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Raja S, Raja A, Ansari Z, Eman S, Bajaj S, Ahmed M, Kumar U, Shah YH, Jawahar S, Aftab F, Rajani D, Kumar S, Khatri M. Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy. Front Surg 2024; 11:1321325. [PMID: 38404293 PMCID: PMC10884233 DOI: 10.3389/fsurg.2024.1321325] [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] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF. Methods PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords "Glue mesh repair," "Tack mesh repair," "Inguinal Hernia," "Herniorrhaphy," "Laparoscopic," "Mesh Fixation," and "Randomized controlled trials." Results In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger's regression to test for publication bias. Conclusion In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.
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Affiliation(s)
- Sandesh Raja
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Adarsh Raja
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Ziyan Ansari
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sara Eman
- Department of Surgery, Foundation University Medical College, Islamabad, Pakistan
| | - Simran Bajaj
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan
| | - Muhammad Ahmed
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Uday Kumar
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Yawar Hussain Shah
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Sachin Jawahar
- Department of Surgery, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Faisal Aftab
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Deepak Rajani
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Satesh Kumar
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Mahima Khatri
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Hadi A, Muhammad S, Alam M. Factors Influencing Recurrence Following Transabdominal Preperitoneal Repair for Inguinal Hernias. Cureus 2023; 15:e50975. [PMID: 38259401 PMCID: PMC10801277 DOI: 10.7759/cureus.50975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Inguinal hernia repair, a globally prevalent surgical procedure, has witnessed the widespread adoption of the transabdominal preperitoneal (TAPP) approach, promising reduced postoperative pain, faster recovery, and lower recurrence rates. However, hernia recurrence remains a persistent challenge, necessitating a comprehensive exploration of influencing factors specific to TAPP repair. OBJECTIVE The objective of this study is to identify and analyze key factors contributing to inguinal hernia recurrence post-TAPP repair Materials and methods: This is a retrospective cohort study involving 152 patients undergoing TAPP repair at Hayatabad Medical Complex Peshawar, from November 2020 to October 2023. Demographic, preoperative, and postoperative data were meticulously collected. Statistical analysis employed IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). RESULTS An 8.5% recurrence rate was observed, with influencing factors including insufficient myopectineal orifice (MPO) dissection in three cases (23%), smaller mesh size in two cases (15.4%), infected mesh in two cases (15.4%), mesh dislodgement in one case (20%), and missed sac in one case (20%). Clinical examination and imaging studies diagnosed recurrences in 30.8% and 69.2% of cases, respectively. CONCLUSION Despite the advantages of TAPP repair, hernia recurrence persists, emphasizing the need for ongoing refinement of surgical techniques. This study identifies critical influencing factors, notably insufficient MPO dissection, guiding efforts to enhance the efficacy of TAPP repair and improve patient outcomes.
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Affiliation(s)
- Ainul Hadi
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Saadia Muhammad
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Muhammad Alam
- Department of General Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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Hu N, Xie H, Wang DC, Lei YH, Wei J, Yu M, Li YJ. Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A meta-analysis of randomized controlled trials. Asian J Surg 2023; 46:3417-3425. [PMID: 37037745 DOI: 10.1016/j.asjsur.2023.03.146] [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: 11/29/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = -1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future.
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Affiliation(s)
- Nan Hu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Hong Xie
- Department of General Medicine, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
| | - Yue-Hua Lei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Jian Wei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Miao Yu
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, 643000, Sichuan, China
| | - Yue-Juan Li
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
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Nishikawa M, Fukuda T, Okazaki M. Predictive factors of postoperative acute pain in laparoscopic inguinal hernia repair in men: A single-centre retrospective study in Japan. J Perioper Pract 2023; 33:133-138. [PMID: 35322720 DOI: 10.1177/17504589211054371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair has significantly reduced the incidence of postoperative acute and chronic pain compared to open repair, but it remains problematic. This study's purpose was to retrospectively identify predictive factors of acute pain after laparoscopic inguinal hernia repair. METHODS We reviewed the medical records of 193 patients. After excluding atypical cases and female patients, 156 patients were analysed. Factors affecting rescue analgesic requirements were investigated via multivariable logistic regression analysis. Independent variables included age, body mass index, analgesics used during surgery and surgical factors (unilateral/bilateral, primary/recurrent). The degree of postoperative pain and the hospital stay duration after surgery were also investigated. RESULTS Of the 156 patients, 40 (25.6%) required rescue analgesics. Patients under 60 years of age were about seven times more likely to need rescue analgesics than patients over 80 years of age. Primary surgery patients were about 5.5 times more likely to need rescue analgesics than recurrent surgery patients. The maximum verbal rating scale score was less than 3 in 89% of patients. All patients were discharged by two days postoperatively. CONCLUSION Laparoscopic inguinal hernia repair results in less postoperative acute pain. However, analgesia management should be considered prudently for younger patients and primary surgery patients.
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Affiliation(s)
- Masashi Nishikawa
- Department of Anesthesiology, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
| | - Taeko Fukuda
- Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Tsuchiura Clinical Education and Training Center, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
| | - Masaya Okazaki
- Department of Surgery, Kasumigaura Medical Center Hospital, National Hospital Organization, Tsuchiura, Japan
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Habib Bedwani NAR, Kelada M, Smart N, Szydlo R, Patten DK, Bhargava A. Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials. Br J Surg 2021; 108:14-23. [PMID: 33640918 DOI: 10.1093/bjs/znaa002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. METHODS A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. RESULTS Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). CONCLUSION Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
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Affiliation(s)
- N A R Habib Bedwani
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - M Kelada
- Imperial College School of Medicine, Imperial College London, London, UK
| | - N Smart
- Department of General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Gastrointestinal Surgery, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - R Szydlo
- Imperial College School of Medicine, Imperial College London, London, UK
| | - D K Patten
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Imperial College School of Medicine, Imperial College London, London, UK.,Deparment of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK
| | - A Bhargava
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Tseng SI, Li CC, Lee HY, Chen JH. Previous unilateral inguinal hernia repair increase risk of new developed inguinal hernia: a nationwide Longitudinal Cohort Study in Asian male adult patients. Surg Endosc 2021; 36:346-351. [PMID: 33492509 DOI: 10.1007/s00464-021-08287-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Our study aims to identify that patients who received hernia repair previously did have higher risk of occurrence of newly developed inguinal hernia, named as a contralateral inguinal hernia (CIH), than patients who never received inguinal hernia surgery before. MATERIALS AND METHODS We collected data from the National Health Insurance Research Database (NHIRD) of Taiwan retrospectively. In the study cohort, 64,089 Asian male adults who underwent primary unilateral inguinal hernia repair during 2003-2008 were included using ICD-9 diagnostic and surgical codes. Another 64,089 male adults without hernia repair history were included as control group via propensity score match. RESULTS The median follow-up period is 93.53 months. After multivariate analysis, the risk of newly developed inguinal hernia in unilateral inguinal hernia (UIH) repair cohort was significantly higher (adjusted HR 6.364, 95% CI 6.012-6.737, P < 0.001) than the control group. In subgroup analysis, patients without mesh repair (adjusted HR 6.706, P < 0.001) and patients with mesh repair (adjusted HR 5.559, P < 0.001) both showed higher risk of developing newly developed inguinal hernia which needs repair. CONCLUSIONS Asian men with UIH repair history had a higher risk of developing new inguinal hernia at the contralateral site, namely CIH, than the general population. The surgeon should inform the possibility of CIH after initial herniorrhaphy, therefore, monitoring the occurrence of CIH is necessary.
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Affiliation(s)
- Shih-I Tseng
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan. .,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Urology Department, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jian-Han Chen
- Department of Bariatric and Metabolic International Surgery Center, E-Da Hospital, No.1, Yida Rd., Yanchao Dist., Kaohsiung City, 82445, Taiwan. .,Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Kinoshita S, Ohyama T, Kawaguchi C, Ikeda N, Sho M. Significance of umbilical trocar size and intra-abdominal pressure on postoperative pain after transabdominal preperitoneal repair for inguinal hernia. Asian J Endosc Surg 2021; 14:63-69. [PMID: 32468624 DOI: 10.1111/ases.12813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair is reported to be associated with lower postoperative pain than open repair. However, in the actual clinical setting, some patients experience relatively severe pain. This study aimed to elucidate surgical factors that affect pain after transabdominal preperitoneal (TAPP) repair. METHODS We evaluated 199 patients who underwent elective TAPP for inguinal hernia from 2014 to 2019 in Heisei Memorial Hospital. The umbilical trocar size was changed from 12 to 5 mm from October 2017. The pneumoperitoneum intra-abdominal pressure was changed from 10 to 8 mmHg from 2019. Postoperative pain scores and analgesics were compared between patients who were grouped according to trocar size and intra-abdominal pressure, as well as 80 patients who received open repair. RESULTS Patients with a 12 mm trocar had significantly higher pain than open repair patients (P < .0001). Patients with a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure had significantly lower pain than a 12 mm trocar (P = .025) and did not significantly differ with pain after open repair. Analgesic use significantly decreased in patients using a 5 mm trocar than 12 mm (P = .002). CONCLUSION Umbilical trocar size and pneumoperitoneum intra-abdominal pressure were significantly associated with post-TAPP pain. Using a 5 mm umbilical trocar and 8 mm Hg intra-abdominal pressure achieved pain levels as comparatively low as open repair.
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Affiliation(s)
- Shoichi Kinoshita
- Department of Surgery, Heisei Memorial Hospital, Kashihara, Japan.,Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Takao Ohyama
- Department of Surgery, Heisei Memorial Hospital, Kashihara, Japan
| | | | - Naoya Ikeda
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Japan
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Thanh Xuan N, Huu Son N. Laparoscopic Transabdominal Preperitoneal Technique for Inguinal Hernia Repair in Adults. Cureus 2020; 12:e8692. [PMID: 32699690 PMCID: PMC7370685 DOI: 10.7759/cureus.8692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia repair is one of the most commonly performed operations in general surgery, especially in the digestive field. Since the introduction of laparoscopic repair as well as using a synthetic mesh, the surgical trends have changed in the last decade in treating inguinal hernias. The laparoscopic transabdominal preperitoneal gives a better view of the inguinal anatomy, and the procedure also has a short learning curve. We aim to evaluate the safety and early outcome of the laparoscopic transabdominal preperitoneal technique for inguinal hernia repair using a Prolene® mesh (Ethicon Somerville, NJ, USA). Methods A prospective study was carried out among 31 adult patients with 34 inguinal hernia cases. They underwent the laparoscopic transabdominal preperitoneal technique with a Prolene mesh at the Hue Central Hospital from December 2018 through May 2019. Results The mean age was 60.4 ± 11.8, and 96.8% of cases were male. Strangulated hernia and incarcerated hernia accounted for 2.9% and 8.8% of cases, respectively. The mean duration of unilateral inguinal hernia repair and bilateral inguinal repair was 57.1 ± 17.3 minutes and 80.3 ± 10.6 minutes, respectively. The mean duration of the postoperative hospital stay was 3.9 ± 1.4 days. One (3.2%) case with contralateral inguinal hernia was detected intraoperatively. An early and three-month postoperative evaluation showed that 93.5% and 96.8% of cases were categorized as "very good", respectively. At the three-month evaluation, one case was reported with sensation disorder of the inguinal area, and there was no recurrence. Conclusions Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and feasible technique. It allows surgeons to explore the opposite site and resolve the combined peritoneal diseases.
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Affiliation(s)
- Nguyen Thanh Xuan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
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Lyu Y, Cheng Y, Wang B, Du W, Xu Y. Comparison of endoscopic surgery and Lichtenstein repair for treatment of inguinal hernias: A network meta-analysis. Medicine (Baltimore) 2020; 99:e19134. [PMID: 32028439 PMCID: PMC7015567 DOI: 10.1097/md.0000000000019134] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 12/14/2019] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to identify the best procedure for addressing inguinal hernias by comparing results after transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), and Lichtenstein repairs using a network meta-analysis. METHODS We conducted a systematic search of MEDLINE, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov up to September 1, 2018 for randomized controlled trials (RCTs) comparing the TAPP, TEP, and Lichtenstein procedures. The study outcome were the hernia recurrence, chronic pain, hematoma, seroma, wound infection, operation time, hospital stay, and return-to-work days. RESULTS Altogether, 31 RCTs were included in the meta-analysis. The results of this network meta-analysis showed there were no significantly differences among the 3 procedures in terms of hernia recurrence, chronic pain, hematoma, seroma, hospital stays. Lichtenstein had a shorter operation time than TAPP+TEP [MD (95%Crl)]: 12 (0.51-25.0) vs 18 (6.11-29.0) minutes, respectively) but was associated with more wound infections than TEP: OR 0.33 (95%Crl 0.090-0.81). Our network meta-analysis suggests that TAPP and TEP require fewer return-to-work days [MD (95%CI)]: - 3.7 (-6.3 to 1.3) vs -4.8 (-7.11 to 2.8) days. CONCLUSION Our network meta-analysis showed that there were no differences among the TAPP, TEP, and Lichtenstein procedures in terms of safety or effectiveness for treating inguinal hernias. However, TAPP and TEP could decrease the number of return-to-work days. A further study with more focus on this topic for inguinal hernia is suggested.
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Comparing 30-day outcomes between different mesh fixation techniques in minimally invasive inguinal hernia repair. Hernia 2020; 24:961-968. [PMID: 31960235 DOI: 10.1007/s10029-020-02123-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The association of postoperative patient-reported outcomes and type of mesh fixation during minimally invasive inguinal hernia repair has not been well characterized. We aimed to compare the 30-day quality of life outcomes between various mesh fixation techniques utilizing the AHSQC prospective registry. METHODS All minimally invasive inguinal hernias with completed 30-day follow-up were abstracted from the AHSQC, excluding patients with primary indication for surgery being chronic groin pain. Mesh fixation was categorized as (1) atraumatic fixation (AF) (2) traumatic non-suture (TNS), (3) traumatic suture (TS). Our outcomes of interest were pain at site at 30-day and EuraHS quality of life assessment. RESULTS After applying inclusion and exclusion criteria, 864 patients had surgical site pain and quality of life outcomes reported; 253 (AF), 451 (TNS), and 160 (TS). After adjusting for identified confounders, there was no statistically significant difference between any fixation method when evaluating pain as a binary variable (Yes/No). However, when looking at the EuraHS evaluation for pain and quality of life outcomes, AF was associated with better scores than both TNS and TS fixation in the cosmetic, restrictions, and overall EuraHS domains. AF was only better than TS fixation in the pain domain. CONCLUSION Our study suggests that AF had a significantly improved hernia-specific quality of life in all domains at 30-days postoperatively. We also identified that pain as a binary variable is inadequate for its states purpose. Thus, the overall well-being and morbidity should be taken into account when evaluating hernia patients postoperatively.
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Lo CW, Chen YT, Jaw FS, Yu CC, Tsai YC. Predictive factors of post-laparoscopic inguinal hernia acute and chronic pain: prospective follow-up of 807 patients from a single experienced surgeon. Surg Endosc 2020; 35:148-158. [PMID: 31932935 DOI: 10.1007/s00464-020-07373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Convalescence after hernia repair is one of the main focuses for hernia surgeons. We analyzed our prospectively collected data to identify possible predictive factors for post-operative acute and chronic pain. MATERIALS AND METHODS We prospectively collected the demographic data and peri-operative findings. Post-operative acute pain was evaluated with Visual Analog Pain Scale. The chronic pain (pain persists for > 6 months since operation) was also recorded. RESULTS From June 2008 to August 2018, there were 807 patients with 1029 sites of inguinal hernia enrolled in our analysis. Pain before operation was associated with the severity of acute pain on OP (operation) day, POD 1 (post-operative day 1), and POD 7 (post-operative day 7). Younger patients had significantly higher post-operative acute pain on OP day, POD 1, and POD 7. The staple mesh fixation method resulted in a higher pain score at OP day and POD 1. The predictive factors for chronic pain were sex (female), young age (< 65 years), having no past history of hypertension, pain before operation, and mesh material. CONCLUSION A younger age and inguinal pain before operation were the main predictive factors for higher post-operative pain. Younger patients, females, having inguinal pain before surgery, and using heavy weight mesh have a higher risk of chronic pain.
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Affiliation(s)
- Chi-Wen Lo
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Postal Hospital, Taipei, Taiwan
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Chin Yu
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan.
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Tavares K, Mayo J, Bogenberger K, Davis SS, Yheulon C. Fibrin versus cyanoacrylate glue for fixation in laparoscopic inguinal hernia repair: a network meta-analysis and indirect comparison. Hernia 2019; 24:927-935. [DOI: 10.1007/s10029-019-02072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022]
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Sharbu Z, Kalidarei B, Mahmoodieh M. Comparison of mesh fixation and nonfixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_15_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Siddaiah-Subramanya M, Ashrafi D, Memon B, Memon MA. Causes of recurrence in laparoscopic inguinal hernia repair. Hernia 2018; 22:975-986. [PMID: 30145622 DOI: 10.1007/s10029-018-1817-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/21/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Recurrence after laparoscopic inguinal herniorrhaphy is poorly understood. Reports suggest that up to 13% of all inguinal herniorrhaphies worldwide, irrespective of the approach, are repaired for recurrence. We aim to review the risk factors responsible for these recurrences in laparoscopic mesh techniques. METHODS A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English language, peer reviewed articles on the causes of recurrence following laparoscopic mesh inguinal herniorrhaphy published between 1990 and 2018. The search terms included 'Laparoscopic methods', 'Inguinal hernia; Mesh repair', 'Recurrence', 'Causes', 'Humans'. RESULTS The literature revealed several contributing risk factors that were responsible for recurrence following laparoscopic mesh inguinal herniorrhaphy. These included modifiable and non-modifiable risk factors related to patient and surgical techniques. CONCLUSIONS Recurrence can occur at any stage following inguinal hernia surgery. Patients' risk factors such as higher BMI, smoking, diabetes and postoperative surgical site infections increase the risk of recurrence and can be modified. Amongst the surgical factors, surgeon's experience, larger mesh with better tissue overlap and careful surgical techniques to reduce the incidence of seroma or hematoma help reduce the recurrence rate. Other factors including type of mesh and fixation of mesh have not shown any difference in the incidence of recurrence. It is hoped that future randomized controlled trials will address some of these issues and initiate preoperative management strategies to modify some of these risk factors to lower the risk of recurrence following laparoscopic inguinal herniorrhaphy.
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Affiliation(s)
- Manjunath Siddaiah-Subramanya
- Sir Charles Gairdner Hospital, Perth, Australia
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Darius Ashrafi
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia
- Department of Surgery, Sunshine Coast University Hospital, Buderim, QLD, Australia
| | - Breda Memon
- South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank, QLD, Australia
| | - Muhammed Ashraf Memon
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
- School of Agricultural, Computing and Environmental Sciences, International Centre for Applied Climate Science, University of Southern Queensland, Toowoomba, QLD, Australia.
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.
- South East Queensland Surgery and Sunnybank Obesity Centre, McCullough Centre, Suite 9, 259 McCullough Street, Sunnybank, QLD, 4109, Australia.
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Panda S, Connolly M, Ramirez MG. Cost comparison of fibrin sealant versus tack screws for mesh fixation in laparoscopic repair of inguinal hernia. Hosp Pract (1995) 2018; 46:233-237. [PMID: 30001669 DOI: 10.1080/21548331.2018.1500369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Inguinal hernias of the abdominal wall are common accounting for 75% of all hernia defects. They can be treated with laparoscopic surgery using a transabdominal preperitoneal (TAPP) approach. However, in surgery there is some contention on how to conclude the hernia repair, as there are alternatives of using fibrin sealant (FS) or tack screws for fixation of a mesh implant over the defect in the abdominal wall. In this study, we evaluate the economic consequences of using FS vs. tacks for mesh fixation in TAPP inguinal hernia repair for the UK from a hospital perspective. METHODS The model was populated with clinical inputs (theater time, hospitalization days, occurrence of seroma, and neuralgia) from a previously conducted study comparing FS and tack screws in patients who had undergone TAPP hernia repair, and cost inputs from official government sources. One-way sensitivity analyses were also conducted to evaluate key drivers of cost analyses. RESULTS The average cost per case treated with FS 2 mL Tisseel® and tack screws (ProTackTM) was £1,098 and £1,348, respectively, for resource expenses paid by the healthcare system. This would suggest a potential savings achieved of £249 per surgery using FS for mesh fixation. The sensitivity analysis showed that the key drivers for the cost difference were a variation in time to complete the surgery, followed by hospitalization days, and lower adverse outcomes such as seroma and neuralgia in the two cohorts. CONCLUSION Using FS resulted in cost savings in hospitals based on reduced time to complete surgery, hospitalization time post-op, and lower adverse outcomes. Indirect cost savings were also found in favor of FS when comparing the two alternatives from a societal perspective, as patients were able to return to work more promptly in the FS group versus the tack screws group.
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Affiliation(s)
- Saswat Panda
- a Department of Health Economics , Global Market Access Solutions LLC , NC , USA
| | - Mark Connolly
- a Department of Health Economics , Global Market Access Solutions LLC , NC , USA.,b Department of Pharmacy, Unit of Pharmacoeconomics , University of Groningen , Groningen , Netherlands
| | - Manuel G Ramirez
- c Global HEOR Advanced Surgery , Baxter Health Care Corporation , Deerfield , IL , USA
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Edwards SJ, Crawford F, van Velthoven MH, Berardi A, Osei-Assibey G, Bacelar M, Salih F, Wakefield V. The use of fibrin sealant during non-emergency surgery: a systematic review of evidence of benefits and harms. Health Technol Assess 2018; 20:1-224. [PMID: 28051764 DOI: 10.3310/hta20940] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Fibrin sealants are used in different types of surgery to prevent the accumulation of post-operative fluid (seroma) or blood (haematoma) or to arrest haemorrhage (bleeding). However, there is uncertainty around the benefits and harms of fibrin sealant use. OBJECTIVES To systematically review the evidence on the benefits and harms of fibrin sealants in non-emergency surgery in adults. DATA SOURCES Electronic databases [MEDLINE, EMBASE and The Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and the Cochrane Central Register of Controlled Trials)] were searched from inception to May 2015. The websites of regulatory bodies (the Medicines and Healthcare products Regulatory Agency, the European Medicines Agency and the Food and Drug Administration) were also searched to identify evidence of harms. REVIEW METHODS This review included randomised controlled trials (RCTs) and observational studies using any type of fibrin sealant compared with standard care in non-emergency surgery in adults. The primary outcome was risk of developing seroma and haematoma. Only RCTs were used to inform clinical effectiveness and both RCTs and observational studies were used for the assessment of harms related to the use of fibrin sealant. Two reviewers independently screened all titles and abstracts to identify potentially relevant studies. Data extraction was undertaken by one reviewer and validated by a second. The quality of included studies was assessed independently by two reviewers using the Cochrane Collaboration risk-of-bias tool for RCTs and the Centre for Reviews and Dissemination guidance for adverse events for observational studies. A fixed-effects model was used for meta-analysis. RESULTS We included 186 RCTs and eight observational studies across 14 surgical specialties and five reports from the regulatory bodies. Most RCTs were judged to be at an unclear risk of bias. Adverse events were inappropriately reported in observational studies. Meta-analysis across non-emergency surgical specialties did not show a statistically significant difference in the risk of seroma for fibrin sealants versus standard care in 32 RCTs analysed [n = 3472, odds ratio (OR) 0.84, 95% confidence interval (CI) 0.68 to 1.04; p = 0.13; I2 = 12.7%], but a statistically significant benefit was found on haematoma development in 24 RCTs (n = 2403, OR 0.62, 95% CI 0.44 to 0.86; p = 0.01; I2 = 0%). Adverse events related to fibrin sealant use were reported in 10 RCTs and eight observational studies across surgical specialties, and 22 RCTs explicitly stated that there were no adverse events. One RCT reported a single death but no other study reported mortality or any serious adverse events. Five regulatory body reports noted death from air emboli associated with fibrin sprays. LIMITATIONS It was not possible to provide a detailed evaluation of individual RCTs in their specific contexts because of the limited resources that were available for this research. In addition, the number of RCTs that were identified made it impractical to conduct independent data extraction by two reviewers in the time available. CONCLUSIONS The effectiveness of fibrin sealants does not appear to vary according to surgical procedures with regard to reducing the risk of seroma or haematoma. Surgeons should note the potential risk of gas embolism if spray application of fibrin sealants is used and not to exceed the recommended pressure and spraying distance. Future research should be carried out in surgery specialties for which only limited data were found, including neurological, gynaecological, oral and maxillofacial, urology, colorectal and orthopaedics surgery (for any outcome); breast surgery and upper gastrointestinal (development of haematoma); and cardiothoracic heart or lung surgery (reoperation rates). In addition, studies need to use adequate sample sizes, to blind participants and outcome assessors, and to follow reporting guidelines. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020710. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh. Surg Endosc 2017; 32:627-637. [PMID: 28779253 DOI: 10.1007/s00464-017-5712-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure. METHODS A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence. RESULTS Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p = 0.01), current smoking status (p = 0.05) and hernia side [p = 0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1 ± 37.1 min vs. 76.8 ± 32.9, p < 0.0001). No cases were converted to open. Average follow-up was 21.6 ± 23.8 months. Ninety-three percent of closure patients had documented resolution of pre-operative pain versus 94.0% of non-closure (p = 0.81). The closure group experienced a higher percentage of post-operative complications, though this did not reach significance (5.5 vs. 2.3%; p = 0.36). Compared to the closure group, the non-closure groups experienced similar post-operative pain (3.6 vs. 1.2%; p = 0.24) and recurrence rate (1.8 vs. 4.0%; p = 0.68). There were no bowel obstructions, surgical site infections, unplanned readmissions, or unplanned re-operations. CONCLUSIONS Equivalent patient outcomes were seen for both procedure types post-operatively and during follow-up. Operative times were significantly shorter for non-closure patients. Larger study population and longer follow-up is necessary to evaluate true long-term complication rates in flap non-closure.
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Nagata J, Watanabe J, Nagata M, Sawatsubashi Y, Akiyama M, Tajima T, Arase K, Minagawa N, Torigoe T, Nakayama Y, Horishita R, Kida K, Hamada K, Hirata K. Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach. Asian J Endosc Surg 2017; 10:336-338. [PMID: 28727314 DOI: 10.1111/ases.12370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/16/2016] [Accepted: 02/07/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. MATERIAL AND SURGICAL TECHNIQUE An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. DISCUSSION This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required.
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Affiliation(s)
- Jun Nagata
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jun Watanabe
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Nagata
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yusuke Sawatsubashi
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaki Akiyama
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takehide Tajima
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichi Arase
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Noritaka Minagawa
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takayuki Torigoe
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshifumi Nakayama
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiko Horishita
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kentaro Kida
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kotaro Hamada
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keiji Hirata
- Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
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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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Hirsch H, Nagatomo K, Gefen J. Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair. J Laparoendosc Adv Surg Tech A 2017; 27:259-263. [PMID: 27893306 PMCID: PMC5369384 DOI: 10.1089/lap.2016.0555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Repair of inguinal hernia is a common procedure, but there is a lack of consensus as to the optimal repair technique along with the use of mesh and methods of mesh fixation. The objective of this study was to evaluate the efficacy and safety of fibrin sealant for mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. MATERIALS AND METHODS A study was conducted of the first 200 patients undergoing TEP hernia repair with mesh fixation using fibrin sealant between March 2012 and January 2014. The primary outcome measures were (1) chronic pain (persisting for >3 months), (2) persistence of hernia (recurrence identified within first 2 weeks postoperatively), (3) hernia recurrence, and (4) any additional perioperative complications. The mean follow-up in the series was 34.4 ± 6.1 months (range 22.2-44.1). RESULTS Of the 278 hernias repaired in 204 patients (74 bilateral, 130 unilateral), 38 were recurrent and 240 were primary. Three patients (1.5%) had a persistent hernia, including one with a planned return to the operating room the next day due to poor visualization. Three patients (1.5%) had a hernia recurrence. Twelve patients (5.9%) reported experiencing chronic pain. The remaining complications were minor and resolved over time. CONCLUSIONS TEP repair of inguinal hernia using mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, unilateral, and bilateral inguinal hernias in adults with minimal recurrence rates and complications during almost 3 years of follow-up.
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Affiliation(s)
- Hank Hirsch
- Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania
| | - Kei Nagatomo
- Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania
| | - Jonathan Gefen
- Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania
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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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Shi Z, Fan X, Zhai S, Zhong X, Huang D. Fibrin glue versus staple for mesh fixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia: a meta-analysis and systematic review. Surg Endosc 2016; 31:527-537. [PMID: 27351657 DOI: 10.1007/s00464-016-5039-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to compare outcomes of mesh fixation using fibrin glue versus staple in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia. METHODS AND PROCEDURES Database searches were carried out in PubMed, Embase, Cochrane Library, Web of Science and Cochrane databases until February 2016 using specific search terms. Studies which compared fibrin glue and staple for mesh fixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled. Outcomes, including inguinal hernia recurrence, chronic inguinal pain, seroma or hematoma formation and operating time, were measured. RESULTS Four randomized controlled trials (RCTs, 430 patients) and six non-randomized controlled trials (non-RCTs, 8637 patients) were analyzed. Meta-analysis of the four RCTs showed no significant difference in hernia recurrence (OR 2.10, 95 % CI 0.61, 7.22), seroma or hematoma formation (OR 0.55, 95 % CI 0.27, 1.14) and operating time (SMD 0.80, 95 % CI -0.34, 1.94). Similarly, there was no significant difference in most of the outcomes of the six non-RCTs. CONCLUSIONS Our meta-analysis and systematic review shows that the use of fibrin glue fixation may provide an alternative approach to staple fixation in TAPP inguinal hernia repair without increasing the postoperative morbidity. Large-scale RCTs with long-term follow-up are still needed to further assess postoperative outcomes such as chronic pain and disease recurrence.
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Affiliation(s)
- Zhaoqi Shi
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou, 310016, China
| | - Xiaoxiao Fan
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou, 310016, China
| | - Shuting Zhai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou, 310016, China
| | - Xin Zhong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou, 310016, China
| | - Diyu Huang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou, 310016, China.
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Tolver MA, Rosenberg J, Bisgaard T. Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review. Surg Endosc 2016; 30:5165-5172. [PMID: 27059966 DOI: 10.1007/s00464-016-4863-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/08/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected prolonged convalescence after laparoscopic inguinal hernia repair. METHODS A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016. Furthermore, snowball search was performed in reference lists of identified articles. Randomized controlled trials and prospective comparative or non-comparative trials of high quality were included. Trials with ≥100 patients, >18 years of age and manuscripts in English were included. Scoring systems were used for assessment of quality. RESULTS The literature search identified 1039 papers. Thirty-four trials were included in the final review including 14,273 patients. There was overall a large variation in duration of convalescence. Trials using non-restrictive recommendations of 1-2 days or "as soon as possible to return to all activities" reported overall a shorter duration of convalescence compared with trials not using recommendations for convalescence. Strenuous physical activity at work, strenuous leisure activity and patients with expectations of a prolonged period of convalescence may be risk factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration of convalescence without increasing risk of pain, complications or recurrence rate.
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Affiliation(s)
- Mette Astrup Tolver
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Thue Bisgaard
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Kettegård Allé 30, 2650, Hvidovre, Denmark
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When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases. Surg Endosc 2016; 30:4363-71. [PMID: 26886454 PMCID: PMC5009149 DOI: 10.1007/s00464-016-4754-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/11/2016] [Indexed: 01/21/2023]
Abstract
Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry. In the period September 01, 2009, to January 31, 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for 1 year. Mesh fixation was used for 7422 (66.1 %) of these patients and no mesh fixation for 3806 patients (33.9 %). Unadjusted analysis did not find any significant difference in the recurrence rate (0.88 % with fixation vs. 1.1 % without fixation; p = 0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation, localization of defect, mesh size) did not identify any factor that impacted recurrence on 1-year follow-up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p < 0.001). With mesh fixation and larger mesh size, it was possible to significantly reduce the recurrence rate for larger medial hernias in this series (p = 0.046). For TAPP repair of an inguinal hernia, mesh fixation is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk of recurrence. In the patient series analyzed, it was possible to significantly reduce the recurrence rate with mesh fixation and larger mesh size for medial defects.
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Meshfixation in open and endoscopic inguinal hernia repair. Eur Surg 2016. [DOI: 10.1007/s10353-015-0376-y] [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]
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Staple Fixation Against Adhesive Fixation in Laparoscopic Inguinal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2015; 25:471-7. [DOI: 10.1097/sle.0000000000000214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antoniou SA, Köhler G, Antoniou GA, Muysoms FE, Pointner R, Granderath FA. Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 2015; 211:239-249.e2. [PMID: 26316363 DOI: 10.1016/j.amjsurg.2015.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/11/2015] [Accepted: 06/29/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence for open groin hernia repair demonstrates less pain with bioglue mesh fixation compared with invasive methods. This study aimed to assess the short- and long-term effects of laparoscopic groin hernia repair with noninvasive and invasive mesh fixation. DATA SOURCES A systematic review of MEDLINE, CENTRAL, and OpenGrey was undertaken. Randomized trials assessing the outcome of laparoscopic groin hernia repair with invasive and noninvasive fixation methods were considered for data synthesis. Nine trials encompassing 1,454 patients subjected to laparoscopic hernia repair with mesh fixation using biologic or biosynthetic glue were identified. Short-term data were inadequate for data synthesis. Chronic pain was less frequently reported by patients subjected to repair with biologic glue fixation than with penetrating methods (odds ratio .46, 95% confidence interval .22 to .93). Duration of surgery, incidence of seroma/hematoma, morbidity, and recurrence were similar. CONCLUSIONS Laparoscopic groin hernia repair with bioglue mesh fixation was associated with a reduced incidence of chronic pain compared with mechanical fixation, without increasing morbidity or recurrence. Longer term data on recurrence are necessary.
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Affiliation(s)
- Stavros A Antoniou
- Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany; Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
| | - Gernot Köhler
- Department of General Surgery, Sisters of Charity Hospital, Linz, Austria
| | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Rudolph Pointner
- Department of General Surgery, Hospital Zell am See, Zell am See, Austria
| | - Frank-Alexander Granderath
- Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany
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Mesh Fixation at Laparoscopic Inguinal Hernia Repair: A Meta-Analysis Comparing Tissue Glue and Tack Fixation. World J Surg 2014; 38:2558-70. [DOI: 10.1007/s00268-014-2547-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Müller SA, Warschkow R, Beutner U, Lüthi C, Ukegjini K, Schmied BM, Tarantino I. Use of human fibrin glue (Tisseel) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty (TISTA): a randomized controlled trial (NCT01641718). BMC Surg 2014; 14:18. [PMID: 24690207 PMCID: PMC3994239 DOI: 10.1186/1471-2482-14-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inguinal hernia repair is one of the most common surgical procedures worldwide. This procedure is increasingly performed with endoscopic techniques (laparoscopy). Many surgeons prefer to cover the hernia gap with a mesh to prevent recurrence. The mesh must be fixed tightly, but without tension. During laparoscopic surgery, the mesh is generally fixed with staples or tissue glue. However, staples often cause pain at the staple sites, and they can cause scarring of the abdominal wall, which can lead to chronic pain. We designed a trial that aims to determine whether mesh fixation with glue might cause less postoperative pain than fixation with staples during a transabdominal preperitoneal patch plastic repair. METHODS/DESIGN The TISTA trial is a prospective, randomized, controlled, single-center trial with a two-by-two parallel design. All patients and outcome-assessors will be blinded to treatment allocations. For eligibility, patients must be male, ≥18 years old, and scheduled for laparoscopic repair of a primary inguinal hernia. One group comprises patients with a unilateral inguinal hernia that will be randomized to receive mesh fixation with either tissue glue or staples. The second group comprises patients with bilateral inguinal hernias. They will be randomized to receive mesh fixation with tissue glue either on the right or the left side and with staples on the other side. The primary endpoint will be pain under physical stress, measured at 24 h after surgery. Pain will be rated by the patient based on a numeric rating scale from 0 to 10, where 10 equals the worst pain imaginable. A total of 82 patients will be recruited (58 patients with unilateral inguinal hernias and 24 patients with bilateral hernias). This number is estimated to provide 90% power for detecting a pain reduction of one point on a numeric rating scale, with a standard deviation of one. DISCUSSION Patients with bilateral hernias will receive two meshes, one fixed with glue, and the other fixed with staples. This design will eliminate the inter-individual bias inherent in comparing pain measurements between two groups of patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT01641718.
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Affiliation(s)
- Sascha A Müller
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
| | - Rene Warschkow
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, D-69120 Heidelberg, Germany
| | - Ulrich Beutner
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
| | - Cornelia Lüthi
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
| | - Kristjan Ukegjini
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
| | - Bruno M Schmied
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
| | - Ignazio Tarantino
- Department of Surgery, Kantonsspital St.Gallen, CH-9007 St. Gallen, Switzerland
- Department of Surgery, Heidelberg University Hospital, D-69120 Heidelberg, Germany
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Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2014; 18:151-63. [PMID: 24647885 DOI: 10.1007/s10029-014-1236-6] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. METHODS The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. RESULTS For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). CONCLUSIONS Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015.
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Martinez V, Baudic S, Fletcher D. Douleurs chroniques postchirurgicales. ACTA ACUST UNITED AC 2013; 32:422-35. [DOI: 10.1016/j.annfar.2013.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
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EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc 2013; 27:3505-19. [PMID: 23708718 DOI: 10.1007/s00464-013-3001-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
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Sajid MS, Ladwa N, Kalra L, McFall M, Baig MK, Sains P. A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 2013; 206:103-11. [PMID: 23388426 DOI: 10.1016/j.amjsurg.2012.09.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 12/25/2011] [Accepted: 09/23/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to systematically analyze the randomized trials comparing tacker mesh fixation with glue mesh fixation (GMF) in laparoscopic inguinal hernia repair (LIHR). METHODS Standard electronic database were searched to retrieve relevant randomized trials comparing tacker mesh fixation with GMF in LIHR, which were analyzed systematically using RevMan. RESULTS Five randomized controlled trials encompassing 1,001 patients were retrieved from the electronic databases. In a random-effects model, operating time, postoperative pain, postoperative complications, length of hospital stay and risk for hernia recurrence were statistically comparable between the 2 techniques of mesh fixation in LIHR. However, GMF was associated with a reduced risk for developing chronic groin pain. CONCLUSIONS GMF in LIHR does not increase the risk for hernia recurrence and reduces the risk for developing chronic groin pain. It is comparable with tacker mesh fixation in terms of operation time, postoperative pain, postoperative complications, length of hospital stay, and risk for hernia recurrence.
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Affiliation(s)
- Muhammad S Sajid
- Department of General and Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK.
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Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair. Surg Endosc 2013; 27:2727-33. [PMID: 23355162 DOI: 10.1007/s00464-012-2766-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Preliminary studies have indicated clinical advantages of mesh fixation using fibrin glue in transabdominal preperitoneal groin hernia repair (TAPP) compared with tack fixation. The aim of this randomized double-blinded, controlled, clinical trial is to compare fibrin glue with tacks fixation of mesh during TAPP. METHODS One hundred and twelve men with unilateral inguinal hernia were enrolled. Primary outcome was pain during coughing on postoperative day 1. Secondary outcomes were postoperative scores of pain at rest, discomfort, and fatigue (day 1 and cumulated day 0-3), incidence of moderate/severe nausea and/or vomiting, foreign-body sensation, and recurrence after 6 months. Outcome measures were assessed by visual analogue scale (VAS, 0-100 mm), verbal rating scale (no, light, moderate or severe) and numerical rating scales (NRS, 1-10). RESULTS One hundred patients were available for analysis. The fibrin group (n = 50) had significantly less pain during coughing on day 1 compared with the tacks group (n = 50) [median 23 (range 0-80) vs 35 (2-100) mm] (p = 0.020). Moreover, day 1 scores and all cumulated scores of pain during rest, discomfort, and fatigue were significantly lower in the fibrin group compared with the tacks group (all p-values ≤ 0.02). There was no significant difference in the incidence of nausea and/or vomiting (p > 0.05) or recurrence (fibrin glue n = 2, tacks n = 0, p = 0.241). Incidence of foreign-body sensation was significantly lower in the fibrin group at 1 month (p = 0.006). CONCLUSIONS Fibrin glue compared with tacks fixation improved the early postoperative outcome after TAPP. The trial was registered at clinicaltrials.gov NCT01000116.
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Haltmeier T, Groebli Y. Small bowel lesion due to spiral tacks after laparoscopic intraperitoneal onlay mesh repair for incisional hernia. Int J Surg Case Rep 2013; 4:283-5. [PMID: 23357009 DOI: 10.1016/j.ijscr.2012.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/21/2012] [Accepted: 12/18/2012] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Laparoscopic intraperitoneal onlay mesh (IPOM) repair has become a widely accepted operative technique for incisional hernias. However, tack fixation poses the risk of adhesions and injury to the intestine. We report the case of spiral tacks adherent to the small bowel after IPOM repair for incisional hernia. PRESENTATION OF CASE 64 years old male patient who underwent laparoscopic IPOM repair for incisional hernia 1 year after open sigmoid resection. A laminated polypropylene mesh was fixed with titanium spiral tacks. 4 years later, elective open cholecystectomy was performed. Two spiral tacks integrated in the seromusular layer of the small bowel were encountered. Tacks were removed and bowel lesions oversewn with interrupted seromuscular stitches. DISCUSSION According to the current literature, complications related to metal spiral tacks in IPOM mesh repair such as intestinal perforation or strangulation ileus seem to be rare. To our knowledge, spiral tacks adherent to the intestine have not yet been published to date. Alternative techniques for mesh fixation are transfascial sutures with single stitches, continuous sutures or fibrin glue, as already used in TAPP and TEP procedures for inguinal hernia repair. The ideal and safest technique for mesh fixation in IPOM repair for incisional hernias remains controversial. CONCLUSION Spiral tacks used for intraperitoneal mesh fixation can lead to adhesions and bowel lesions. Sutures, absorbable tacks or fibrin glue are alternatives for mesh fixation. Further clinical trials are needed to evaluate the safest technique of laparoscopic IPOM incisional hernia repair.
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Affiliation(s)
- Tobias Haltmeier
- Department of Surgery, Hospital of Neuchâtel, Rue de la Maladière, 2000 Neuchâtel, Switzerland.
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Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal (TEP) groin hernia repairs using fibrin glue (Tisseel™): a United Kingdom experience. Hernia 2012; 16:647-53. [DOI: 10.1007/s10029-012-0936-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
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TOLVER MA, ROSENBERG J, BISGAARD T. Early pain after laparoscopic inguinal hernia repair. A qualitative systematic review. Acta Anaesthesiol Scand 2012; 56:549-57. [PMID: 22260427 DOI: 10.1111/j.1399-6576.2011.02633.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early post-operative pain after laparoscopic groin hernia repair may, as in other laparoscopic operations, have its own individual pain pattern and patient-related predictors of early pain. The purpose of this review was to characterise pain within the first post-operative week after transabdominal pre-peritoneal repair (TAPP) and total extraperitoneal repair (TEP), and to identify patient-related predictors of early pain. METHODS A qualitative systematic review was conducted. Pubmed, Embase, CINAHL, and the Cochrane database were searched for studies on early pain (first week) after TAPP or TEP. RESULTS We included 71 eligible studies with 14,023 patients. Post-operative pain is most severe on day 0 and mainly on a level of 13-58 mm on a visual analogue scale and decreases to low levels on day 3. There seems to be no difference in pain intensity and duration when TEP and TAPP are compared. Deep abdominal pain (i.e. groin pain/visceral pain) dominates over superficial pain (i.e. somatic pain) and shoulder pain (i.e. referred pain) after TAPP. Predictors of early pain are young age and pre-operative high pain response to experimental heat stimulation. Furthermore, evidence supported early pain intensity as a predictive risk factor of chronic pain after laparoscopic groin hernia repair. CONCLUSION Early pain within the first week after TAPP and TEP is most severe on the first post-operative day, and the pain pattern is dominated by deep abdominal pain. Early post-operative pain is most intense in younger patients and can be predicted by pre-operative high pain response to experimental heat stimulation.
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Affiliation(s)
- M. A. TOLVER
- Department of Surgery; Køge Hospital, University of Copenhagen; Copenhagen; Denmark
| | - J. ROSENBERG
- Department of Surgery; Herlev Hospital, University of Copenhagen; Copenhagen; Denmark
| | - T. BISGAARD
- Department of Surgery; Køge Hospital, University of Copenhagen; Copenhagen; Denmark
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Tolver MA, Strandfelt P, Forsberg G, Hjørne FP, Rosenberg J, Bisgaard T. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 2012; 151:556-63. [DOI: 10.1016/j.surg.2011.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 08/18/2011] [Indexed: 11/15/2022]
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The Glubran 2 glue for mesh fixation in Lichtenstein's hernia repair: a double-blind randomized study. Wideochir Inne Tech Maloinwazyjne 2012; 7:96-104. [PMID: 23256009 PMCID: PMC3516972 DOI: 10.5114/wiitm.2011.27429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 11/10/2011] [Accepted: 02/13/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction With an average incidence rate of 11%, chronic pain is considered the most serious complication of inguinal hernioplasty after surgical site infection. One of the proposed solutions to this problem is to use tissue adhesive for mesh fixation, which helps prevent nerve and tissue damage. Aim The goal of this study was to compare mesh fixation with the use of sutures vs. adhesive in Lichtenstein's inguinal hernia repair in a randomized, double-blind one-center study. Material and methods The study group consisted of 41 males with primary inguinal hernia undergoing Lichtenstein's repair (20 – adhesive; 21 – suture) and remaining in follow-up from July 2008 to November 2010. Randomization took place during the operation. The follow-up was performed by one surgeon (blinded) according to a pre-agreed schedule; the end-of-study unblinding was performed during the last follow-up visit, usually 16 months postoperatively. Results In 1 patient from the “adhesive” group, a recurrence was observed one year after the initial repair. The early postoperative pain was less intense in this group. In later postoperative periods the method of mesh fixation had no influence on the pain experienced by the patient. Other complications were not correlated with the method of mesh fixation. Conclusions In this randomized, one-center double-blind clinical study of males with primary inguinal hernia it has been show during follow-up that the use of Glubran 2 cyanoacrylate adhesive for mesh implant fixation yields similar recurrence and chronic pain rates as the classical suture technique. In the early postoperative period, the pain reported by these patients was relatively weaker; patients undergoing adhesive mesh fixation experienced a quicker return to daily household activities.
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Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review. Surg Endosc 2012; 26:1803-12. [PMID: 22278103 DOI: 10.1007/s00464-012-2156-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/15/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Abdominal wall and inguinal hernia repair are the most frequently performed surgical procedures in the United States and Europe. However, traditional methods of mesh fixation are associated with a number of problems including substantial risks of recurrence and of postoperative and chronic pain. The aim of this systematic review is to summarize the clinical safety and efficacy of Tisseel/Tissucol fibrin sealant for hernia mesh fixation. METHODS A PubMed title/abstract search was conducted using the following terms: (fibrin glue OR fibrin sealant OR Tisseel OR Tissucol) AND hernia repair. The bibliographies of the publications identified in the search were reviewed for additional references. RESULTS There were 36 Tisseel/Tissucol studies included in this review involving 5,993 patients undergoing surgery for hernia. In open repair of inguinal hernias, Tisseel compared favorably with traditional methods of mesh fixation, being associated with shorter operative times and hospital stays and a lower incidence of chronic pain. Similarly, after laparoscopic/endoscopic inguinal hernia repair, Tisseel/Tissucol was associated with less use of postoperative analgesics and less acute and chronic postoperative pain than tissue-penetrating mesh-fixation methods. Other end points of concern to surgeons and patients are the risks of inguinal hernia recurrence and of complications such as hematoma formation and intraoperative bleeding. Comparative studies show that Tisseel/Tissucol does not increase the risk of these outcomes and may, in fact, decrease the risk compared with tissue-penetrating fixation methods. When used in the repair of incisional hernias, Tisseel/Tissucol significantly decreased both postoperative morbidity and duration of hospital stay. CONCLUSIONS Clinical evidence published to date supports the use of Tisseel/Tissucol as an option for mesh fixation in open and laparoscopic/endoscopic repair of inguinal and incisional hernias. Guidelines of the International Endohernia Society recommend fibrin sealant mesh fixation, especially in inguinal hernia repair. Nonfixation is reserved for selected cases.
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Kosai N, Sutton PA, Evans J, Varghese J. Laparoscopic preperitoneal mesh repair using a novel self-adhesive mesh. J Minim Access Surg 2011; 7:192-4. [PMID: 22022105 PMCID: PMC3193763 DOI: 10.4103/0972-9941.83514] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 07/22/2010] [Indexed: 11/04/2022] Open
Abstract
Prosthetic mesh is now used routinely in inguinal hernia repairs, although its fixation is thought to be a potential cause of chronic groin pain. The Parietene ProGrip™ (TYCO Healthcare) mesh, which is semi-resorbable and incorporates self-fixing properties, has been shown to provide satisfactory repair in open surgery. We describe the use of this mesh in TAPP hernia repair, which has not previously been reported in the literature. A prospective study of 29 patients showed a mean operative time to be 47.6 min, with 96% of patients discharged home on the day of surgery or the day after. Visual analog pain scales (out of 10) reduced from 4 preoperatively to 0 at 6 months, and only 1 patient suffered a minor wound complication. The use of this mesh in transabdominal preperitoneal hernia repair is therefore feasible, safe, and may reduce postoperative pain.
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Affiliation(s)
- Nik Kosai
- Department of Surgery, Royal Bolton Hospital, Bolton, United Kingdom
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Brügger L, Bloesch M, Ipaktchi R, Kurmann A, Candinas D, Beldi G. Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks. Surg Endosc 2011; 26:1079-85. [DOI: 10.1007/s00464-011-2003-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/07/2011] [Indexed: 10/16/2022]
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Prospective, Comparative Study of Postoperative Quality of Life in TEP, TAPP, and Modified Lichtenstein Repairs. Ann Surg 2011; 254:709-14; discussion 714-5. [DOI: 10.1097/sla.0b013e3182359d07] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Eriksen JR, Bisgaard T, Assaadzadeh S, Jorgensen LN, Rosenberg J. Randomized clinical trial of fibrin sealant versus titanium tacks for mesh fixation in laparoscopic umbilical hernia repair. Br J Surg 2011; 98:1537-45. [PMID: 21964681 DOI: 10.1002/bjs.7646] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of tacks for mesh fixation may induce pain after surgery for ventral hernia. The aim of this study was to compare postoperative pain after laparoscopic ventral hernia repair (LVHR) with conventional mesh fixation using titanium tacks versus fibrin sealant (FS). METHODS This randomized clinical trial included patients with an umbilical hernia defect ranging from 1·5 to 5 cm at three Danish hernia centres. Participants were assigned randomly to FS or titanium tack fixation. The primary outcome was acute pain, defined as the mean pain score on days 0-2 after surgery, measured on a 0-100-mm visual analogue scale (VAS). RESULTS Forty patients were included, of whom 38 were available for intention-to-treat analysis after 1 month. Patients in the FS group reported less pain than those in the tack group on days 0-2, both at rest (median 19 versus 47 mm; P = 0·025) and during activity (38 versus 60 mm; P = 0·014). The absolute difference in pain score between groups was 19 (95 per cent confidence interval 3 to 34) and 20 (4 to 35) mm at rest and during activity respectively. Patients in the FS group resumed normal daily activity earlier (after median 7 versus 18 days; P = 0·027) and reported significantly less discomfort. No recurrences were observed. CONCLUSION Mesh fixation with FS in LVHR was associated with less acute postoperative pain, discomfort and a shorter convalescence than tack fixation. Long-term follow-up is needed to show whether the effect of FS fixation persists in terms of chronic pain and recurrence. REGISTRATION NUMBER NCT00842842 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J R Eriksen
- Surgical Department Z/D, Gentofte and Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
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Tolver MA, Strandfelt P, Rosenberg J, Bisgaard T. Pain characteristics after laparoscopic inguinal hernia repair. Surg Endosc 2011; 25:3859-64. [PMID: 21688078 DOI: 10.1007/s00464-011-1810-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 05/19/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP). METHODS The study was a single-centre prospective trial including 50 consecutive male patients with primary or recurrent inguinal and/or femoral hernia undergoing elective repair. Several pain components (visceral pain, incisional pain and shoulder pain) were studied as well as pain at the three different trocar incisions. Pain was recorded before operation and on a daily basis during the first four postoperative days using a visual analogue and a verbal rating scale. We used 1 × 12 and 2 × 5 mm trocars for TAPP. RESULTS A total of 46 patients were available for analyses (age median 58 years, range 27-69 years). Visceral pain dominated significantly compared with incisional pain (P < 0.01), which again dominated over shoulder pain intensity and incidence (P < 0.01). Pain intensity did not significantly differ between different trocar incisions (5 and 12 mm) (P > 0.05). The overall pain intensity (a conglomerate of the different pain components) was most intense 3 h after TAPP and declined to preoperative levels on day 3 (P > 0.5). CONCLUSION Pain was most intense 3 h after the operation and declined to low levels within the first 3 days. Visceral pain was by far the dominating pain component compared with incisional and shoulder pain.
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Affiliation(s)
- Mette A Tolver
- Department of Surgery, Køge Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Denmark.
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Linderoth G, Kehlet H, Aasvang EK, Werner MU. Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Hernia 2011; 15:521-9. [PMID: 21479588 DOI: 10.1007/s10029-011-0815-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 03/18/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim of the study was to describe and classify patients with severe persistent pain after laparoscopic herniorrhaphy. METHODS Eleven patients with severe persistent pain following laparoscopic inguinal herniorrhaphy were assessed in detail by their medical history, questionnaires (impairments of daily activities, pain description, psychological parameters, socio-economic status), physical examination, sensory mapping, and quantitative sensory testing. RESULTS The median time since operation was 2 years (range 1-14 years). Ten patients experienced pain in the inguinal region and five patients had pain outside the inguinal region. Based upon the clinical pain pattern and the detailed quantitative sensory testing, the patients could be separated into three different entities, suggesting different pathogenic mechanisms leading to the persistent pain state. Four patients experienced dysejaculation. Six patients were unemployed or retired due to the postherniorrhaphy pain. CONCLUSIONS These results suggest that patients with severe persistent pain after laparoscopic inguinal herniorrhaphy belong to distinctive subgroups with indicators of either neuropathic, inflammatory, or mechanical irritation from the mesh, or a combination of these symptoms. The findings of a number of pain localizations outside the inguinal region demarcate it from persistent pain following open groin hernia repair. A classification based on a larger study group is required in order to define mechanism-based treatment strategies.
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Affiliation(s)
- G Linderoth
- Section of Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen, Denmark
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One-year results of a prospective, randomised clinical trial comparing four meshes in laparoscopic inguinal hernia repair (TAPP). Hernia 2011; 15:503-10. [DOI: 10.1007/s10029-011-0810-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Morales-Conde S, Barranco A, Socas M, Alarcón I, Grau M, Casado MA. Systematic review of the use of fibrin sealant in abdominal-wall repair surgery. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2011. [PMID: 21452012 DOI: 10.1007/s10029-011-0809-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Our objective was to analyze the advantages and inconveniences associated with the use of fibrin sealant compared with mechanical means for mesh fixation following abdominal-wall surgery. METHODS Literature search was conducted in MedLine, EMBASE, and Cochrane Library Plus databases. Articles were randomized clinical trials, nonrandomized comparative studies, and case series containing at least ten patients. RESULTS The fibrin sealant was shown to be biocompatible with the surrounding tissue. In patients treated with fibrin sealant, lower prevalence of acute and chronic postoperative pain was observed, and less hemorrhagic complications occurred. There are no data on the influence of fibrin sealant on seroma decrease. Efficiency in experimental models was similar to that observed for mechanical methods of fixation. Also, adhesions with fibrin sealant were less than that for mechanical methods. CONCLUSIONS Compared with mechanical methods, fibrin sealant is an efficacious alternative for mesh fixation postsurgery of the abdominal wall.
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Affiliation(s)
- S Morales-Conde
- Advanced Laparoscopic Unit, University Hospital Virgen del Rocío, Betis-65, 1°, 41010, Seville, Spain.
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Morales-Conde S, Barranco A, Socas M, Alarcón I, Grau M, Casado MA. Systematic review of the use of fibrin sealant in abdominal-wall repair surgery. Hernia 2011; 15:361-9. [PMID: 21452012 DOI: 10.1007/s10029-011-0809-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 03/04/2011] [Indexed: 11/30/2022]
Affiliation(s)
- S Morales-Conde
- Advanced Laparoscopic Unit, University Hospital Virgen del Rocío, Betis-65, 1°, 41010, Seville, Spain.
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