Benefits of laparoscopic posterior wall suture repair in treating adolescent indirect inguinal hernias

Laparoscopic iliopubic tract repair for asymptomatic contralateral occult inguinal hernia

PURPOSE

Metachronous contralateral inguinal hernia (MCIH) may occur after unilateral inguinal hernia (IH) repair, potentially as a result of occult IH (OIH). Contralateral OIH can be checked for during laparoscopic transabdominal hernioplasty for the treatment of unilateral IH. This study aims to assess the efficacy of laparoscopic iliopubic tract repair (IPTR) in treating contralateral OIH to reduce MCIH.

METHODS

The medical charts of 3165 patients aged > 18 years who underwent laparoscopic transabdominal hernioplasty for unilateral IH from January 2013 to December 2021 were retrospectively reviewed. The patients were categorized into two groups based on contralateral OIH presence: negative OIH (nOIH, 2657 patients) and OIH (508 patients). In cases of OIH, IPTR was performed, involving suturing of the iliopubic tract and transversalis fascia arch.

RESULTS

MCIH was indirect in 26 and direct in 4 patients in the nOIH group, and was direct in 3 patients in the OIH group. The incidence of indirect MCIH was higher in the nOIH group than in the OIH (1.0% [n = 26/2657] vs. 0.0% [n = 0/508], p = 0.048). There was no difference in postoperative complication rates, pain scores, return to daily life, or duration of hospitalization between the nOIH and OIH groups.

CONCLUSION

Laparoscopic IPTR for OIH treatment is an effective method for reducing the risk of indirect MCIH.

Characteristics of pantaloon inguinal hernia and evaluation of added laparoscopic iliopubic tract repair to transabdominal preperitoneal hernioplasty: a retrospective observational study

Purpose

Pantaloon hernia (PH), defined as concurrent ipsilateral direct and indirect inguinal hernias, is known for its high postoperative recurrence rate. This study retrospectively investigated the characteristics of PHs and evaluated the safety and efficacy of incorporating laparoscopic iliopubic tract repair (IPTR) into transabdominal preperitoneal (TAPP) hernioplasty.

Methods

A total of 3,355 patients who underwent TAPP hernioplasty for groin hernias between October 2014 and December 2021 were analyzed. These patients were divided into 2 groups: PH (97 patients) and non-PH (3,258 patients). The PH group was further subdivided based on the surgical technique used: TAPP hernioplasty without IPTR (TAPP group, 39 patients) and TAPP hernioplasty with IPTR for defect closure (TAPP + IPTR group, 58 patients).

Results

The study included 93 male and 4 female patients with PH. Patients with PH were generally older and predominantly male compared to the non-PH group. The recurrence rate in the PH group was notably higher than in the non-PH group (2.1% [2 of 97] vs. 0.2% [6 of 3,258], respectively; P = 0.007). Among the PH group, reoperations were more frequent in the TAPP group compared to the TAPP + IPTR group (10.3% [4 of 39] vs. 0% [0 of 58], respectively; P = 0.048). The reasons for reoperation in the PH group included recurrences (2 patients), mesh bulge (1 patient), and chronic seroma (1 patient).

Conclusion

TAPP + IPTR hernioplasty is an acceptable approach in PH treatment, reducing reoperation.

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

Groin hernias are common and hernia repair is one of the most frequent surgical procedures performed worldwide. Despite this, there is no international guideline on the management of groin hernias in adolescents. Mesh reinforcement is used for repair in adults but not in young children. Adolescents, positioned between these age groups, pose unique challenges for surgeons due to their varying growth patterns. Placing a synthetic mesh in growing patients is a concern, particularly in relation to chronic pain. Traditionally, the hernia literature has defined adults as individuals aged 18 years and above. Considering that growth can continue until age 19, this review proposes a revised definition of adolescence for patients with groin hernias encompassing ages 10 to 19. Symptomatic groin hernias in adolescents should be repaired with an open non-mesh technique because of acceptable recurrence rates and the desire to avoid introducing synthetic foreign materials into young patients with ongoing growth potential. Watchful waiting is suggested for asymptomatic groin hernias, postponing repair until the adolescent has become a fully grown adult and symptoms from the hernia develop. Most groin hernias in adolescents are lateral hernias, but before pursuing a watchful waiting strategy in females, an ultrasound or magnetic resonance imaging scan is suggested to rule out the presence of a femoral hernia that may need repair.

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

OBJECTIVE

Inguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.

METHODS

The data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People's Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.

RESULTS

A total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13-18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .

CONCLUSION

Laparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Efficacy of Laparoscopic Iliopubic Tract Repair Plus Transabdominal Preperitoneal Hernioplasty for Treating Inguinal Hernia After Robot-assisted Radical Prostatectomy

BACKGROUND

Robot-assisted radical prostatectomy (RARP) is a risk factor for inguinal hernia (IH). Furthermore, in patients who have undergone RARP, the fibrotic scar tissue in the RARP area limits preperitoneal dissection. This study aimed to evaluate the efficacy of performing laparoscopic iliopubic tract repair (IPTR) in addition to transabdominal preperitoneal hernioplasty (TAPPH) to treat IH after RARP.

PATIENTS AND METHODS

A total of 80 patients with an IH after RARP were treated with TAPPH from January 2013 to October 2020 and were included in this retrospective study. Patients who underwent conventional TAPPH were categorized as the TAPPH group (25 patients with 29 hernias), whereas those who underwent TAPPH with IPTR were categorized as the TAPPH + IPTR group (55 patients with 63 hernias). The IPTR comprised suture fixation of the transversus abdominis aponeurotic arch to the iliopubic tract.

RESULTS

All patients had indirect IH. The incidence of intraoperative complications was significantly higher in the TAPPH group than in the TAPPH + IPTR group [13.8% (4/29) vs 0.0% (0/63), P = 0.011]. The average operative time was also significantly shorter in the TAPPH + IPTR group than in the TAPPH group ( P < 0.001). There were no differences between the two groups in the duration of hospitalization, recurrence rate, and pain severity.

CONCLUSIONS

The addition of laparoscopic IPTR to TAPPH for treating IH after RARP is safe and is associated with a minimal risk of intraoperative complications and a short operative time.

Low incidence of recurrence and chronic pain after groin hernia repair in adolescents: a systematic review and meta-analysis

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.

Adolescent inguinal hernia repair: a review of the literature and recommendations for selective management

BACKGROUND

The choice of how to repair inguinal hernias in adolescents has historically been a matter of experience and differed between pediatric surgeons who traditionally performed a high ligation of the sac and general surgeons who typically perform a repair using mesh. This up-to-date review thoroughly examines the subject and discusses the suitability of both types of repairs in this unique age group.

METHODS

A 20-year Pub Med search was performed for the following terms: adolescent hernia repair including reports of mesh hernia repair in adolescents and postoperative complications including chronic inguinal pain and recurrences.

RESULTS

The evidence in the literature suggests that while there appears to be no difference between the two types of repairs with regards to recurrence and complications, changes in the pelvic floor physiology in adolescents suggest that a selective, individualized approach can be recommended depending on the size and nature of the presenting pathology.

CONCLUSIONS

A selective approach to the inguinal hernia in adolescent patients based on the size of the defect appears justified.

Laparoscopic hydrocelectomy with transabdominal preperitoneal hernioplasty or iliopubic tract repair for treatment of encysted spermatic cord hydrocele

BACKGROUND

An encysted spermatic cord hydrocele (ESCH) causes an inguinal swelling resembling an inguinal hernia (IH). An ESCH should be considered as a differential diagnosis of IH. Although laparoscopic operations have been performed to treat ESCHs in pediatric patients, such operations have not been reported in adults. This study was performed to evaluate the outcomes of laparoscopic hydrocelectomy for treatment of ESCHs in adults.

METHODS

The medical charts of 49 patients who underwent laparoscopic transabdominal hydrocelectomy for ESCHs from January 2015 to December 2020 at a single institution were retrospectively reviewed. The patients were divided into those with and without an IH. Laparoscopic hydrocelectomy was performed, and the internal inguinal ring was closed with iliopubic tract repair (IPTR) or transabdominal preperitoneal (TAPP) hernioplasty depending on the presence of an IH. The patients' age, ESCH location, postoperative complications, recurrence, and operating time were examined.

RESULTS

The patients' mean age was 46.7 (20-77) years. All patients underwent laparoscopic hydrocelectomy without open conversion. ESCHs were more common on the right side (35/49, 71.4%) than on the left (14/49, 28.6%). The presenting symptom in all patients was inguinal swelling. The ESCH was located inside the inguinal canal in 47 patients and protruded to the abdominal cavity from the inguinal canal in 2 patients. After laparoscopic hydrocelectomy, 32 patients without an IH underwent IPTR and 17 patients with an IH underwent TAPP hernioplasty. The mean operating time was shorter in the IPTR than TAPP hernioplasty group. The postoperative complications and hospital stay were not different between the two groups. There were no recurrences in either group.

CONCLUSIONS

Laparoscopic hydrocelectomy with IPTR or TAPP hernioplasty is safe and feasible for treatment of ESCHs in adults.

Laparoscopic iliopubic tract repair to treat recurrent pediatric inguinal hernia

BACKGROUND

Congenital defects, such as open processus vaginalis and the canal of Nuck, are common causes of primary pediatric inguinal hernia (PIH). However, in some patients, PIH occurs via acquired defects rather than congenital defects. The most representative cause of PIH is recurrent hernia. Recurrent PIH is treated with high ligation (HL), which is the same method that is used to treat primary PIH. However, the re-recurrence rate of recurrent PIH is high. This study aimed to compare laparoscopic iliopubic tract repair (IPTR) with laparoscopic HL for the treatment of recurrent PIH after primary PIH repair.

METHODS

From June 2013 to March 2019, 126 patients (< 10 years old) with recurrent PIH were retrospectively enrolled. Patients were divided into two groups according to the operative technique: laparoscopic HL (58 patients) and laparoscopic IPTR (68 patients). With HL, the hernial sac was removed and the peritoneum closed. With IPTR, iliopubic tract and transversalis fascia sutures were applied.

RESULTS

There were no cases of conversion to open surgery. Re-recurrence only occurred in the HL group; no patients in the IPTR group developed re-recurrence (8.6% [5/58] vs. 0.0% [0/68], respectively; p = 0.044). The mean duration from re-operation to re-recurrence in these five patients was 10.6 months. Other surgical outcomes and complications did not differ between the two groups.

CONCLUSIONS

Laparoscopic IPTR is an effective surgical treatment for reducing re-recurrence of recurrent PIH.

Comparison of laparoscopic transabdominal preperitoneal hernioplasty and laparoscopic iliopubic tract repair for Nyhus type II hernia in women

BACKGROUND

Indirect inguinal hernia with a dilated internal ring but an intact posterior inguinal wall is classified as Nyhus type II. Females have a higher incidence of indirect hernia than direct hernia. The purpose of this study was to evaluate the efficacy of laparoscopic iliopubic tract repair (IPTR) compared with laparoscopic transabdominal preperitoneal (TAPP) hernioplasty in treating women with Nyhus type II hernia.

METHODS

This retrospective study included 318 women aged ≥ 20 years who were treated for Nyhus type II hernia from January 2013 to December 2018. The patients were categorized into two groups in accordance with the operative technique: the TAPP group (33 patients) and the IPTR group (285 patients). In the IPTR group, intraabdominal suturing of the iliopubic tract and transversalis fascia arch was performed without mesh implantation.

RESULTS

The mean operation time was shorter in the IPTR group (17.2 ± 3.9 min) than the TAPP group (20.5 ± 8.1 min, p = 0.028). The postoperative complication rate was higher in the TAPP group than the IPTR group [6.1% (2/33) vs. 0.4% (1/285), respectively; p = 0.001]. Inguinodynia occurred in one patient in the TAPP group and no patients in the IPTR group. The hospital stay did not significantly differ between the two groups. The numeral rating scale pain scores at 1 day and 1 week postoperatively did not significantly differ between the two groups. There was no recurrence in either group.

CONCLUSIONS

Laparoscopic IPTR was safe and feasible for treating Nyhus type II hernia in women.

Recurrence after laparoscopic high ligation in adolescents: A multicenter international retrospective study of ten hospitals

PURPOSE

Inguinal hernia repairs are among the most common operations performed by pediatric surgeons. Laparoscopic high ligation is a popular technique, but its recurrence rate in adolescents is unknown. We hypothesized that recurrence after laparoscopic high ligation in adolescents would be similar to open repair (1.8%-6.3%).

METHODS

We evaluated adolescent patients (12-18 years old at the time of surgery) who underwent laparoscopic high ligation across eleven hospitals. At least six months postoperatively, they were contacted by telephone for follow-up. Variables analyzed included demographics, operative details, recurrence, and other complications.

RESULTS

A total of 144 patients were enrolled. One hospital (n=9) had a recurrence rate of 44.4%, compared to 3.0% (4/135) for the other hospitals. By accounting for 50.0% of recurrences, it represented a statistical outlier and was excluded, leaving 135 patients for analysis. The median age was 14 years, and 63.7% were male. Recurrence with the excluded center was 5.6% (8/144). Use of absorbable suture (OR 42.67, CI 4.41-412.90, p<0.01) and braided suture (OR 12.10, CI 1.54-95.25, p=0.02) was weakly associated with recurrence. Recurrence was not significantly different from published results.

CONCLUSION

Laparoscopic high ligation of adolescent inguinal hernias has a recurrence rate similar to open repair when performed by experienced surgeons.

TYPE OF STUDY

Prognosis study (retrospective study) LEVEL OF EVIDENCE: Level II.