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Suzuki Y, Wakasugi M, Mikamori M, Tamaoka K, Nakahara Y, Tei M, Furukawa K, Ohtsuka M, Masuzawa T, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic totally extra-peritoneal inguinal hernia repair: a single-institution experience of 186 consecutive cases. Surg Today 2021; 52:114-119. [PMID: 34115209 DOI: 10.1007/s00595-021-02323-4] [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: 02/23/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This retrospective study was conducted to compare the long-term outcomes of single-incision totally extraperitoneal (S-TEP) inguinal hernia repair and conventional multiport totally extraperitoneal (M-TEP) inguinal hernia repair. METHODS The study population included 186 consecutive patients (S-TEP, n = 149; M-TEP, n = 37) who underwent elective surgery for inguinal hernia at Osaka Police Hospital between 2011 and 2013. RESULTS No significant between-group difference was found in patient or hernia characteristics or in perioperative outcomes, with the exception of age (S-TEP group vs. M-TEP group: median 69 [IQR 60-75] years vs. 64 [55-69] years, respectively; P = 0.019). Furthermore, no significant between-group difference was found in follow-up time (5.5 [3.0-5.8] vs. 5.4 [3.1-5.7] years, P = 0.839), recurrence rate (0.6 vs. 2.4%, P = 0.358), chronic pain (1.2 vs. 0%, P = 1.000), feeling the mesh (2.3 vs. 7.1%, P = 0.142), or movement limitation (0.6 vs. 0%, P = 1.000). All chronic symptoms were "mild but not bothersome." A metachronous contralateral inguinal hernia developed in 8.1% of patients. CONCLUSION The long-term outcomes of S-TEP repair were comparable to those of M-TEP, with rates of recurrence, chronic pain, feeling the mesh, and movement limitation falling within acceptable limits.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Shibaharacho 4-14-1, Toyonaka, Osaka, 560-8565, Japan.
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Kohei Tamaoka
- Department of Endoscopic Diagnosis and Therapeutics, Kanto Central Hospital of the Mutual Aid and Association of Public School Teachers, Setagaya-ku Kamiyoga 6-25-1, Tokyo, 158-8531, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Kita-ku Nagasonecho 1179-3, Sakai, Osaka, 591-8025, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
| | - Toru Masuzawa
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, Tennoji-Ku Kitayamacho 10-31, Osaka, Osaka, 543-0035, Japan
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Wu F, Zhang X, Liu Y, Cao D, Yu Y, Ma Y. Lightweight mesh versus heavyweight mesh for laparo-endoscopic inguinal hernia repair: a systematic review and meta-analysis. Hernia 2019; 24:31-39. [PMID: 31367963 DOI: 10.1007/s10029-019-02016-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to determine if the prognoses of inguinal hernia patients improved with the application of lightweight mesh (LWM). METHODS Medline, Embase, and Cochrane library were searched for randomized controlled trails related to laparo-endoscopic inguinal hernia repair with different prosthetic meshes. Data were extracted and analyzed using the guidelines of the Cochrane handbook. The primary endpoints were recurrence and chronic postoperative inguinal pain. The second endpoints encompassed acute postoperative pain, foreign body sensation, seroma, infection, and numbness. Data were processed using Review Manager 5.3. RESULTS The heavyweight mesh (HWM) had a distinctive advantage for recurrence (RR 2.30; 95% CI 1.21-4.38; P = 0.01), with comparable results for postoperative pain (RR 0.91; 95% CI 0.37-2.22; P = 0.83), foreign body sensation (RR 1.18; 95% CI 0.91-1.51; P = 0.21), seroma(RR 0.87; 95% CI 0.75-1.01; P = 0.06), infection (RR 0.85; 95% CI 0.31-2.34; P = 0.75), and numbness, compared to LWM. CONCLUSION HWM had a distinctive advantage over LWM with regard to recurrence. The two types of prosthetic meshes had equivalent outcomes for postoperative pain, seroma, foreign body sensation, infection, and numbness. Studies focused on defect sizes and fixation methods are warranted for further stratification.
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Affiliation(s)
- F Wu
- The First Clinical Medical School, Lanzhou University, 199 west Donggang road, Chengguan district, Lanzhou City, Gansu, China
| | - X Zhang
- Department of Surgery/Hernia Clinic, The First Hospital of Lanzhou University, 1 west Donggang road, Chengguan district, Lanzhou City, Gansu, China
| | - Y Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlish Road, Xicheng district, Beijing, China
| | - D Cao
- Department of Surgery/Hernia Clinic, The First Hospital of Lanzhou University, 1 west Donggang road, Chengguan district, Lanzhou City, Gansu, China
| | - Y Yu
- Department of Surgery/Hernia Clinic, The First Hospital of Lanzhou University, 1 west Donggang road, Chengguan district, Lanzhou City, Gansu, China.
| | - Y Ma
- The First Clinical Medical School, Lanzhou University, 199 west Donggang road, Chengguan district, Lanzhou City, Gansu, China
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Incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chinchilla Hermida PA, Baquero Zamarra DR, Guerrero Nope C, Bayter Mendoza EF. Incidencia y factores asociados al dolor crónico postoperatorio en pacientes llevados a herniorrafia inguinal. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chinchilla Hermida PA, Baquero Zamarra DR, Guerrero Nope C, Bayter Mendoza EF. Incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Liew W, Wai YY, Kosai NR, Gendeh HS. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers. Hernia 2017; 21:549-554. [PMID: 28417279 DOI: 10.1007/s10029-017-1611-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s. Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5% of patients. The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair. METHODS Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair. The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein, white blood cell count at 48 h, and ESR at 3 months postoperatively. Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period. RESULTS The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values (p < 0.05), however, did not differ significantly between the two study groups at 48 h (p > 0.05). The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only (p < 0.05), however, did not differ significantly between the two study groups (p > 0.05). There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group (p > 0.05). CONCLUSION Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible.
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Affiliation(s)
- W Liew
- Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Y Y Wai
- Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - N R Kosai
- Upper Gastrointestinal, Bariatric and Metabolic Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - H S Gendeh
- Depatment of Otrorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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Long-term follow-up of laparoscopic total extraperitoneal (TEP) repair in inguinal hernia without mesh fixation. Hernia 2016; 21:37-43. [DOI: 10.1007/s10029-016-1558-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis. Surg Endosc 2016; 31:2109-2121. [PMID: 27585467 DOI: 10.1007/s00464-016-5207-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. METHODS Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. RESULTS From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors. CONCLUSIONS Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.
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Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage? Hernia 2016; 21:79-88. [PMID: 27209631 DOI: 10.1007/s10029-016-1502-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Due to their relative scarcity and to limit single-center bias, multi-center data are needed to study femoral hernias. The aim of this study was to evaluate outcomes and quality of life (QOL) following laparoscopic vs. open repair of femoral hernias. METHODS The International Hernia Mesh Registry was queried for femoral hernia repairs. Laparoscopic vs. open techniques were assessed for outcomes and QOL, as quantified by the Carolinas Comfort Scale (CCS), preoperatively and at 1, 6, 12, and 24 months postoperatively. Outcomes were evaluated using the standard statistical analysis. RESULTS A total of 80 femoral hernia repairs were performed in 73 patients: 37 laparoscopic and 43 open. There was no difference in mean age (54.7 ± 14.6 years), body mass index (24.2 ± 3.8 kg/m2), gender (60.3 % female), or comorbidities (p > 0.05). The hernias were recurrent in 21 % of the cases with an average of 1.23 ± 0.6 prior repairs (p > 0.1). Preoperative CCS scores were similar for both groups and indicated that 59.7 % of patients reported pain and 46.4 % had movement limitations (p > 0.05). Operative time was equivalent (47.2 ± 21.2 vs. 45.9 ± 14.8 min, p = 0.82). There was no difference in postoperative complications, with an overall 8.2 % abdominal wall complications rate (p > 0.05). The length of stay was shorter in the laparoscopic group (0.5 ± 0.6 vs. 1.3 ± 1.6 days, p = 0.02). Follow-up was somewhat longer in the open group (23.8 ± 10.2 vs. 17.3 ± 10.9 months, p = 0.02). There was one recurrence, which was in the laparoscopic group (3.1 vs. 0 %, p = 0.4). QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation. Postoperative QOL scores improved for both groups when compared to preoperative scores. CONCLUSION In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.
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AlJamal YN, Zendejas B, Gas BL, Ali SM, Heller SF, Kendrick ML, Farley DR. Annual Surgeon Volume and Patient Outcomes Following Laparoscopic Totally Extraperitoneal Inguinal Hernia Repairs. J Laparoendosc Adv Surg Tech A 2016; 26:92-8. [DOI: 10.1089/lap.2015.0368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yazan N. AlJamal
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin Zendejas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Becca L. Gas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Shahzad M. Ali
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F. Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael L. Kendrick
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R. Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
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Lange JFM, Lange MM, Voropai DA, van Tilburg MWA, Pierie JPEN, Ploeg RJ, Akkersdijk WL. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients. World J Surg 2015; 38:1922-8. [PMID: 24510248 DOI: 10.1007/s00268-014-2475-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques have their own specific disadvantages, with regard to potential nerve damage and the necessity of general anesthesia, respectively. OBJECTIVE The goal of this study was to evaluate the results of a new technique in which the inguinal nerves are not at risk, and in which general anesthesia is not needed: trans rectus sheath extraperitoneal procedure (TREPP). MATERIAL AND METHODS Between 2006 and 2010, a total of 1,000 patients were treated for inguinal hernia with TREPP. A questionnaire concerning pain, sensibility changes, patient satisfaction, and recurrence was sent to all patients. RESULTS The questionnaire was completed by 932 patients. Almost 90% of patients had not experienced any pain since the surgical procedure; 8% of patients reported experiencing some pain, but less than preoperatively; and 2% of patients reported an increase in pain postoperatively. Recurrence occurred in 1 and 3% were unsure about this. Reduced sensibility of the scar, scrotum, and upper leg was reported by 12.4, 1.4, and 1.5%, respectively. Overall, 97.4% of patients were satisfied with the results of the surgical procedure. The time period in which TREPP was performed was not associated with any of the outcome measures. CONCLUSION TREPP has proven to be a feasible new technique for inguinal hernia repair, with excellent results, justifying a randomized controlled trial in which TREPP should be compared with standard techniques.
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Affiliation(s)
- J F M Lange
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands,
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Burgmans JPJ, Schouten N, Clevers GJ, Verleisdonk EJMM, Davids PHP, Voorbrood CEH, Simmermacher RKJ, Van Dalen T. Pain after totally extraperitoneal (TEP) hernia repair might fade out within a year. Hernia 2015; 19:579-85. [PMID: 25899107 DOI: 10.1007/s10029-015-1384-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/04/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The incidence of chronic pain after endoscopic hernia repair varies between 1 and 16 %. Studies regarding the course of pain in time after the operation are scarce. METHODS 473 male patients ≥18 years of age, scheduled for totally extraperitoneal (TEP) hernia repair (Prolene® mesh) between March 2010 and August 2012 were requested to record pain symptoms preoperative, and 1 day, 1 week, 6 weeks, 3 months and 1 year postoperatively and visit the outpatient department 3 months and 1 year postoperatively for a standardized interview and physical examination. RESULTS Preoperatively, 25 % (n = 114) of the patients had moderate-to-severe pain (NRS 4-10). Six weeks postoperatively, 3 % (n = 12) of the patients still experienced moderate-to-severe pain. Three months after TEP, only 3 patients (0.6 %) had moderate-to-severe pain, while 83 patients (18 %) experienced mild pain. One year after TEP, 39 patients experienced mild pain (8 %) and 3 patients moderate pain (0.7 %), no patients experienced severe pain after 1 year. Patients with moderate-to-severe pain preoperatively had a higher risk of pain persisting until 3 months and 1 year postoperatively (p = 0.03). In most patients who had pain 3 months postoperatively and were pain-free 1 year after TEP, pain 'faded out' at 4-6 months postoperatively. Two patients had a not-painful recurrent hernia, diagnosed 2 and 5 months after TEP repair. CONCLUSION Moderate-to-severe pain after TEP hernia repair is self-limiting, with less than 1 % of the patients reporting moderate pain 1 year postoperatively.
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Affiliation(s)
- J P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands,
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Bioabsorbable Hernia Plugs in Laparoscopic Inguinal Herniorraphy. Surg Laparosc Endosc Percutan Tech 2015; 25:163-7. [DOI: 10.1097/sle.0000000000000107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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