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Lillo-Albert G, Villa EB, Boscà-Robledo A, Carreño-Sáenz O, Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis. Hernia 2024; 28:1427-1439. [PMID: 38837072 DOI: 10.1007/s10029-024-03077-x] [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: 03/22/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia. METHODS Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI). RESULTS Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92). CONCLUSIONS This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
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Affiliation(s)
| | - Elvira Buch Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
| | - Andrea Boscà-Robledo
- Department of HPB Surgery and Transplantation, La Fe University Hospital, University of Valencia, Valencia, Spain
| | - Omar Carreño-Sáenz
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - José Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jesús Martínez-Hoed
- Unit of Abdominal Wall Surgery. R. A. Calderón Guardia Hospital, San José, Costa Rica
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
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Guidi Lyra V, Brandão Dos Santos S, Bevilacqua Trigo Rocha C, Guimarães FAG, Riva WJ. Comparison of postoperative chronic inguinal pain between the lichtenstein and laparoscopic techniques in the treatment of inguinal hernia: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03099-5. [PMID: 39031236 DOI: 10.1007/s10029-024-03099-5] [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: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Currently, inguinal hernias are highly prevalent in the Brazilian population, accounting for 75% of all abdominal wall hernias. The recommended treatment to correct them is inguinal herniorrhaphy, which can be performed through open surgery, mainly using the Lichtenstein technique, or laparoscopically, primarily through Transabdominal Preperitoneal Repair (TAPP) or Total Extraperitoneal Repair (TEP) approaches. Like any surgery, these procedures have post-operative complications, with pain being the most common and debilitating. Currently, in European and Brazilian guidelines, the open Lichtenstein and endoscopic inguinal hernia techniques are recommended as best evidence-based options for repair of a primary unilateral hernia providing the surgeon is sufficiently experienced in the specific procedure. In that matter, the surgeon should make a choice based on assessment of the benefits and risks of performing each of them, and practice shared making decision with it patient. Therefore, the objective of this review was to assess the incidence of chronic postoperative pain by comparing the aforementioned surgical approaches to evaluate which procedure causes less disability to the patient. METHODS The search conducted until May 2024 was performed on Medline (PubMed), Cochrane (CENTRAL), and Lilacs databases. The selection was limited to randomized clinical trials, nonrandomized clinical trials and cohort studies comparing TAPP or TEP to LC, evaluating the incidence of chronic postoperative pain published between 2017 and 2023. Evidence certainty was assessed using the GRADE Pro tool, and bias risk was evaluated with the RoB 2.0 tool and ROBINS I tool. Thirteen studies were included. RESULTS: The meta-analysis showed a significant difference between the groups in both techniques, favoring the laparoscopic approach, which had a lower occurrence of postoperative inguinodynia with a relative risk of 0.49 (95% CI = 0.32, 0.75; I2 = 66% (P = 0.001); Z = 3.28 (P = 0.001) with low certainty of evidence. CONCLUSION The presence of chronic postoperative pain was lower in laparoscopic TEP/TAPP techniques when compared to the open Lichtenstein technique, meaning that the former can bring more benefits to patients who requires inguinal herniorrhaphy. Nevertheless, further randomized clinical trials are needed to optimize the analysis, minimizing the bias.
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Affiliation(s)
- Valentina Guidi Lyra
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil.
| | - Sofia Brandão Dos Santos
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Carolina Bevilacqua Trigo Rocha
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Fernando Augusto Garcia Guimarães
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
| | - Wagner José Riva
- Faculdade de Ciências Médicas de Santos, Department of General Surgery, Centro Universitário Lusíada, St. Oswaldo Cruz, 179-Boqueirão, Santos, São Paulo, Brazil
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Baig A, Lakhani M, Usmani SUR. Laparoscopic Transabdominal Pre-peritoneal Repair of a Bilateral Inguinal Hernia in a Pediatric Female Patient in Pakistan: A Case Report. Cureus 2024; 16:e54186. [PMID: 38496120 PMCID: PMC10941969 DOI: 10.7759/cureus.54186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Inguinal hernias, although a common occurrence, pose a significant threat to the surgical community on account of their complexity and socioeconomic consequences. Bilateral inguinal hernias, which are a rare subtype of inguinal hernias, in particular, are problematic since there are no existing definitive international guidelines for their repair. It is estimated that between 8% and 30% of inguinal hernia patients have bilateral hernias, but there is still no clarity as to whether a bilateral hernia represents a special type of inguinal hernia or two different hernias in one patient. The transabdominal pre-peritoneal repair (TAPP), totally extra-peritoneal repair (TEP), and Lichtenstein repair techniques are commonly employed depending on the resources and surgical expertise available, but there is a need to conduct large-scale, prospective, randomized-controlled trials to guide the formation of evidence-based guidelines that could be followed globally. Herein, we present the first known case of a bilateral inguinal hernia in a female pediatric patient repaired by the laparoscopic TAPP technique from Pakistan.
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Affiliation(s)
- Arsalan Baig
- General Surgery, Dr. Ruth Pfau Hospital, Karachi, PAK
| | - Murk Lakhani
- Surgery, Dow University of Health Sciences, Karachi, PAK
- Surgery, Civil Hospital Karachi, Karachi, PAK
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [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: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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Hakeem A, Saqib SU, Zafar H. Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair. Cureus 2023; 15:e39202. [PMID: 37378228 PMCID: PMC10292120 DOI: 10.7759/cureus.39202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657. One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.
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Affiliation(s)
- Abdul Hakeem
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Hasnain Zafar
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
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Hidalgo NJ, Guillaumes S, Bachero I, Holguín V, Momblán D. Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study. Surg Endosc 2023:10.1007/s00464-023-09967-y. [PMID: 36914783 DOI: 10.1007/s00464-023-09967-y] [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: 10/06/2022] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND International guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain. METHODS We performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis. RESULTS A total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p < 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p = 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient's region of residence (OR 2.04, 95% CI 1.88-2.21). Other factors were age < 65 years (OR 1.65, 95% CI 1.52-1.79) and recurrent inguinal hernia (OR 1.31, 95% CI 1.15-1.49). The type of approach for BIHR was not independently associated with perioperative complications. CONCLUSIONS Despite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient's region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Victor Holguín
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Towards automatic verification of the critical view of the myopectineal orifice with artificial intelligence. Surg Endosc 2023:10.1007/s00464-023-09934-7. [PMID: 36828887 DOI: 10.1007/s00464-023-09934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos. METHODS Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data. RESULTS Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%. CONCLUSION This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity.
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Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [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: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Doudakmanis C, Kolla C, Bouliaris K, Efthimiou M, Koukoulis GD. Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique? World J Methodol 2022; 12:193-199. [PMID: 36159094 PMCID: PMC9350731 DOI: 10.5662/wjm.v12.i4.193] [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: 01/29/2022] [Revised: 04/03/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
Inguinal hernias are amongst the most common conditions requiring general surgical intervention. For decades, the preferred approach was the open repair. As laparoscopy became more popular and available and more surgeons became familiarized with this modality, laparoscopic inguinal hernia repair became an alternative. The aim of this study is to assess the effectiveness of laparoscopic inguinal repair, with a focus on bilateral inguinal hernias. Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias. However, there are only a few studies concerning laparoscopic repair of bilateral hernias. It is yet to be proven that laparoscopy is the “gold standard” in the treatment of bilateral inguinal hernias. So far, the choice of an inguinal hernia repair technique has been up to each surgeon, depending on their expertise and available resources after taking into consideration each patient’s needs.
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Affiliation(s)
- Christos Doudakmanis
- Department of General Surgery, General Hospital of Larissa, Larissa 41221, Greece
| | - Christina Kolla
- Department of General Surgery, General Hospital of Larissa, Larissa 41221, Greece
| | | | - Matthaios Efthimiou
- Department of General Surgery, General Hospital of Larissa, Larissa 41221, Greece
| | - Georgios D Koukoulis
- Department of General Surgery, General Hospital of Larissa, Larissa 41221, Greece
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Takeuchi M, Collins T, Ndagijimana A, Kawakubo H, Kitagawa Y, Marescaux J, Mutter D, Perretta S, Hostettler A, Dallemagne B. Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence. Hernia 2022; 26:1669-1678. [PMID: 35536371 DOI: 10.1007/s10029-022-02621-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration. METHODS This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated. RESULTS A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees. CONCLUSION An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.
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Affiliation(s)
- M Takeuchi
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - T Collins
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - A Ndagijimana
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - H Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - J Marescaux
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - D Mutter
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
| | - S Perretta
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
| | - A Hostettler
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) Africa, Kigali, Rwanda
| | - B Dallemagne
- IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital, Strasbourg, France
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11
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Shankar H, Sureshkumar S, Gurushankari B, Samanna Sreenath G, Kate V. Factors predicting prolonged hospitalization after abdominal wall hernia repair - a prospective observational study. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: The aim of this study was to identify the factors predicting prolonged hospitalization following abdominal wall hernia repair.
Material and Methods: This was a prospective observational study which included patients operated for elective and emergency abdominal wall hernias. Details of the patients including demographic profile, hernia characteristics, and perioperative factors were collected. Patients were followed up till discharge from the hospital to record the postoperative local and systemic complications. Patients who stayed for more than three days were considered as longer hospital stay. Analysis was performed to identify factors associated with the longer hospital stay.
Results: A total of 200 consecutive patients of abdominal wall hernia were included over a period of two years. Female sex (p< 0.05), obesity (p= 0.022), and smoking and alcohol consumption (0.002) led to a prolonged hospital stay. Patients with incisional hernias (p< 0.05), American Society of Anesthesiologists (ASA) class of two or more (p= 0.002), complicated hernia (p= 0.007), emergency surgeries (p= 0.002), general anesthesia (p= 0.001), longer duration of surgery (>60 minutes, p< 0.05), usage of drain (p< 0.05), and surgical site infection (SSI, p= 0.001) were significantly associated with increased length of hospital stay. Whereas, age distribution, socio-economic status, co-morbidities, recurrent surgery, type of hernia repair and the level of surgeon did not affect the length of hospital stay.
Conclusion: The risk factors associated with prolonged hospital stay in patients undergoing abdominal wall hernia repair were female sex, obesity, smoking and alcoholism, incisional hernia, complicated hernias, higher ASA class, and prolonged duration of surgeries.
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Caruso R, Vicente E, Quijano Y, D'Ovidio A, Ielpo B, Ferri V. Review with video of a laparoscopic transabdominal preperitoneal (TAPP) repair for giant inguinoscrotal hernia. Int J Surg Case Rep 2020; 76:549-551. [PMID: 33207429 PMCID: PMC7607209 DOI: 10.1016/j.ijscr.2020.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Giant inguinoscrotal (GIS) hernias are rarely encountered in clinical settings and are often associated with mental neglect for many years. This type of hernia is defined as "giant" if it descends below the mid-point of the inner thigh of a patient in an upright position. The laparoscopic repair approach of a GIS hernia is technically challenging. It has been claimed that laparoscopic surgery has several advantages over the open surgical approach, with less pain and an earlier recovery. The aim of this video is to evaluate the efficacy of TAPP (laparoscopic transabdominal preperitoneal) in order to treat a GIS hernia. CASE PRESENTATION A 65-year-old male without a relevant past medical history was admitted to the emergency service with abdominal pain, belching and nausea. He denied any other symptoms, and no previous surgical operations were recorded. Physical examination showed a large mass in the left scrotum below the mid-point of the inner thigh of the patient in an upright position. A CT scan confirmed the diagnosis of a GIS. A laparoscopic TAPP procedure was decided upon as the best course of treatment. RESULTS The patient underwent a successful repair procedure. The operation time was 150 min. No intraoperative blood transfusion was necessary. The patient's diet was resumed on the first day post surgery, and the postoperative hospital stay was three days. CONCLUSIONS Laparoscopic TAPP repair is a safe and feasible method for surgically managing GIS hernias.
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Affiliation(s)
- Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Angelo D'Ovidio
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Benedetto Ielpo
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
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Coratti F, Trafeli M, Barbato G, Maggioni C, Manetti A, Cianchi F. The Gauze technique: a simple method of dissection in laparoscopic inguinal hernia repair. MINERVA CHIR 2020; 75:426-429. [PMID: 32456400 DOI: 10.23736/s0026-4733.20.08335-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hernia repair is one of the most frequent operation in general surgery. The aim of this is study is to present a new preperitoneal atraumatic dissection of peritoneal flap during laparoscopic transabdominal preperitoneal inguinal hernia repair. METHODS From January 2019 to December 2019, 30 patients (19 male, 11 female) attended TAPP inguinal hernia repairs. The inclusion's criteria were: patients from 32 to 88 years; male and woman; bilateral inguinal hernia. RESULTS The median age of patients was 46,46 (32-88). The median time of operation was 63,8 (45-100) minutes. All procedures were performed without complications and convertions. CONCLUSIONS Based on our experience the soft technique is a safe and feasible way to create a preperitoneal flap. Operating time is drastically reduced and the learning curve is reduced even for less experienced surgeons.
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Affiliation(s)
- Francesco Coratti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy -
| | - Martina Trafeli
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Giuseppe Barbato
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Andrea Manetti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
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A 19 year population-based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs. Hernia 2019; 24:793-800. [PMID: 31786699 PMCID: PMC7395908 DOI: 10.1007/s10029-019-02073-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/19/2019] [Indexed: 11/17/2022]
Abstract
Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61–2.08, p < 0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007–1.013, p < 0.001), being more affluent (HR 1.18, 95% CI 1.01–1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22–2.88, p < 0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.
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Quispe MRF, Salgado Júnior W. Transabdominal preperitoneal (TAPP) versus open Lichtenstein hernia repair. Comparison of the systemic inflammatory response and the postoperative pain1. Acta Cir Bras 2019; 34:e201900206. [PMID: 30843939 PMCID: PMC6585912 DOI: 10.1590/s0102-8650201900206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare open Lichtenstein repair and laparoscopic transabdominal
preperitoneal (TAPP) repair to treat primary unilateral hernia, regarding
systemic inflammatory response, postoperative pain, and complications. Methods A non-randomized prospective cohort study, with the preoperative and
postoperative (24 hours) collection of blood samples for C reactive protein
(CRP), interleukin 6 (IL-6), leukocyte and neutrophil analysis. Visual
Analog Scale (VAS) was used to quantify the level of pain, and the operative
time was correlated with the inflammatory response. VAS and CRP were also
obtained on the 8th postoperative day. Results Groups were homogeneous regarding preoperative characteristics. There were no
differences between groups in 24h values of CRP, IL-6, leukocytes,
neutrophils or VAS. Similarly, CRP and VAS did not differ between groups on
the 8th postoperative day. However, the operative time for laparoscopic
hernia repair was longer than the time for the open procedure. There was a
weak correlation (r coefficient 0.31) between the duration of the surgical
procedure and the VAS score at the eighth day. Conclusions There were no statistically significant differences in the inflammatory
response, pain scores, or complications between groups. We conclude that
there is no advantage performing a primary unilateral hernia repair by
laparoscopy.
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Affiliation(s)
- Milton Rigoberto Fonseca Quispe
- Fellow PhD degree, Department of Surgery, Dr. Enrique Garcés Hospital, Equador. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistics analysis
| | - Wilson Salgado Júnior
- PhD, Associate Professor, Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, Universidade de São Paulo (USP), Ribeirao Preto-SP, Brazil. Conception and design of the study, analysis and interpretation of data, manuscript preparation and writing, critical revision, final approval
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16
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Vu JV, Gunaseelan V, Dimick JB, Englesbe MJ, Campbell DA, Telem DA. Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair. Surg Endosc 2019; 33:4032-4037. [PMID: 30767140 DOI: 10.1007/s00464-019-06695-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/06/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Black patients and older adults are less likely to receive minimally invasive hernia repair. These differences by race and age may be influenced by surgeon-specific utilization rate of minimally invasive repair. In this study, we explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. METHODS A retrospective cohort study was performed in patients undergoing elective primary inguinal hernia repair from 2012 to 2016, using data from the Michigan Surgical Quality Collaborative, a 72-hospital clinical registry. Surgeons were stratified by proportion of MIS performed. Using hierarchical logistic regression models, we investigated the association between receiving MIS repair and race, age, and surgeon MIS utilization rate. RESULTS Out of 4667 patients, 1253 (27%) received MIS repair. Out of 190 surgeons, 81 (43%) performed only open repair. Controlling for surgeon MIS utilization, race was not associated with MIS receipt (OR 0.93, p = 0.775), but older patients were less likely to receive MIS repair (OR 0.41, p < 0.001). CONCLUSIONS Race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients. Interventions to address disparities should include systematic efforts to improve access, as well as provider and patient education for older adults.
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Affiliation(s)
- Joceline V Vu
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA. .,Center for Health Outcomes and Policy, Ann Arbor, MI, 48109, USA.
| | - Vidhya Gunaseelan
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.,Michigan Surgical Quality Collaborative, Ann Arbor, MI, 48109, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.,Center for Health Outcomes and Policy, Ann Arbor, MI, 48109, USA
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.,Michigan Surgical Quality Collaborative, Ann Arbor, MI, 48109, USA
| | - Darrell A Campbell
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.,Michigan Surgical Quality Collaborative, Ann Arbor, MI, 48109, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Ann Arbor, MI, 48109, USA.,Center for Health Outcomes and Policy, Ann Arbor, MI, 48109, USA
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Sun L, Shen YM, Chen J. Laparoscopic versus Lichtenstein hernioplasty for inguinal hernias: a systematic review and Meta-analysis of randomized controlled trials. MINIM INVASIV THER 2019; 29:20-27. [PMID: 30762458 DOI: 10.1080/13645706.2019.1569534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: This meta-analysis aimed to explore the safety and efficacy of Lichtenstein versus laparoscopic hernioplasty for inguinal hernias based on eligible randomized controlled trials (RCTs).Material and methods: We searched several electronic databases to identify eligible studies based on the index words updated to March 2018.We also searched related publication sources and only included eligible RCTs in the current analysis. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were used for the main outcome of our analysis.Results: In total, 21 studies were included with 3772 patients in the laparoscopic group and 3910 patients in the Lichtenstein group. The results indicated that compared with the Lichtenstein group, the laparoscopic surgery group had significantly increased operative time. Besides, there was no significant difference in the rate of hematoma or seroma and complications between the two groups. However, compared with the Lichtenstein group, the laparoscopic group had a higher hernia recurrence rate, a lower incidence of chronic pain and a lower rate of wound infection, but no significant difference was found.Conclusion: The results demonstrated that laparoscopic repair reduced chronic pain and wound infection compared with Lichtenstein repair. But Lichtenstein could reduce the operative time and hernia recurrence.
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Affiliation(s)
- Li Sun
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ying-Mo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Laparoscopic Versus Conventional Open Surgery for the Treatment of Bilateral Inguinal Hernias. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.2478/jim-2018-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To evaluate and compare laparoscopic and conventional open procedures for bilateral inguinal hernia surgical repair, using clinical, intraoperative, and postoperative criteria.
Methods: Forty-three patients with bilateral inguinal hernia were included in a retrospective study, between 2014–2017. All patients underwent conventional open or laparoscopic bilateral hernioplasty, and were divided into two groups: a conventional open group (COG) and a laparoscopy group (LG). Clinical, intraoperative, and postoperative outcomes were reviewed.
Results: In the laparoscopic hernioplasty group, there was a significantly shorter hospitalization period (p = 0.026), less postoperative pain (p = 0.03), and a prompt return to work (p = 0.043) compared to the conventional open procedure. On the other hand, patients who underwent hernioplasty with the Progrip-type synthetic mesh developed a lower pain score, an earlier return to work, and a quick start to normal physical activities in comparison with other mesh types used for the treatment of bilateral inguinal hernias. For patients who underwent conventional open procedure, there was a significantly shorter operating time (p = 0.042).
Conclusion: Laparoscopic bilateral inguinal hernioplasty is a time-consuming and technically demanding procedure. However, the current study underlines the benefits of this type of surgery. This technique presents comparable clinical, intraoperative, and postoperative results with the conventional open surgery.
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Scientific surgery. Br J Surg 2018. [DOI: 10.1002/bjs.11053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Quezada N, Maturana G, Pimentel E, Crovari F, Muñoz R, Jarufe N, Pimentel F. Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series. Hernia 2018; 23:119-123. [PMID: 30259218 DOI: 10.1007/s10029-018-1824-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cholecystectomy and inguinal hernioplasty are the most frequent surgeries in Chile and the world. Laparoscopic inguinal hernioplasty, being a clean surgery, reports mesh infection rates of less than 2% and adding a simultaneous laparoscopic cholecystectomy is controversial due to an increase in the risk of mesh infection. The aim of this paper is to report the results of simultaneous TAPP hernioplasty with laparoscopic cholecystectomy. METHOD Retrospective analysis of the digestive surgery database. We identified cases in which laparoscopic inguinal TAPP repair and simultaneous laparoscopic cholecystectomy were performed. Demographic, clinical information, hernia type and size, data from the surgery and its complications were also retrieved and analyzed. RESULTS We identified 21 patients, 86% male and with an average age of 61 years range 46-84. 72% of the hernias were unilateral, predominating indirect 50%, direct 28% and the remaining were femoral and mixed. The average hernia size was 2.2 cm. The meshes used were 56% polypropylene, 37% polyester and 5% PVDF. We report one gallblader perforation. At a median time of 40 months of follow-up (range 4-89 months), one hernia recurrence was found (3.7%), there were no reoperations at the time of the interview and there were no cases of mesh infection. Complications of surgery includes one ipsilateral testicular atrophy 4.8% and 1 ipsilateral inguinal seroma 4.8%. CONCLUSIONS In this series of cases, adding clean contaminated surgery to the inguinal TAPP hernioplasty was not associated with an increase in the infection of the mesh.
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Affiliation(s)
- N Quezada
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile.
| | - G Maturana
- Medicine Faculty, Pontifical Catholic University of Chile, Santiago, Chile
| | - E Pimentel
- Medicine Faculty, Pontifical Catholic University of Chile, Santiago, Chile
| | - F Crovari
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - R Muñoz
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - N Jarufe
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - F Pimentel
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
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Affiliation(s)
- Hamid Reza Zahiri
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland
| | - Igor Belyansky
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland
| | - Adrian Park
- Anne Arundel Medical Center, Department of Surgery, Division of Minimally Invasive Surgery, Annapolis, Maryland.
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