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da Silveira CAB, Dias Rasador AC, Lima DL, Kasakewitch JPG, Nogueira R, Sreeramoju P, Malcher F. Transinguinal preperitoneal (TIPP) versus minimally invasive inguinal hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03091-z. [PMID: 38888838 DOI: 10.1007/s10029-024-03091-z] [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: 04/10/2024] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for groin hernia repair. SOURCE Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of TAPP and TEP techniques separately. Statistical analysis was performed with R Studio. PRINCIPAL FINDINGS 81 studies were screened and 19 were thoroughly reviewed. Six studies were included, of which two compared TIPP with TEP technique, two compared TIPP with TAPP, and two compared TIPP with both TEP and TAPP techniques. We found lower recurrence rates for the TEP technique compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). Also, we found lower seroma rates for TIPP group on the overall analysis (RR 0.21; P = 0.002). We did not find statistically significant differences regarding overall recurrence (RR 1.6; P = 0.19), chronic pain (RR 1.53; P = 0.2), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.29; P = 0.76) between MIS and TIPP. No statistically significant differences were found in the subgroup analysis of TAPP technique for all the outcomes. CONCLUSION Our systematic review and meta-analysis found no differences between TIPP and MIS approaches in the overall analysis of recurrence, SSI, and chronic pain rates. Further research is needed to analyze individual techniques and draw a more precise conclusion on this subject. PROSPERO REGISTRATION ID CRD42024530107, April 8, 2024.
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Affiliation(s)
| | | | | | - João P G Kasakewitch
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raquel Nogueira
- Department of Surgery, Montefiore Medical Center, The Bronx, NY, USA
| | | | - Flavio Malcher
- Division of General Surgery, NYU Langone, New York, NY, USA
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Silveira CAB, Poli de Figueiredo SM, Dias YJM, Martin RRH, Rasador ACD, Fernandez MG, Lu R. Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis. Hernia 2023; 27:1375-1385. [PMID: 37715825 DOI: 10.1007/s10029-023-02882-0] [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: 07/14/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE We aimed to perform a systematic review and meta-analysis comparing postoperative outcomes in inguinal hernia repair with TIPP versus Lichtenstein technique. METHODS Cochrane Central, Scopus, and PubMed were systematically searched for studies comparing TIPP and Lichtenstein´s technique for inguinal hernia repair. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, the Visual Analogue Pain Score, chronic pain, paresthesia rates, and recurrence. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if I2 > 25%. RESULTS 790 studies were screened and 44 were thoroughly reviewed. A total of nine studies, comprising 8428 patients were included, of whom 4185 (49.7%) received TIPP and 4243 (50.3%) received Lichtenstein. We found that TIPP presented less chronic pain (OR 0.43; 95% CI 0.20-0.93 P = 0.03; I2 = 84%) and paresthesia rates (OR 0.27; 95% CI 0.07-0.99; P = 0.05; I2 = 63%) than Lichtenstein group. In addition, TIPP was associated with a lower VAS pain score at 14 postoperative day (MD - 0.93; 95% CI - 1.48 to - 0.39; P = 0.0007; I2 = 99%). The data showed a lower operative time with the TIPP technique (MD - 7.18; 95% CI - 12.50, - 1.87; P = 0.008; I2 = 94%). We found no statistical difference between groups regarding the other outcomes analyzed. CONCLUSION TIPP may be a valuable technique for inguinal hernias. It was associated with lower chronic pain, and paresthesia when compared to Lichtenstein technique. Further long-term randomized studies are necessary to confirm our findings. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42023434909).
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Affiliation(s)
- C A B Silveira
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
| | | | - Y J M Dias
- Washington University in St. Louis, St. Louis, MO, USA
| | - R R H Martin
- Endocrine Surgery Department, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A C D Rasador
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - M G Fernandez
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - R Lu
- University of Texas Medical Branch, Galveston, TX, USA
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Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, Köckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023; 7:zrad080. [PMID: 37862616 PMCID: PMC10588975 DOI: 10.1093/bjsopen/zrad080] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.
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Affiliation(s)
| | - Nadine van Veenendaal
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eske Aasvang
- Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ferdinando Agresta
- Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Ine Burgmans
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Chen
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Barbora East
- Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic
| | | | - Nadia Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Ferdinand Köckerling
- Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Jan Kukleta
- Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland
| | - Maarten Loos
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Manuel Lopez-Cano
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ralph Lorenz
- Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - Marc Miserez
- Department of Surgery, KU Leuven–University Hospital Leuven, Leuven, Belgium
| | | | | | - Chris Oppong
- Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK
| | - Maciej Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Mauro Podda
- Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Wolfgang Reinpold
- Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany
| | - David Sanders
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Alberto Sartori
- Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy
| | - Hanh Minh Tran
- Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia
| | - Mireia Verdaguer
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Reiko Wiessner
- Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany
| | - Michael Yeboah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa
| | - Willem Zwaans
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Maarten Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
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