Results at 3-year follow-up of totally extraperitoneal (TEP) hernia surgery with long-term resorbable mesh

Establishing Peer Consensus About the Use of Long-Term Biosynthetic Absorbable Mesh for Hernia (Grades 2-3) as the Standard of Care

BACKGROUND

Standard synthetic and biologic meshes, often used in hernia repair, have commonly been used and each have their strengths but associated drawbacks. Long-term biosynthetic absorbable (LTBA) mesh has been developed to combine the strengths of synthetic and biologic meshes without the associated weaknesses. As a newer type of mesh, the supporting evidence base is still growing, and their optimum use has yet to be defined. This consensus was initiated to provide insight into those situations where a LTBA might be considered the Standard of Care in ventral hernia repair grades 2-3 (original classification, 2010) of the Ventral Hernia Working Group.

METHODS

A steering group of expert surgeons identified 35 statements, based around the evidence supporting LTBA, surgical technique, patients type most suitable for LTBA, risk-benefit of LTBA, patient and surgeon considerations, LTBA value. Surgeons involved in hernia repair received an online survey to assess consensus with these statements. Consensus was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed. Statements that had not achieved consensus agreement were revised and these were then issued for a subsequent round. Finally, 34 statements were included.

RESULTS

Two hundred fifty-five surgeons were involved. Fourteen statements (41%) achieved very high consensus, 24 achieved consensuses (≥ 70-< 90%), whilst one (3%) just failed to achieve consensus with an agreement score of 69%.

CONCLUSIONS

Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the Standard of Care was achieved. Based on the consensus scores, the steering group derived eleven keys.

Efficacy of Laparoscopic Totally Extraperitoneal Repair for Inguinal Hernia

Objective

To assess the treatment efficacy of laparoscopic totally extraperitoneal repair for inguinal hernia.

Methods

Between November 2018 and May 2020, 130 patients with inguinal hernias diagnosed and treated in our hospital were randomly recruited and assigned to receive either tension-free hernia repair (control group) or laparoscopic totally extraperitoneal repair (study group) at the random method. All patients received routine care including external traditional Chinese medicine (TCM) application. Outcome measures included surgical indices, numeric rating scale (NRS) scores, infections, and postoperative complications.

Results

Laparoscopic surgery is associated with a shorter operation duration, time-lapse before postoperative off-bed activity, and hospital stay, as well as less intraoperative hemorrhage volume compared to tension-free hernia repair in the control group. Patients in the study group had considerably lower NRS ratings after therapy than those in the control group. (P < 0.05). After treatment, the levels of blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in the study group were lower than those in the control group (P < 0.05). In the control group, there were 0 cases of hematoma, 3 cases of subcutaneous effusion, 4 cases of urinary retention, 5 cases of scrotal effusion, and 1 case of bladder injury. In the study group, there were 0 cases of hematoma, 1 case of subcutaneous fluid, 1 case of urinary retention, 0 cases of scrotal fluid, and 0 cases of bladder injury. Laparoscopic surgery resulted in a lower incidence of postoperative complications versus traditional surgery (P <0.05).

Conclusion

Laparoscopic totally extraperitoneal repair for inguinal hernia improves the intraoperative indices, mitigates postoperative pain, and reduces the risks of infections and complications, with the advantages of short operation duration, less hemorrhage volume, and shorter hospital stay. It shows great potential for clinical promotion.