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Nanayakkara KDL, Viswanath NG, Wilson M, Mahawar K, Baig S, Rosenberg J, Rosen M, Sheen AJ, Goodman E, Prabhu A, Madhok B. An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study. Hernia 2023; 27:1235-1243. [PMID: 37310493 DOI: 10.1007/s10029-023-02818-8] [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: 12/11/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. METHODS A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). RESULTS A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. CONCLUSION This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.
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Affiliation(s)
- K D L Nanayakkara
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK.
| | - N G Viswanath
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
| | - M Wilson
- Forth Valley NHS Trust, Larbert, UK
| | - K Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - S Baig
- Belle Vue Hospital, Kolkata, India
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Rosen
- Cleveland Clinic, Cleveland, USA
| | - A J Sheen
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - A Prabhu
- Cleveland Clinic, Cleveland, USA
| | - B Madhok
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
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Lim WSR, Yew AKS, Lie H, Chou SM, Lie DTT. Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study. World J Orthop 2023; 14:319-327. [PMID: 37304195 PMCID: PMC10251272 DOI: 10.5312/wjo.v14.i5.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair. We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs. We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.
AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.
METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear. We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair. In seven specimens, the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens. Five specimens with an intact tendon were tested. The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.
RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group, and 4.16 mm in the mattress group (P = 0.001). The mean ultimate failure load was significantly higher at 549.2 N in the continuous group, 426.4 N in the mattress group and 370 N in the intact group (P = 0.003).
CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
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Affiliation(s)
- Winston Shang Rong Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Hannah Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Siaw Meng Chou
- College of Engineering, Nanyang Technical University, Singapore 797101, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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Malazgirt Z, Yildirim K, Karabicak I, Gursel MF, Acikgoz A, Ozturk H. Retrospective analysis of open preperitoneal mesh repair of complex inguinal hernias. Hernia 2022; 26:1121-1130. [PMID: 35380305 DOI: 10.1007/s10029-022-02595-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: 09/10/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The open posterior approach in the form of either a Stoppa or Wantz operation may be a good alternative technique particularly in the repair of complex inguinal hernias. The term "complex inguinal hernia" designates hernias with a combination of arduous features including large hernia defects, large to giant hernia sacs, multiple recurrences, and bilaterality. In this retrospective analysis, we investigated our results of open posterior repair in view of its feasibility in patients with complex inguinoscrotal hernias. METHODS From a series of 845 inguinal hernia patients, we retrospectively reviewed the records of 60 patients with complex inguinal hernias whom were directed to open preperitoneal repair by either a Stoppa or Wantz procedure. RESULTS More than 80% of cases were males with large to giant inguinoscrotal hernias. One half of patients had bilateral hernias, and one fourth had recurrent hernias. Early postoperative complications occurred in almost half of patients; however, most of them were minor. The most important early complication in this series was the full recurrences we encountered in the very next morning in two patients. Eighty-three percent of patients left hospital in the first 2 days averaging 1.8 days of hospital stay. The mesh:defect area ratio is < 7 in recurrent hernias while it is > 9 in nonrecurrent cases. CONCLUSION The open posterior approach to complex inguinal hernias facilitated both handling and repair of difficult hernias. It was very well tolerated by the patients, and yielded favorable postoperative results. We think the open posterior repair may be a method of choice in the repair of complex inguinal hernias.
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Affiliation(s)
- Z Malazgirt
- Department of General Surgery, VM Medical Park Samsun Hospital, Alparslan Bulvarı 17, Atakum, 55200, Samsun, Turkey.
| | - K Yildirim
- Department of General Surgery, VM Medical Park Samsun Hospital, Alparslan Bulvarı 17, Atakum, 55200, Samsun, Turkey
| | - I Karabicak
- Department of General Surgery, VM Medical Park Samsun Hospital, Alparslan Bulvarı 17, Atakum, 55200, Samsun, Turkey
| | - M F Gursel
- Department of General Surgery, VM Medical Park Samsun Hospital, Alparslan Bulvarı 17, Atakum, 55200, Samsun, Turkey
| | - A Acikgoz
- Department of Urology, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - H Ozturk
- Department of Urology, VM Medical Park Samsun Hospital, Samsun, Turkey
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Novik B, Sandblom G, Ansorge C, Thorell A. Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs. J Am Coll Surg 2022; 234:311-325. [PMID: 35213495 PMCID: PMC8834140 DOI: 10.1097/xcs.0000000000000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND International guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair. STUDY DESIGN All TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs. RESULTS Of 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6). CONCLUSIONS With StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.
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Affiliation(s)
- Bengt Novik
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
- the Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden (Novik)
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Gabriel Sandblom
- the Department of Clinical Science and Education, South Hospital (Sandblom), Karolinska Institutet, Stockholm, Sweden
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Christoph Ansorge
- the Department of Clinical Science, Interventions and Technology (Ansorge), Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
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Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials. Ann Surg 2021; 274:954-961. [PMID: 33427757 DOI: 10.1097/sla.0000000000004735] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS Systematic review and network meta-analyses of Randomized Controlled Trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk Ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% Credible Intervals (CrI) were used to assess relative inference. RESULTS Thirty-five RCTs (7,777 patients) were included. Overall, 3,496 (44.9%) underwent Lichtenstein, 1,269 (16.3%) TAPP, and 3,012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12-hour, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs. Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs. Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs. Lichtenstein (WMD = -3.3; 95% CrI -4.9; -1.8) and TEP vs. Lichtenstein (WMD = -3.6; 95% CrI -4.9; -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches while no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
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A preliminary evaluation of two different meshes in minimally invasive inguinal hernia surgery. Surg Endosc 2020; 35:1342-1347. [PMID: 32232645 DOI: 10.1007/s00464-020-07512-9] [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: 11/12/2019] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many meshes are available for use in laparoscopic inguinal hernia repair. The surgeon must consider several factors when choosing a mesh for hernia repair including clinical outcomes, cost, and ease of use. The purpose of this study was to compare two different lightweight polypropylene meshes for laparoscopic and robotic inguinal hernia repairs. METHODS Subjects were randomized immediately before surgery. Data were reported in N (%) and median [Q1-Q3], comparisons of mesh insertion time were tested using a 2 × 2 ANOVA on the ranked times, comparisons between categorical variables were tested with Fisher's Exact, and all data were analyzed using SAS® 9.4 (SAS Institute, Inc.). RESULTS Between January 2015 and June 2016, 50 subjects were enrolled; two were excluded. Of 48 eligible subjects, most were Caucasian (N = 42, 88%), male (N = 37, 77%), with a median age of 63, and were randomized evenly between 3DMax™ mesh and Ultrapro® mesh. Robotic mesh placement significantly increased insertion time regardless of mesh type (p < .0001). When comparing NASA-TLX self-assessment surveys, there was no significant difference between the meshes in difficulty of placement. The type of mesh did not significantly impact the insertion time regardless of robot use (p = 0.523). CONCLUSION Our data demonstrate that mesh insertion times comparing two different lightweight polypropylene meshes were not significantly different. Increased insertion times associated with robotic repair are likely due to the mechanics of robotic suturing and associated learning curve. Our data suggest that these meshes can be used interchangeably based on the surgeon's preference. CLINICAL TRIAL REGISTRATION NUMBER NCT01825187.
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