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Feasibility of a smartphone application for inguinal hernia care: a prospective pilot study. Updates Surg 2023:10.1007/s13304-023-01455-1. [PMID: 36781816 PMCID: PMC9924875 DOI: 10.1007/s13304-023-01455-1] [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: 11/15/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
The Inguinal Hernia Application (IHAPP) is designed to overcome current limitations of regular follow-up after inguinal hernia surgery. It has two goals: Minimizing unnecessary healthcare consumption by supplying patient information and facilitating registration of patient-reported outcome measures (PROMs) by offering simple questionnaires. In this study we evaluated the usability and validity of the app. Patients (≥18 years) scheduled for elective hernia repair were assessed for eligibility. Feasibility of the app was evaluated by measuring patient satisfaction about utilization. Validity (internal consistency and convergent validity) was tested by comparing answers in the app to the scores of the standardized EuraHS-Quality of Life instrument. Furthermore, test-retest reliability was analyzed correlating scores obtained at 6 weeks to outcomes after 44 days (6 weeks and 2 days). During a 3-month period, a total of 100 patients were included. Median age was 56 years and 98% were male. Most respondents (68%) valued the application as a supplementary tool to their treatment. The pre-operative information was reported as useful by 77% and the app was regarded user-friendly by 71%. Patient adherence was mediocre, 47% completed all questionnaires during follow-up. Reliability of the app was considered excellent (α > 0.90) and convergent validity was significant (p = 0.01). The same applies to test-retest reliability (p = 0.01). Our results demonstrate the IHAPP is a useful tool for reliable data registration and serves as patient information platform. However, further improvements are necessary to increase patient compliance in recording PROMs.
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Yıldırım MB, Sahiner IT. The effect of mesh fixation on migration and postoperative pain in laparoscopic TEP repair: prospective randomized double-blinded controlled study. Hernia 2023; 27:63-70. [PMID: 35286511 DOI: 10.1007/s10029-022-02587-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The development of chronic pain is one of the major post-surgery problems after inguinal hernia repair. Although the possibility of chronic pain formation decreases with laparoscopic methods, pain may develop due to the staples used. It is thought that absence of mesh fixation in total extra-peritoneal (TEP) repair does not increase the recurrence rate. This study aims to investigate the absence of mesh fixation in the TEP on the development of postoperative pain, mesh displacement, and recurrence rate. METHODS Between December 2019 and December 2020, 100 patients who underwent TEP repair due to unilateral inguinal hernia in the General Surgery Clinic of Hitit University were included in the study. Study was registered at http://Clinicaltrials.gov (NCT05152654). Patients were divided into two groups as repairs in which the mesh was fixed with a tacker and no-fixation (NF) was used. The mesh is marked with radiopaque clips. Patients were compared in terms of postoperative pain, mobilization time, hospital stay, return to work, chronic pain, early-late mesh displacement, and recurrence. RESULTS While there was no significant difference between the groups in terms of mesh displacement and recurrence, it was observed that the NF group developed significantly less pain in the early and late postoperative period compared to the other group. The time-dependent reduction rate of postoperative pain was higher in NF group than in other group. In addition, operation time was shorter in the NF group. CONCLUSION While the absence of mesh fixation in TEP hernia repair does not increase the recurrence rate, it can be used safely, because it causes less acute and chronic pain. TRAIL REGISTRATION Clinicaltrials number: NCT05152654.
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Affiliation(s)
- M B Yıldırım
- Faculty of Medicine, Department of Surgery, Hitit University, Çorum, Turkey.
| | - I T Sahiner
- Faculty of Medicine, Department of Surgery, Hitit University, Çorum, Turkey
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Varying convalescence recommendations after inguinal hernia repair: a systematic scoping review. Hernia 2022; 26:1009-1021. [PMID: 35768670 DOI: 10.1007/s10029-022-02629-3] [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: 01/18/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The most recent international guideline on inguinal hernia management recommends a short convalescence after repair. However, surgeons' recommendations may vary. The objective of this study was to give an overview of the current convalescence recommendations in the literature subdivided on the Lichtenstein and laparoscopic inguinal hernia repairs. METHODS In this systematic review, three databases were searched in August 2021 to identify studies on inguinal hernia repairs with a statement about postoperative convalescence recommendations. The outcome was convalescence recommendations subdivided on daily activities, light work, heavy lifting, and sport. RESULTS In total, 91 studies fulfilled the eligibility criteria, and 50 and 58 studies reported about convalescence recommendations after Lichtenstein and laparoscopic repairs, respectively. Patients were instructed with a wide range of convalescence recommendations. A total of 34 Lichtenstein studies and 35 laparoscopic studies recommended resumption of daily activities as soon as possible. Following Lichtenstein repairs, the patients were instructed to resume light work after median 0 days (interquartile range (IQR) 0-0), heavy lifting after 42 days (IQR 14-42), and sport after 7 days (IQR 0-29). Following laparoscopic procedures, the patients were instructed to resume light work after median 0 days (IQR 0-0), heavy lifting after 14 days (IQR 10-28), and sport after 12 days (IQR 7-23). CONCLUSION This study revealed a broad spectrum of convalescence recommendations depending on activity level following inguinal hernia repair, which likely reflects a lack of high-quality evidence within this field.
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Kurtulus I, Culcu OD, Degerli MS. Zig Maneuver in Total Extraperitoneal Inguinal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2022; 32:329-334. [PMID: 35297809 DOI: 10.1097/sle.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The difficulties in the hernia sac dissection in repairing large inguinal hernias with the endoscopic total extraperitoneal (TEP) technique prolong the operation and increase the risk of injury. This study investigates the effectiveness of the Zig maneuver (ligation of the hernia sac at the deep inguinal ring) in TEP in male patients with L3 inguinal hernia by European Hernia Society classification. MATERIALS AND METHODS A total of 224 male patients with L3 inguinal hernia who underwent laparoscopic TEP surgery in 2018 and 2019 were retrospectively screened and included in the study. The patients were divided into 2 groups as Zig group (n=99) and the non-Zig group (n=125), depending on whether the Zig maneuver was performed during TEP application. RESULTS The mean patient age was 45.49 for the non-Zig group and 47.12 for the Zig group. The median operative time was 50 minutes in the non-Zig group and 43 minutes in the Zig group (P<0.005). The median value of the postoperative first 24 hours pain score was 3 in the non-Zig group and 2 in the Zig group (P=0.033). Scrotal edema was 7.2% in the non-Zig group and 1% in the Zig group (P=0.023). According to logistic regression analysis, the Zig maneuver reduced the probability of scrotal edema by 87% in almost the entire population (odds ratio=0.130, 95% confidence interval: 0.016-1.047). There was no statistically significant difference between the groups in terms of early and late recurrence. CONCLUSIONS Zig maneuver shortened the operative time and significantly reduced the feeling of pain in the first 24 hours postoperatively in male patients with indirect L3 hernia who underwent endoscopic TEP. It also significantly reduced the likelihood of scrotal edema in almost the entire population. As a result, the Zig maneuver is an effective method that could be applied during endoscopic TEP.
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Affiliation(s)
- Idris Kurtulus
- Department of General Surgery, Basaksehir State Hospital
| | - Osman D Culcu
- Department of General Surgery, Basaksehir State Hospital
| | - Mahmut S Degerli
- Department of General Surgery, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
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Kurtulus I, Culcu OD, Degerli MS. Extended View Totally Extraperitoneal Technique and Its Advantages in Laparoscopic Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2021; 32:842-847. [PMID: 34935480 DOI: 10.1089/lap.2021.0601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Endoscopic total extraperitoneal (TEP) is used increasingly in inguinal hernias. Perhaps the most fundamental difficulty of the classical TEP method is that the dissection plan it offers is overly limited, which is among the reasons why techniques other than TEP are preferred in large scrotal hernias. This study discusses our experience with the extended view totally extraperitoneal (e-TEP) method, which significantly expands the dissection plan compared to the classical method. Methods: Patients who had inguinal hernia surgery in 2018 and 2019 were retrospectively analyzed, and 21 male patients with L3 inguinal hernia by European Hernia Society classification, who underwent laparoscopic e-TEP surgery, were included in the study. Patient data were obtained from the hospital's electronic database and patient files. One year after the surgery, the patients were invited to the hospital by telephone and re-examined. Results: The median patient age was 47 years. The mean duration of surgery was 43.6 minutes, and the median postoperatively pain score in the first 24 hours was 1.975. Zig maneuver was performed in 85.7%, and drains were placed in 33.4% of patients. In 28.6% of patients, the peritoneal violation occurred. However, there was no conversion to another surgical technique. The mean length of stay was 1.33 days. Two patients had seroma, one had scrotal edema, and one had urinary retention. No recurrence was observed in any patient during the 1-year follow-up. Conclusions: According to our experience, the e-TEP technique can be safely performed in scrotal hernias as it offers a larger dissection plane. It also allows patients with large scrotal hernias to benefit from all the advantages of the TEP technique.
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Affiliation(s)
- Idris Kurtulus
- Department of General Surgery, Basaksehir State Hospital, Istanbul, Turkey
| | - Osman Deniz Culcu
- Department of General Surgery, Basaksehir State Hospital, Istanbul, Turkey
| | - Mahmut Said Degerli
- Department of General Surgery, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
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Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial. Wideochir Inne Tech Maloinwazyjne 2019; 15:1-10. [PMID: 32117479 PMCID: PMC7020706 DOI: 10.5114/wiitm.2019.83611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/03/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction The use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used. Aim To evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR. Material and methods Unilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later. Results No statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL. Conclusions Lack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.
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Ece İ, Yılmaz H. An overlooked complication of the inguinal hernia repair: Dysejaculation. Turk J Surg 2018; 34:1-4. [PMID: 29756096 DOI: 10.5152/ucd.2015.4103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 11/22/2022]
Abstract
The objective of this study was to investigate the rate of post-herniorrhaphy dysejaculation in the current literature. A comprehensive search of PubMed, Medline, Google Scholar, and Google databases was performed using the keywords "groin hernia and chronic pain," "inguinal hernia and chronic pain," "dysejaculation," and "ejaculatory pain." The eligible studies were evaluated in terms of ejaculatory pain and surgical technique used. Ten studies with 122 patients were eligible for the analysis. The rate of ejaculatory pain for a total of 5521 patients was found to be 2.2%. The incidence of postoperative ejaculatory pain was found to be 2.1% following laparoscopic techniques and 1.1 % following open repair. Open techniques were not related to the increased frequency of dysejaculation. Sufficient data could not be obtained from the studies for the ejaculatory pain, and thus, no statistical evaluation was performed. Dysejaculation is a common cause of postoperative morbidity after inguinal hernia repair. Attention to technical details of the primary operation may reduce the incidence of dysejaculation.
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Affiliation(s)
- İlhan Ece
- Department of Surgery, Selcuk University, Konya, Turkey
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Liew W, Wai YY, Kosai NR, Gendeh HS. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers. Hernia 2017; 21:549-554. [PMID: 28417279 DOI: 10.1007/s10029-017-1611-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s. Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5% of patients. The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair. METHODS Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair. The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein, white blood cell count at 48 h, and ESR at 3 months postoperatively. Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period. RESULTS The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values (p < 0.05), however, did not differ significantly between the two study groups at 48 h (p > 0.05). The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only (p < 0.05), however, did not differ significantly between the two study groups (p > 0.05). There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group (p > 0.05). CONCLUSION Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible.
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Affiliation(s)
- W Liew
- Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Y Y Wai
- Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - N R Kosai
- Upper Gastrointestinal, Bariatric and Metabolic Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - H S Gendeh
- Depatment of Otrorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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Pryor MB, Carrion R, Wang R, Henry G. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis. Asian J Androl 2017; 18:754-8. [PMID: 26459782 PMCID: PMC5000799 DOI: 10.4103/1008-682x.163266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1–2 h daily for 6–24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
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Affiliation(s)
- Michael B Pryor
- Regional Urology, 255 Bert Kouns Industrial Loop, Shreveport, LA, USA
| | - Rafael Carrion
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Run Wang
- Department of Urology, University of Texas School of Medicine at Houston and MD Anderson Cancer Center, Houston, TX, USA
| | - Gerard Henry
- Regional Urology, 255 Bert Kouns Industrial Loop, Shreveport, LA, USA
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Mommers EHH, Hünen DRM, van Hout JCHM, Guit M, Wegdam JA, Nienhuijs SW, de Vries Reilingh TS. Patient-reported outcomes (PROs) after total extraperitoneal hernia repair (TEP). Hernia 2017; 21:45-50. [PMID: 27917457 PMCID: PMC5281684 DOI: 10.1007/s10029-016-1554-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/18/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) such as quality of life (QoL), patient satisfaction, and work impairment, are arguably the most important outcomes of any medical treatment. In 2011, Staerkle and Villiger developed the Core Outcome Measurements Index (COMI) to standardise PROs and PRO measurement for inguinal hernia patients, in an attempt to increase inter-study comparability. The aim of this study is to prospectively evaluate the short- and long-term postoperative QoL, function, patient well-being, pain, and social/work disability, after total extraperitoneal (TEP) inguinal hernia repair and to provide the first clinical experience with the COMI-hernia questionnaire. METHODS Between January 2013 and December 2014, all patients ≥18 years that were scheduled for elective uni- or bilateral TEP in a regional hospital were approached to participate in this study. Measurements were taken preoperatively, and 6 weeks and 1 year postoperatively. RESULTS One hundred and twenty patients (113 men, 7 women), mean age 59 years (SD ±12), completed the follow-up of 1 year. Ninety-seven percent of the population reported that the operation improved their complaints. QoL, function, well-being, and pain all improved after 6 weeks and 1 year after surgery. Patients experienced more social and work-related limitations 6 weeks after surgery compared to baseline measurements, though this improved to normal 1 year postoperatively. The incidence of chronic pain was 14% (VAS ≥ 2), which had a negative impact on the patients' sense of well-being. CONCLUSION Patients recovered well after TEP repair with a good quality of life and fast restore of function. Patient well-being was lower than expected due to a 14% incidence of chronic pain. The COMI-hernia scale provided reasonable insight into the patients' experience, though it was difficult to interpret for both patient and physician.
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Affiliation(s)
- E H H Mommers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
| | - D R M Hünen
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - J C H M van Hout
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - M Guit
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J A Wegdam
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Garofalo F, Mota-Moya P, Munday A, Romy S. Total Extraperitoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation. World J Surg 2016; 41:100-105. [DOI: 10.1007/s00268-016-3710-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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