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Dong H, Li L, Feng HH, Wang DC. Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci 2023; 16:138-147. [PMID: 37964861 PMCID: PMC10641249 DOI: 10.1016/j.sopen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Background Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.
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Affiliation(s)
- Hui Dong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Li Li
- Department of Pediatric Surgery, Zigong First People's Hospital, Zigong 643000, Sichuan, China
| | - Hui-He Feng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
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Nagata S, Orita H, Korenaga D. Nonfixation of mesh in laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score matched analysis. Asian J Surg 2022:S1015-9584(22)01410-5. [DOI: 10.1016/j.asjsur.2022.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 12/23/2022] Open
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Matikainen M, Vironen JH, Silvasti S, Ilves I, Kössi J, Kivivuori A, Paajanen H. A randomized clinical trial comparing early patient-reported pain after open anterior mesh repair versus totally extraperitoneal repair of inguinal hernia. Br J Surg 2021; 108:1433-1437. [PMID: 34791044 PMCID: PMC10364913 DOI: 10.1093/bjs/znab354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/11/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. METHODS Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. RESULTS A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P < 0.001) and used less analgesics after TEP repair, compared to those who had modified Lichtenstein repair. Two patients in the TEP group and five in the Lichtenstein group developed superficial wound infection (P = 0⋅446). Only one reoperation was performed in the Lichtenstein group due to haematoma. CONCLUSION TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. TRIAL REGISTRATION NCT03566433 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Markku Matikainen
- Department of Gastrointestinal Surgery, Kuopion Yliopistollinen Sairaala, Kuopio, Finland
| | - Jaana Hellevi Vironen
- Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Espoo, Finland
| | - Seppo Silvasti
- Surgery, Pohjois-Karjalan Keskussairaala, Joensuu, Finland
| | - Imre Ilves
- Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - Jyrki Kössi
- Surgery, Päijät-Hämeen Sosiaali- ja Terveysyhtymä, Lahti, Finland
| | - Antti Kivivuori
- Department of Gastrointestinal Surgery, Kuopion Yliopistollinen Sairaala, Kuopio, Finland
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Suzuki Y, Wakasugi M, Mikamori M, Tamaoka K, Nakahara Y, Tei M, Furukawa K, Ohtsuka M, Masuzawa T, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic totally extra-peritoneal inguinal hernia repair: a single-institution experience of 186 consecutive cases. Surg Today 2021; 52:114-119. [PMID: 34115209 DOI: 10.1007/s00595-021-02323-4] [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: 02/23/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This retrospective study was conducted to compare the long-term outcomes of single-incision totally extraperitoneal (S-TEP) inguinal hernia repair and conventional multiport totally extraperitoneal (M-TEP) inguinal hernia repair. METHODS The study population included 186 consecutive patients (S-TEP, n = 149; M-TEP, n = 37) who underwent elective surgery for inguinal hernia at Osaka Police Hospital between 2011 and 2013. RESULTS No significant between-group difference was found in patient or hernia characteristics or in perioperative outcomes, with the exception of age (S-TEP group vs. M-TEP group: median 69 [IQR 60-75] years vs. 64 [55-69] years, respectively; P = 0.019). Furthermore, no significant between-group difference was found in follow-up time (5.5 [3.0-5.8] vs. 5.4 [3.1-5.7] years, P = 0.839), recurrence rate (0.6 vs. 2.4%, P = 0.358), chronic pain (1.2 vs. 0%, P = 1.000), feeling the mesh (2.3 vs. 7.1%, P = 0.142), or movement limitation (0.6 vs. 0%, P = 1.000). All chronic symptoms were "mild but not bothersome." A metachronous contralateral inguinal hernia developed in 8.1% of patients. CONCLUSION The long-term outcomes of S-TEP repair were comparable to those of M-TEP, with rates of recurrence, chronic pain, feeling the mesh, and movement limitation falling within acceptable limits.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Shibaharacho 4-14-1, Toyonaka, Osaka, 560-8565, Japan.
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Kohei Tamaoka
- Department of Endoscopic Diagnosis and Therapeutics, Kanto Central Hospital of the Mutual Aid and Association of Public School Teachers, Setagaya-ku Kamiyoga 6-25-1, Tokyo, 158-8531, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Toru Masuzawa
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
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Gallyamov EA, Agapov MA, Busyrev YB, Kakotkin VV, Kubyshkin VA, Donchenko KA, Gadlevskiy GS, Wu Z. [Outcomes of various techniques of mesh prosthesis fixation in laparoscopic hernia repair]. Khirurgiia (Mosk) 2021:34-41. [PMID: 33395510 DOI: 10.17116/hirurgia202101134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair. MATERIAL AND METHODS It is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated. RESULTS Early postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%). CONCLUSION There were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.
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Affiliation(s)
- E A Gallyamov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Agapov
- Lomonosov Moscow State University, Moscow, Russia
| | - Yu B Busyrev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V V Kakotkin
- Lomonosov Moscow State University, Moscow, Russia
| | | | | | - G S Gadlevskiy
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Z Wu
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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BOLAT H, KOCAÖZ S. Laparoskopik Total Ekstraperitoneal Herniorafi veya Lichtenstein Herniorafi operasyonu geçiren hastaların izlem sonuçlarının karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.662917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Polytetrafluoroethylene versus polypropylene mesh during laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia: short- and long-term results of a double-blind clinical randomized controlled trial. Hernia 2020; 24:1011-1018. [PMID: 32350735 DOI: 10.1007/s10029-020-02200-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/19/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Aim of the study is to compare macroporous (> 1 mm2) polytetrafluoroethylene mesh (LP-PTFE) versus microporous (< 1 mm2) polypropylene mesh (SP-PPL) in terms of postoperative acute and chronic discomfort and pain, difficulty in mesh handling and long-term recurrence rate. METHODS Fifty-two patients with bilateral hernia were enrolled in this double-blind randomized controlled trial (NCT02023203). Each hernia, in the same patient, was randomized to implant LP-PTFE or SP-PPL mesh during totally extraperitoneal laparoscopic hernia repair. Patients were followed at 7 days, 1, 3, 6, 12 and 60 months after surgery. Visual analog scale (VAS) score was employed to evaluate the outcomes. Student's t test was used in case of normally distributed continuous variables, while the nonparametric Mann-Whitney U test was used in case of not normally distributed variables. Chi square test was used for analysis of categorical variables. RESULTS Median VAS discomfort score with SP-PPL was significantly higher than LP-PTFE at 1 and 3 months after surgery (p = 0.003 in both cases). LP-PTFE showed significantly lower median score than SP-PPL at 7 days after surgery (p = 0.025) regarding pain at movement. Testicular pain was lower in case of LP-PTFE than SP-PPL at 7 days, 1 and 3 months after surgery (p = 0.005, p = 0.004 and p = 0.004, respectively). LP-PTFE was significantly more difficult to handle (p = 0.001). At 60 months, one recurrence was observed in the LP-PTFE group (p = 1.0000). CONCLUSIONS LP-PTFE has less postoperative discomfort and pain up to 3 months after surgery, without differences after that period, although it shows more difficulty in handling and recurrences occur even if not statistically significant.
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A Randomized Controlled Trial Comparing Short-term Outcomes of Self-Gripping (Progrip) Mesh Versus Fibrin Sealant in Laparoscopic Total Extraperitoneal Hernioplasty. Surg Laparosc Endosc Percutan Tech 2020; 30:203-208. [DOI: 10.1097/sle.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanna A, Felicioni L, Cecconi C, Cola R. Retromuscular Mesh Repair Using Extended Totally Extraperitoneal Repair Minimal Access: Early Outcomes of an Evolving Technique-A Single Institution Experience. J Laparoendosc Adv Surg Tech A 2019; 30:246-250. [PMID: 31895628 DOI: 10.1089/lap.2019.0661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Enhanced-view extended totally extraperitoneal repair (eTEP) technique for laparoscopic retromuscular ventral hernia (VHR) repair is a novel application recently described by some authors. We present our early single institution experience on this technique. Methods: Retrospective review of the eTEP technique for laparoscopic retromuscular VHR repair cases at our institution from October 2018 to June 2019 with 1 month follow-up was evaluated. Data analyses include patients characteristics, operative details, and complications. Results: A total of 18 patients were treated with eTEP. One patient was reoperated using the same procedure and hospital stay was 6 days. The same patient who had undergone transversus abdominis release developed a seroma that could be observed 20 days after surgery. Conclusion: Our short-term experience with eTEP access suggests feasibility of this approach in accordance with results from other authors. We do not think the technique is challenging, but it is necessary for it to be performed by surgeons with skills in laparoscopic abdominal wall reconstruction.
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Affiliation(s)
- Andrea Sanna
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Luca Felicioni
- Division of General and Minivasive Surgery, Misericordia Hospital della Misericordia, Grosseto, Italy
| | - Claudia Cecconi
- Division of General Surgery, resident of Padova University School of Medicine, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
| | - Roberto Cola
- Division of General Surgery, AULSS 6 Hospital "Madre Teresa di Calcutta," Monselice, Italy
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10
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Lo CW, Tsai YC, Yang SSD, Hsieh CH, Chang SJ. Comparison of short- to mid-term efficacy of nonfixation and permanent tack fixation in laparoscopic total extraperitoneal hernia repair: A systematic review and meta-analysis. Tzu Chi Med J 2019; 31:244-253. [PMID: 31867253 PMCID: PMC6905242 DOI: 10.4103/tcmj.tcmj_47_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/04/2018] [Accepted: 04/18/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We systematically reviewed the literature and pooled data for a meta-analysis to compare the efficacy and safety of mesh fixation and nonfixation in laparoscopic total extraperitoneal (TEP) hernia repair. MATERIALS AND METHODS We performed a systematic search of PubMed® and a Cochrane review for all randomized controlled trials that compared the efficacy and complications of mesh fixation versus nonfixation in TEP hernia repair. The evaluated outcomes included perioperative (operative time and conversion rate) and postoperative parameters (pain scores, duration of hospital stay, surgical complications including seroma, delayed return of bladder function, chronic pain, and recurrence). Cochrane Collaboration Review Manager Software (RevMan®, version 5.2.6) was used for statistical analysis. RESULTS Ten trials met the inclusion criteria and were included in a pooled analysis. In total, 1099 patients (1467 hernias) had received TEP hernia repair (748 and 719 hernia defects in the nonfixation and fixation groups, respectively). The nonfixation group required shorter operative time (weighted mean difference [WMD] = -2.36 min, P = 0.0006) and had less pain on postoperative day 1 (WMD = -0.44, P = 0.04) than the fixation group. No significant differences were observed between groups with regard to conversion rate, hospital stay, recurrence rate, or complication rate. However, the incidence of postoperative urine retention was higher in the fixation group (odds ratio = 0.26, P = 0.03). CONCLUSION For patients with a nonrecurrent uncomplicated hernia defect with the size <3 cm, nonfixation yielded comparable efficacy with mesh fixation, but less short-term postoperative pain, and a lower risk of urine retention. In addition, the nonfixation method involved a shorter operative time and lower costs. However, no difference in the incidence of chronic pain was observed.
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Affiliation(s)
- Chi-Wen Lo
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Stavert B, Chan DL, Ozmen J, Loi K. Laparoscopic totally extra-peritoneal groin hernia repair with self-gripping polyester mesh: a series of 780 repairs. ANZ J Surg 2019; 89:1261-1264. [PMID: 31452324 DOI: 10.1111/ans.15378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post-operative pain and infection. Post-operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self-gripping mesh, has a theoretical benefit of avoiding tacks for mesh-fixation. This case series reflects our long-term experience of this technique. METHODS We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re-operation as primary data points. RESULTS A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self-gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo-hernia repairs (0.38%). Post-operative follow-up was up to 4.4 years. CONCLUSIONS Our series of laparoscopic groin hernia repair with self-gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.
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Affiliation(s)
- Bethany Stavert
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - John Ozmen
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
| | - Ken Loi
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 2017; 10:119-127. [PMID: 28547932 DOI: 10.1111/ases.12388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed.
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