement. Current measuring instruments (PROMs) have several disadvantages, for example, fixed measuring moments with a chance of recall bias. The Q1.6 Inguinal Hernia application has been developed to overcome these challenges. This pilot study reports the first clinical feasibility results. METHODS All surgically treated inguinal hernia patients were eligible for inclusion. The application uses "twitch crowdsourcing"; after unlocking a smartphone or tablet, a single short question is asked. This can easily be repeated multiple times a day/week/month. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualised set of questions. Alerts are generated when a complication is suspected. RESULTS A total of 229 patients were given over 50.000 questions of which 92% were answered. Pre- and postoperative patient characteristics and their reported clinical outcomes confirmed a standard inguinal hernia population. Compliance with the application was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. After months 3, 6 and 11, respectively, 3.0%, 4.4% and 4.5% of patients reported inguinal pain or discomfort (NRS ≥ 4). Patients were highly satisfied (92.8% preferred the app over standard care). CONCLUSIONS This smartphone application shows promising results for clinical practice. It might allow for continuous digital patient-reported outcome measurement using non-intrusive, concise questions. Remote monitoring may become standard postoperative care after (inguinal hernia) surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.
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Affiliation(s)
- L van Hout
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands.
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - W J V Bökkerink
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P W H E Vriens
- Department of Surgery, Hernia Center Brabant, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Sekhon Inderjit Singh HK, Massey LH, Arulampalam T, Motson RW, Pawa N. Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis. Am J Surg 2022; 224:1135-1149. [DOI: 10.1016/j.amjsurg.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
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Jiang W, Zhang X, Wang R, Cao D, Yu Y. Mesh fixation techniques in Lichtenstein tension‐free repair: a network meta‐analysis. ANZ J Surg 2022; 92:2442-2447. [PMID: 35429222 DOI: 10.1111/ans.17730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/09/2021] [Accepted: 04/03/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Wei‐Rong Jiang
- The First Clinical Medical School of Lanzhou University Lanzhou City Gansu China
| | - Xiao‐Bei Zhang
- Department of Surgery/Hernia Clinic The First Hospital of Lanzhou University Lanzhou City Gansu China
| | - Rui Wang
- The Second Clinical Medical School Lanzhou University Lanzhou City Gansu China
| | - Dong Cao
- Department of Surgery/Hernia Clinic The First Hospital of Lanzhou University Lanzhou City Gansu China
| | - Yong‐Jiang Yu
- Department of Surgery/Hernia Clinic The First Hospital of Lanzhou University Lanzhou City Gansu China
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Seita K. Long-Term Outcomes Using a Questionnaire After Inguinal Hernia Repair in Female. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The comparison of self-gripping mesh and conventional mesh in laparoscopic inguinal hernia repair: the results of meta-analysis. Updates Surg 2022; 74:857-863. [PMID: 35034343 DOI: 10.1007/s13304-021-01218-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
Self-gripping mesh is widely used in laparoscopic inguinal hernia repair and some researches report its advantages compared with conventional mesh. The aim of this study was to assess outcomes of self-gripping mesh and conventional mesh in laparoscopic inguinal hernia repair. A systematic literature review was undertaken to identify studies comparing the results of self-gripping mesh and conventional mesh in laparoscopic inguinal hernia repair. Outcomes, including recurrence, chronic pain, operation time, hematoma, seroma and infection, were measured. Four randomized controlled trials and 1 prospective comparative study were analyzed. The incidence of chronic pain in self-gripping group was significantly lower than that in conventional group (OR 0.43, 95% CI 0.20, 0.93, P = 0.03), and there was no significant difference in hernia recurrence (OR 0.31, 95% CI 0.03, 3.06, P = 0.32), operation time (MD 0.06, 95%CI - 2.32, 2.44, P = 0.96), hematoma (OR 1.01, 95% CI 0.33, 3.07, P = 0.99) and seroma (OR 0.90, 95% CI 0.49, 1.66, P = 0.73). Laparoscopic inguinal hernia repair using self-gripping mesh is associated with a decreased incidence of chronic pain compared with conventional mesh, without increased postoperative complications.
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A Non-randomized Comparative Study of Self-Fixing and Standard Polypropylene Mesh in Open Inguinal Hernia Repair. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia. Hernia 2022; 26:989-997. [PMID: 35006472 DOI: 10.1007/s10029-021-02554-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair. METHODS In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data. RESULTS Seven studies enrolling 1891 patients undergoing TREPP were included. The mean operative time was 26 min (95% CI 15-36). Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00-6.00%) risk of recurrence, 3.00% (95% CI 2.00-6.00%) risk of chronic pain, 8.00% (95% CI 0.00-20.00%) risk of haematoma, and 3.00% (95% CI 0.00-6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR 1.57, P = 0.26) and chronic pain (OR 1.16, P = 0.59). CONCLUSIONS The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high-quality randomised controlled trials for definite conclusions. Although the available evidence is not adequate for definite conclusions, the results of current study can be used for sample size calculation and power analysis in future trials.
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Zhou Z, Yan L, Li Y, Zhou J, Ma Y, Tong C. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance. Surg Radiol Anat 2022; 44:1531-1543. [PMID: 36404360 PMCID: PMC9734211 DOI: 10.1007/s00276-022-03046-y] [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: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. METHODS Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. RESULTS Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. CONCLUSIONS We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.
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Affiliation(s)
- Zheqi Zhou
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China ,grid.440747.40000 0001 0473 0092Yan’an University, Yan’an, China
| | - Likun Yan
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Yi Li
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Jinsong Zhou
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Yanbing Ma
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Cong Tong
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
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Laparoscopic repair of inguinal hernias: Risk factors for urinary retention and chronic pain after totally extraperitoneal repair and transabdominal preperitoneal repair. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:215-222. [PMID: 35602856 PMCID: PMC8965974 DOI: 10.7602/jmis.2021.24.4.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
Purpose There are various opinions about the postoperative complications of the two methods for laparoscopic inguinal hernia surgery; totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). The aim of this study was to compare the postoperative course after TAPP and TEP, focusing on immediate postoperative pain, incidence of postoperative urinary retention (POUR), and chronic pain. Methods This study retrospectively analyzed a consecutive series of 344 inguinal hernia patients who were treated with laparoscopic surgery between November 2016 and December 2019 at a single tertiary referral center. Results Patient demographics did not differ significantly between the groups. The operation time was significantly shorter in the TEP group than in the TAPP group (43.1 ± 14.9 minutes vs. 63.5 ± 16.5 minutes, p < 0.001). The postoperative pain scores were significantly lower in the TEP group than in the TAPP group immediately (3.6 ± 1.3 vs. 4.4 ± 1.1, p < 0.001) and 6 hours (1.5 ± 1.4 vs. 2.3 ± 1.8, p < 0.001) after the operation. The other complications did not differ significantly between the groups. Age was a significant risk factor for POUR (odds ratio [OR], 1.083; 95% confidence interval [CI], 1.018–1.151; p = 0.011), and history of benign prostate hyperplasia (BPH) was a significant risk factor for chronic pain (OR, 5.363; 95% CI, 1.028–27.962; p = 0.046). Conclusion TEP and TAPP seem to be safe and effective for laparoscopic inguinal hernia repair and have similar postoperative outcomes. Age was a significant risk factor for POUR, and BPH history was a significant risk factor for chronic pain.
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Bara BK, Mohanty SK, Behera SN, Sahoo AK, Agasti S, Patnaik S, Swain SK. Role of Neurectomy in Inguinodynia Following Hernioplasty: A Randomized Controlled Trial. Cureus 2021; 13:e20306. [PMID: 35024257 PMCID: PMC8742623 DOI: 10.7759/cureus.20306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To date, Lichtenstein tension-free mesh hernioplasty is being adopted widely for inguinal hernia repair in adults, although it is accompanied by procedural complications such as recurrences, infection, testicular atrophy, post-operative pain, and nerve injury. As the recurrence rate decreased after Lichtenstein's tension-free hernioplasty, surgeons’ point of focus shifted more toward postoperative groin pain (inguinodynia) after inguinal hernia repair, as it has become a quite significant problem. The nerves of interest in the inguinal region are ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. Out of all the nerves, the ilioinguinal nerve is at the greatest risk of entrapment during meshplasty. Chronic groin pain is quite significant following hernia repair, and irrespective of the severity, it can interfere with normal daily activity. The traditional surgical technique recommends the preservation of the ilioinguinal nerve to avoid the morbidity associated with the cutaneous sensory loss supplied by the nerve. One popular belief is that if we excise the ilioinguinal nerve, then the chance of getting post-operative neuralgia due to entrapment, inflammation, neuroma, or fibrotic reactions will almost become zero. Hence, this study was conducted to evaluate the effect of prophylactic excision of the ilioinguinal nerve in the patients undergoing Lichtenstein hernioplasty for inguinal hernias. Methods All consecutive male patients presenting to the Department of Surgery with inguinal hernia and age above 18 years were included in the study. All the patients were operated on under spinal anesthesia. Lichtenstein tension-free hernia repair was taken as the standard procedure for hernia repair. Patients in whom the nerve was preserved were kept in group A, whereas group B comprised patients who had undergone neurectomy. Patients were followed up regarding pain at first, third, and sixth months, at rest, and after exercise. The pain was graded according to the VAS (visual analog scale) scoring. Results In the present study, out of a total of 92 patients, 80 patients were included. In the first month, 15% of the patients in group A had mild pain, while 5% in group B had experienced a moderate degree of pain at rest. After exercise, the result was 30% in group B. Similarly, in the third month of follow-up, it was found that 25% of the patients in group A experienced mild pain, while 12.5% complained about a moderate degree of pain who had to take analgesics for a longer period. After putting them to exercise and then grading the pain, it was found that 32.5% in group A and 15% in group B experienced pain. After follow-up for six months in both groups, it was revealed that there was no significant difference in post-operative pain at rest (10% and 7.5% in groups A and B, respectively). After exercise, 20% of patients in group A complained of pain, while in group B, only 10% experienced pain. There was no significant difference between both the groups while comparing chronic groin pain at rest and after exercise, and after different time intervals in follow-up (p = 0.4513 and 0.548, respectively). Conclusion Prophylactic excision of the ilioinguinal nerve in Lichtenstein tension-free meshplasty decreased the incidence of chronic groin pain after surgery but it was statistically insignificant. Furthermore, this procedure did not affect the quality of life after surgery.
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Aleman R, Blanco DG, Funes DR, Montorfano L, Semien G, Szomstein S, Lo Menzo E, Rosenthal RJ. Does Transverse Abdominis Plane Block Increase the Risk of Postoperative Urinary Retention after Inguinal Hernia Repair? JSLS 2021; 25:JSLS.2021.00015. [PMID: 34803366 PMCID: PMC8580164 DOI: 10.4293/jsls.2021.00015] [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] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Postoperative urinary retention (POUR) is a common adverse event after inguinal hernia repair (IHR), with an incidence of up to 22.2%. The aim of this study is to determine if pre-operative transverse abdominis plane (TAP) block increases the incidence of POUR. Methods: A retrospective review was performed for all patients who underwent IHR (open or laparoscopic) at this institution, from January 1, 2016 to December 31, 2017. Patients were divided into two groups: Patients that had a TAP block before surgery (group 1) and patients with no TAP block (group 2). Common demographics and comorbidities were collected along with postoperative outcomes and POUR incidence rates for every group to determine procedural influence. Results: From 276 patients reviewed, 28.2% (N = 78) underwent TAP block before surgery. The patient cohort mean age was 61.1 ± 14.4 years. Most the interventions were laparoscopic (81.2%) and an overall POUR incidence rate of 7.6% (N = 21) was observed. Comparatively, common demographics and comorbidities were statistically similar for both groups, with the exception of type 2 diabetes mellitus (p = 0.049). Individually, group 1 and 2 presented POUR incidence rates of 14.1% and 5.05%, respectively. While intraoperative fluid administration, early readmission rate, and length were similar in both groups, there was a significant difference in POUR incidence rates (p = 0.01). Conclusion: Patients undergoing TAP block during IHR might have an increased risk of developing POUR. Further larger, prospective, and randomized controlled studies are necessary to better assess these findings.
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Affiliation(s)
- Rene Aleman
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Gutierrez Blanco
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - David Romero Funes
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - George Semien
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Samuel Szomstein
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Emanuele Lo Menzo
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL
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Bökkerink WJV, Koning GG, Vriens PWHE, Mollen RMHG, Harker MJR, Noordhof RK, Akkersdijk WL, van Laarhoven CJHM. Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial. Ann Surg 2021; 274:698-704. [PMID: 34342299 PMCID: PMC8500364 DOI: 10.1097/sla.0000000000005130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare chronic postoperative inguinal pain (CPIP) in patients with an inguinal hernia after the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal Technique (TIPP). BACKGROUND The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding CPIP with low recurrence rates. Two open preperitoneal techniques, TREPP and TIPP, were compared in a randomized clinical trial with the hypothesis of fewer patients with CPIP after TREPP due to complete avoidance of nerve contact. METHODS Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Before the trial's start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events, and health-related quality of life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months, and 1 year. RESULTS Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but CPIP at rest at 1 year was comparable: 1.9% after TREPP vs 1.4% after TIPP, P = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, P = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, P = 0.591). CONCLUSION Both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1-year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation. TRIAL REGISTRATION ISRCTN18591339.
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Affiliation(s)
- Willem J V Bökkerink
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Giel G Koning
- Department of Surgery, ZGT Hospital Almelo, Almelo, the Netherlands
| | | | | | - Mitchell J R Harker
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robin K Noordhof
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Mandujano CC, Tchokouani L, Lima DL, Malcher F, Jacob B. Robotic mesh explantation (RoME): a novel approach for patients with chronic pain following hernia repair. Surg Endosc 2021; 36:4862-4868. [PMID: 34724577 DOI: 10.1007/s00464-021-08835-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Post-herniorrhaphy pain is common with an estimated 8-10% incidence of mesh-related complications, requiring mesh explantation in up to 6% of cases, most commonly after inguinal hernia repairs. Reoperation for mesh explantation poses a surgical challenge due to adhesions, scarring and mesh incorporation to the surrounding tissues. Robotic technology provides a versatile platform for enhanced exposure to tackle these complex cases. We aim to share our experience with a novel robotic approach to address these complex cases. METHODS A descriptive, retrospective analysis of patients undergoing a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia by two surgeons between the period of March 2016 and January of 2020. The patients were evaluated for resolution of mesh related abdominal pain as well as early post-operative complications. RoME was performed with concomitant hernia repair in cases of recurrences. RESULTS Twenty-nine patients underwent a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia between March 2016 and January of 2020. Nineteen patients (65.5%) had a prior inguinal hernia repair and 10 patients (34.5%) had a prior ventral hernia repair. Indications for mesh removal included chronic pain with or without hernia recurrence. Seventeen patients (58.6%) reported improvement or resolution of pain postoperatively (63% with a prior inguinal hernia repair and 50% of patients with a prior ventral hernia repair). Five patients (17.2%) required mesh reinforcement after explantation. Nineteen patients (65.5%) underwent mesh explantation with primary fascial closure or no mesh reinforcement. The mean follow-up was 36.4 days. The most common postoperative complication was seroma formation (6.8%), with one reported recurrence (3.4%). CONCLUSION Robotic mesh explantation in challenging cases due to the effect of chronic scarring, adhesions and mesh incorporation to the surrounding tissues is safe and provides an advantageous platform for concomitant hernia repair in these complex cases.
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Affiliation(s)
- Cosman Camilo Mandujano
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA.
| | - Loic Tchokouani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA
| | - Flavio Malcher
- Director Abdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Brian Jacob
- Department of Surgery, Mount Sinai Health System, New York, NY, USA
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Quevedo Orrego E, Robla Costales J, Rodríguez Aceves C, Diana Martín R, González Álvarez A, Socolovsky M. Neuropathic inguinal pain due to nerve injury after a laparoscopic appendectomy: first pediatric case described in the literature. Childs Nerv Syst 2021; 37:1825-1830. [PMID: 33904935 DOI: 10.1007/s00381-021-05177-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the first pediatric case in the literature of neuropathic inguinal pain secondary to iatrogenic nerve injury that occurred during a laparoscopic appendectomy, detailing clinical and morphological findings before and after surgery. The literature on adult patients is reviewed and pathophysiological, therapeutic, and prognostic factors are discussed. CLINICAL PRESENTATION A 14-year-old female patient presented with a history of a laparoscopic appendectomy 3 years previously. Three months post-operatively, she developed progressively worsening neuropathic inguinal pain refractory to neuromodulators and several nerve blocks. Given her deterioration, poor response to conservative therapy, and clearly meeting the criteria for chronic post-operative inguinal pain (CPIP), surgical management was undertaken. RESULTS Open surgery was performed through the previous incision, during which injury to a branch of the iliohypogastric nerve (IH) was confirmed. Neurolysis of the affected branch was performed, after which the patient experienced significant pain relief, resolution of allodynia, and reversal of skin hyperpigmentation. After discharge, analgesic therapy was gradually withdrawn and, ultimately, discontinued altogether. CONCLUSIONS Understanding the neuroanatomy of the inguinal region is an indispensable requirement for all surgeons operating in this region, to avoid complications including CPIP and optimize patient outcomes. Surgical management of CPIP can be effective for controlling severe pain in patients in whom conservative management has failed. Studies are needed in the pediatric population to identify specific characteristics of this entity in youth.
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Affiliation(s)
| | - Javier Robla Costales
- Neurosurgical Department, HM Hospitales Regla/San Francisco, Calle Cardenal Landázuri 2, 24003, León, Spain.
| | | | - Rubén Diana Martín
- Neurosurgical Department, Complejo Asistencial Universitario de León, León, Spain
| | | | - Mariano Socolovsky
- Neurosurgical Department, Complejo Asistencial Universitario de León, León, Spain.,Peripheral Nerve & Plexus Program, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Intra-Operative Vascular Injury and Control During Laparoscopic and Robotic Mesh Explantation for Chronic Post Herniorrhaphy Inguinal Pain (CPIP). Surg Technol Int 2021. [PMID: 33878193 DOI: 10.52198/21.sti.38.hr1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Chronic postherniorrhaphy inguinal pain (CPIP) is common following inguinal hernia repair. As even primary minimally-invasive inguinal hernia repairs carry a risk of significant intra-operative bleeding, it is unsurprising that reoperative groin exploration and mesh explantation for chronic post-inguinal herniorrhaphy pain confers an even higher risk of arteriotomy or venotomy due to a distorted anatomy and the presence of adhesions. In this report, we present a single institution's experience with the management of intra-operative vascular injury encountered during minimally invasive groin exploration and mesh explantation for CPIP. MATERIALS AND METHODS We performed a retrospective consecutive case series study at a single academic center of patients with CPIP who underwent minimally invasive groin exploration and mesh removal during which an iatrogenic arteriotomy or venotomy occurred from September 2015 to September 2020. Descriptive statistics were collected for age, laterality of hernia repair, mean follow-up time, surgical approach (robotic vs. laparoscopic), type of intra-operative vascular injury, vascular control technique, and post-operative complications. RESULTS Of 196 minimally invasive groin exploration and mesh removal cases, 46 were performed with robotic assistance and 150 were performed using traditional laparoscopy. The overall incidence of intra-operative vascular injury was 43 (22%). Fifteen of 46 (32%) robotic groin exploration and mesh removal cases and 28 of 150 (19%) laparoscopic cases involved vascular control. Three of 15 (20%) robotic cases and 23 of 28 (82%) laparoscopic cases involved a hybrid open inguinal approach to address anterior pathology (neurectomy, anterior mesh removal, hernia repair) or facilitate exposure for vascular repair. The most common site of injury was the inferior epigastric vessels. Other sites included the iliac vein, iliac artery, corona mortis, and accessory obturator vessels. Vascular control techniques included ligation with an energy device or suture, primary suture repair of injured vessel, or bovine pericardium patch angioplasty. All were managed without intra-operative vascular surgery intervention except for one case with extensive calcification that required endarterectomy and angioplasty to improve patency. No cases required conversion to midline laparotomy. Ninety three percent of the cases with large vessel bleeding during laparoscopic-assisted procedures were repaired via an open groin incision, whereas all cases of large vessel bleeding during robotic-assisted procedures were repaired robotically. None of the patients required transfusion. Postoperative complications occurred in 3 patients (7%), 2 (5%) developed hematoma formation requiring surgical evacuation, and 1 (2%) developed ipsilateral iliofemoral deep vein thrombosis (DVT) and underwent peripheral angiography and thrombolysis. CONCLUSIONS Although minimally invasive groin exploration and mesh explantation for CPIP is technically challenging, it is a safe and effective operation when performed at experienced centers. Iatrogenic vascular injury should be anticipated but can be effectively controlled laparoscopically, robotically, or via a hybrid open inguinal incision without conversion to a midline laparotomy and with low post-operative complication rates.
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Aiolfi A, Cavalli M, Bonitta G, Bona D, Campanelli G. Letter to the Editor: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: a Systematic Literature Review and Meta-analysis. World J Surg 2021; 45:2629-2630. [PMID: 33966097 DOI: 10.1007/s00268-021-06154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - Marta Cavalli
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Giampiero Campanelli
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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