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Choi MJ, Lee KS, Oh HK, Ahn SH, Ahn HM, Shin HR, Lee TG, Jo MH, Kim DW, Kang SB. Comparative analysis of different surgical approaches for recurrent inguinal hernia: a single-center observational study. Ann Surg Treat Res 2024; 106:330-336. [PMID: 38868581 PMCID: PMC11164657 DOI: 10.4174/astr.2024.106.6.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose Managing recurrent inguinal hernias is complex, and choosing the right surgical approach (laparoscopic vs. open) is vital for patient outcomes. This study compared the outcomes of using the same vs. different surgical approaches for initial and subsequent hernia repairs. Methods We retrospectively analyzed patients who underwent recurrent inguinal hernia repair at Seoul National University Bundang Hospital between January 2014 and May 2023. Patients were divided into the "concordant" and "discordant" groups, comprising patients who underwent same and different approaches in both surgeries, respectively. Preoperative baseline characteristics, index surgery data, postoperative outcomes, and recurrence rates were analyzed and compared. Results In total, 131 patients were enrolled; the concordant and discordant groups comprised 31 (open, n = 19; laparoscopic, n = 12) and 100 patients (open to laparoscopic, n = 68; laparoscopic to open, n = 32), respectively. No significant differences were observed in the mean operation time (50.5 ± 21.7 minutes vs. 50.2 ± 20.0 minutes, P = 0.979), complication rates (6.5% vs. 14.0%, P = 0.356), or 36-month cumulative recurrence rates (9.8% vs. 9.8%; P = 0.865). The mean postoperative hospital stay was significantly shorter in the discordant than in the concordant group (1.8 ± 0.7 vs. 1.4 ± 0.6, P = 0.003). Conclusion Most recurrent inguinal hernia repairs were performed using the discordant surgical approach. Overall, concordance in the surgical approach did not significantly affect postoperative outcomes. Therefore, the selection of the surgical approach based on the patient's condition and surgeon's preference may be advisable.
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Affiliation(s)
- Mi Jeong Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kang-Seok Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Rim Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Gyun Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Hyeong Jo
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Szasz P, Mainprize M, Spencer Netto FAC. Muscular groin hernias: an anatomical variation as a cause of recurrence. Hernia 2023; 27:1483-1489. [PMID: 37480501 DOI: 10.1007/s10029-023-02840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/09/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The objective of this study was to understand our center's experience with the rare entity of muscular groin hernias. Specifically, to determine this hernia's incidence and characteristics and provide valuable information to surgeons that can be utilized at the time of a hernia repair regardless of modality used. METHODS This was a retrospective chart review between 2005 and 2019. Patients who had a primary or recurrent groin hernia operation for an atypically located hernia (other than direct, indirect, or femoral) were included. Descriptive statistics were utilized to present the hernia and patient data as median (interquartile range, range). RESULTS There were 152 patients with 155 muscular hernias identified in primary operations and 41 patients with 41 muscular hernias identified in recurrent operations. In both primary and recurrent groups there were more males, and the males were on average younger with a higher body mass index (BMI) than females. Most muscular hernias were located lateral (76) or lateral/superior (33) to the internal ring with a median distance between 2 and 3 cm (1, 0.3-5; 2.8,2-5) from the internal ring. A concurrent ipsilateral inguinal hernia was found and repaired in 42.3% of left and 46.8% of right sided primary muscular hernia operations. A concurrent ipsilateral inguinal hernia was noted in 5% of left and 14.3% of right sided recurrent muscular operations. In left sided recurrent operations for a muscular hernia, 68.9% had a previous ipsilateral inguinal hernia repair and in right sided recurrent operations, 67.7% had a previous ipsilateral inguinal hernia repair. CONCLUSION This study describes a previously unidentified groin muscular hernia in both primary and recurrent hernia operations as a potential cause of hernia recurrence and identifies muscular hernia locations. This information can be utilized at the time of surgery to identify and subsequently repair these defects, leading to improved patient and hernia outcomes.
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Affiliation(s)
- Peter Szasz
- Department of Surgery, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 7N2, Canada.
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Arici S. Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP). Surg Laparosc Endosc Percutan Tech 2023; 33:511-514. [PMID: 37725830 DOI: 10.1097/sle.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair has gained popularity due to its advantages over open procedures. However, technical challenges and anatomical variations can affect surgical outcomes. The umbilicus-symphysis pubis (USP) distance has been identified as a potential factor impacting laparoscopic operations. This study aims to investigate the association between USP distance, technical difficulties, and operative time in the transabdominal preperitoneal (TAPP) surgery. METHODS A retrospective analysis was conducted on 122 patients who underwent elective TAPP surgery. USP distance was measured, and surgical data were collected. Statistical analysis was performed to evaluate the relationship between USP distance and operative time. RESULTS Among the patients, 80 underwent unilateral hernia repair, and 42 underwent bilateral hernia repair. In unilateral repair, USP distance did not significantly affect operative time. However, in bilateral repair, there was a significant association between USP distance and operation time prolongation ( P =0.039). DISCUSSION TAPP surgery presents challenges due to limited visualization and anatomical variations. Factors like USP distance can impact surgical outcomes. A shorter distance increases complexity, while a longer distance facilitates smoother procedures. Surgeons should consider USP distance during surgical planning to optimize outcomes. CONCLUSION The study findings indicate that USP distance is associated with prolonged operative time in TAPP bilateral hernia repair. Surgeons, especially those in the learning phase, can benefit from considering this relationship to optimize surgical outcomes and resource allocation. Further research is needed to validate these findings and explore additional factors influencing operative time in hernia repair surgeries.
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Affiliation(s)
- Sinan Arici
- Department of General Surgery, T.C. Bursa Yüksek İhtisas Training and Research Hospital, Yildirim, Bursa, Turkey
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Spencer Netto FAC, Mainprize M, Yilbas A, Degani C, Svendrovski A, Szasz P. Surgical aspects and early morbidity of patients undergoing open recurrent inguinal hernia repair. Hernia 2023; 27:1225-1233. [PMID: 37140758 DOI: 10.1007/s10029-023-02801-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE This study aims to characterize the patterns of recurrence associated with specific types of primary inguinal hernia repair techniques used for and their respective correlations with early morbidity, in patients undergoing open repair for their first hernia recurrence. METHODS After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant. RESULTS 1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques. CONCLUSIONS Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.
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Affiliation(s)
- F A C Spencer Netto
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | - M Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada.
| | - A Yilbas
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | - C Degani
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | | | - P Szasz
- Department of Surgery, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
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Novel modification of Marcy operation for indirect inguinal hernia reconstituting deep inguinal ring shutter action. Hernia 2023; 27:181-190. [PMID: 36129572 DOI: 10.1007/s10029-022-02682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The two most frequent and significant complications after inguinal hernia repair are hernia recurrence and post-herniorrhaphy chronic pain. To add anatomic and physiologic strength to the tissue repair, especially in indirect inguinal herniorrhaphy, we devised a modification of Marcy operation that can reconstitute inguinal shutter action more efficiently by changing the direction of the sutures vertical to horizontal. METHODS During 36 months from 1st Jan. 2019, 148cases of 140 patients were operated for Indirect inguinal hernia or Pantaloon hernia (11 cases). 145 indirect inguinal herniorrhaphy were performed exclusively with author's modification of Marcy operation. Hernia recurrence during the follow-up period (3 months-36 months), and postoperative chronic pain at 3 months after herniorrhaphy were analyzed. RESULTS 104 cases among the 145 indirect inguinal hernia (71.7%) were operated with only deep inguinal ring (DIR) reconstruction as author modified. In 41 cases (28.3%), posterior wall reconstruction was done simultaneously. There was no recurrence or reoperation case during the follow-up period. The incidence of postoperative chronic pain at postoperative 3 months of VAS greater than 3.0 was 2.2% (3 cases). CONCLUSIONS Author's modification of Marcy operation was feasible anatomically in all indirect inguinal hernia repair, which is theoretically superior to classic Marcy operation in that repositioning the DIR more laterally and securing the obliquity and shutter action of the DIR. Result is at least not inferior in the aspect of short-term recurrence and chronic post-herniorrhaphy pain.
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Chen J, Glasgow RE. What is the Best Inguinal Hernia Repair? Adv Surg 2022; 56:247-258. [PMID: 36096570 DOI: 10.1016/j.yasu.2022.02.007] [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] [Indexed: 06/15/2023]
Abstract
As the management of inguinal hernias have evolved over hundreds of years, so too has our paradigm of what constitutes the "best repair." To best answer what the ideal inguinal hernia repair is, the authors take an in-depth look at considerations to the patient, the provider, and the health care system.
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Affiliation(s)
- Jennwood Chen
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Veterans Affairs, Department of Surgery, 550 Foothill Dr, Salt Lake City, UT 84113, USA.
| | - Robert E Glasgow
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, 1950 Circle of Hope, Salt Lake City, UT 84112, USA.
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Guillaumes S, Juvany M. Inguinal hernia repairs performed for recurrence in Spain: population-based study of 16 years and 1,302,788 patients. Hernia 2022; 26:1023-1032. [PMID: 35624186 DOI: 10.1007/s10029-022-02630-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to assess data on inguinal hernia repairs (IHR) performed for recurrence over a 16 year period (2004-2019) in Spain. METHODS A retrospective cohort study of 1,302,788 patients who underwent IHR from January 2004 to December 2019 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary objective was to analyse the proportion of IHR performed by recurrence. As secondary objectives, we evaluated factors related to recurrent hernia (analysed by univariate analysis and multivariable logistic regression analysis) and trends in the recurrent case rate over the 16 year period. RESULTS We identified 95,025 patients (7.3% of all IHR) who underwent surgery for recurrent inguinal hernia. Patients undergoing recurrent IHR were more likely to be male (OR 1.687, 95% CI 1.645-1.730), elderly (age > 74 years), and more complicated when they arrived in the operating room (gangrene OR 3.951, 95% CI 3.734-4.180; occlusion OR 1.905, 95% CI 1.853-1.960), and thus had more surgical site occurrences and related mortality. The proportion of IHR performed for recurrence has been dropping over the years (8.7% in 2004 vs. 6.5% in 2019, p < 0.005). CONCLUSION The rate of recurrent IHR in Spain (2004-2019) is 7.3%. Recurrent IHR correlates to emergent and complicated surgery and thus to a worst outcome. The trend of this 16 year period is of decreasing operated recurrent inguinal hernia. This is good news even though the improvement is slight and certainly insufficient. Establishing and optimising the rate of hernia recurrence is important for patients and for the health-care system.
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Affiliation(s)
- S Guillaumes
- Department of Gastrointestinal Surgery, Hospital Clinic de Barcelona, Clinic-Plató. C/Plató 21, 08006, Barcelona, Spain.
| | - M Juvany
- Department of Surgery, Hospital Universitari de Granollers, Universitat Internacional de Catalunya, Granollers, Spain
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Novik B, Sandblom G, Ansorge C, Thorell A. Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs. J Am Coll Surg 2022; 234:311-325. [PMID: 35213495 PMCID: PMC8834140 DOI: 10.1097/xcs.0000000000000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND International guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair. STUDY DESIGN All TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs. RESULTS Of 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6). CONCLUSIONS With StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.
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Affiliation(s)
- Bengt Novik
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
- the Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden (Novik)
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Gabriel Sandblom
- the Department of Clinical Science and Education, South Hospital (Sandblom), Karolinska Institutet, Stockholm, Sweden
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Christoph Ansorge
- the Department of Clinical Science, Interventions and Technology (Ansorge), Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
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Koppatz H, Takala S, Peltola K, But A, Mäkisalo H, Nordin A, Sallinen V. Gallbladder cancer epidemiology, treatment and survival in Southern Finland - a population-based study. Scand J Gastroenterol 2021; 56:929-939. [PMID: 34224306 DOI: 10.1080/00365521.2021.1915373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Gallbladder cancer (GBC) is a rare malignancy in Western population with poor prognosis. This study aimed to investigate the trends in GBC incidence, treatment pattern, and survival in Finland. METHODS Patients diagnosed with primary GBC in a geographically defined area (Southern Finland Regional Cancer Center) during 2006-2017 were identified. RESULTS Final cohort included 270 patients with GBC. The incidence was 1.32/100,000 persons, and it decreased 6.8 cases per million personyears during the study period. One hundred fifty-one (56%) patients were diagnosed at Stage IV. Fifty-one patients (19%) underwent curative-intent resection with 96% R0-resection rate. The median overall survival was 7.1 months and 5-year overall survival 11.6% for all patients, and 67.7 months and 56.8% after curative-intent resection, respectively. No improvement was noted over time in overall survival in patients with GBC, or in subgroups of different stages of GBC. CONCLUSIONS The incidence of GBC is slightly decreasing in Southern Finland, but survival has not improved over time.
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Affiliation(s)
- Hanna Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sini Takala
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katriina Peltola
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna But
- Biostatistics consulting, Department of Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Mäkisalo
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Guillaumes S, Hoyuela C, Hidalgo NJ, Juvany M, Bachero I, Ardid J, Martrat A, Trias M. Inguinal hernia repair in Spain. A population-based study of 263,283 patients: factors associated with the choice of laparoscopic approach. Hernia 2021; 25:1345-1354. [PMID: 33837883 DOI: 10.1007/s10029-021-02402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study is to evaluate the laparoscopic inguinal hernia repair (IHR) rate in Spain and identify the factors associated with the choice of this surgical approach. METHODS A retrospective cohort study of 263,283 patients who underwent IHR from January 2016 to December 2018 was conducted. Data were extracted from the Spanish Minimum Basic Data Set (MBDS) of the Health Ministry database. The primary outcome was laparoscopic (LAP) rate utilization. Univariate analysis and multivariable logistic regression analysis were performed to identify factors associated with LAP-IHR. RESULTS Only 5.7% (15,059) patients underwent LAP-IHR, whereas the remnant 94.3% (248,224 patients) underwent open repair. High variability in the LAP-IHR rate across the country was observed; ranged between provinces from 0 to 19.7%, for a unilateral hernia, and between 0 to 57.4% in the case of bilateral hernias. On multivariate logistic regression analysis, the patient place of residence was the most remarkable factor associated with the likelihood of receiving LAP-IHR (OR 4.96; p < 0.001). There were also significant differences favoring LAP-IHR for bilateral operation (OR 4.596; p < 0.001), insurance coverage (OR 4.439, p < 0.001) and self-pay patients (OR 2.317; p < 0.001), as well as a recurrent hernia (OR 1.780; p < 0.001), age younger than 65 years (OR 1.555; p < 0.001) and male sex (OR 1.162, p < 0.001). CONCLUSION LAP-IHR remains a not frequent choice among surgeons in Spain, even when dealing with recurrent and bilateral hernias. The results suggest that the choice of LAP-IHR could depend on the surgeon's preference rather than on the indication appropriateness.
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Affiliation(s)
- S Guillaumes
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain.
| | - C Hoyuela
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - N J Hidalgo
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Juvany
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - I Bachero
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - J Ardid
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - A Martrat
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
| | - M Trias
- Department of General and Digestive Surgery, Hospital Plató, c/ Plató 21, 08006, Barcelona, Spain
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Hassan M, Stutsrim AE, J Clark C. Large Canal of Nuck Hernia: The Female Equivalent of the Inguinoscrotal Hernia. Am Surg 2021:3134821998672. [PMID: 33626888 DOI: 10.1177/0003134821998672] [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: 11/16/2022]
Abstract
Our patient was a 78-year-old woman with a large indirect inguinal hernia who underwent Lichtenstein repair. Literature review of the pathophysiology of indirect hernias revealed important discussion of the canal of Nuck in women and understanding embryologic development of ovaries and descent of testes.
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Affiliation(s)
- Monalisa Hassan
- Department of General Surgery, 20814Howard University Hospital, Washington, DC, USA
| | - Ashlee E Stutsrim
- Department of General Surgery, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of General Surgery, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Shouldice standard 2020: review of the current literature and results of an international consensus meeting. Hernia 2021; 25:1199-1207. [PMID: 33502639 DOI: 10.1007/s10029-020-02365-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION For many years the Shouldice technique was the gold standard for inguinal hernia repair. Nowadays mesh repair has been proven to entail better results in randomized trials. Since the first publication 1953 the Repair has been described in detail in many textbooks, articles and You Tube videos. It appears that the original technique is used almost exclusively in the Shouldice Hospital in Thornhill/ Canada and despite the success of the Shouldice Hospital many surgeons inexplicably modify this original technique in their daily practice. In the last couple of years there appears to be an increasing interest in pure tissue repairs for various reasons, often fear of mesh-related pain. The aim of the study was to review the current evidence and to define an updated standard with key principles of the Shouldice repair. METHODS Because of unpublished evidence regarding many operative details the organizing group decided to create a technical update via a consensus meeting with 13 international designated hernia surgeons from six countries. In preparation of the meeting a review of the current literature regarding Shouldice repair was done by the organizing group. A questionnaire was prepared and sent to all participants before the meeting to get an independent answer on all critical aspects. RESULTS All questions regarding a detailed standard of the operation technique could be outlined. As result of the consensus meeting the participants have formulated all key-points of preparation/dissection and repair of the Shouldice technique. For 5 of 6 critical technical surgical steps a strong consensus could be defined in the group. There was no consensus among the group regarding the cremaster resection and the ideal indication for Shouldice repair. CONCLUSION After a 75-year history of the Shouldice repair the technique should continue to merit consideration by all hernia surgeons. After this consensus meeting a clear binding standard of the Shouldice technique for all interested surgeons is proposed.
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Gram-Hanssen A, Jessen ML, Christophersen C, Zetner D, Rosenberg J. Trends in the use of patient-reported outcome measures for inguinal hernia repair: a quantitative systematic review. Hernia 2020; 25:1111-1120. [PMID: 33074397 DOI: 10.1007/s10029-020-02322-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To quantitatively assess the use of patient-reported outcome measures in studies involving patients undergoing inguinal hernia repair. METHODS We performed a systematic literature search in Medline and EMBASE. We included all studies published between 2000 and 2019 that involved > 5 patients receiving inguinal hernia repair and evaluated a postoperative patient-reported outcome measure. Studies were stratified in 5-year intervals. We extracted data on which patient-reported outcome measure was used, its time of administration, study design, and the size and composition of the study population. Data were presented using descriptive statistics. RESULTS We included 929 studies that covered 81 different patient-reported outcome measures. Of these, the Short-Form 36 was the most commonly used generic instrument (14%), the Carolinas Comfort Scale was the most commonly used hernia-specific instrument (5%), and the Visual Analogue Scale was the most commonly used domain-specific instrument (70%). There was a proportional decrease in the use of generic instruments, from 24% of studies in 2000-2004 to only 14% of studies in 2015-2019. Conversely, there was an increase in the use of hernia-specific instruments, from 0% in 2000-2004 to 18% in 2015-2019. CONCLUSIONS There is heterogeneity in the use of patient-reported outcome measures in the field of inguinal hernia research. The use of hernia-specific instruments is increasing, the use of generic instruments is decreasing, and the use of domain-specific instruments remains consistently high. This study serves as a repository of all available patient-reported outcome measures relevant to patients undergoing inguinal hernia repair.
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Affiliation(s)
- A Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - M L Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - C Christophersen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - D Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Koppatz HE, Harju JI, Sirén JE, Mentula PJ, Scheinin TM, Sallinen VJ. Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study. Surg Endosc 2019; 34:4857-4865. [PMID: 31754852 PMCID: PMC7572346 DOI: 10.1007/s00464-019-07266-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Three-dimensional (3D) laparoscopy improves technical efficacy in laboratory environment, but evidence for clinical benefit is lacking. The aim of this study was to determine whether the 3D laparoscopy is beneficial in transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP). METHOD In this prospective, single-blinded, single-center, superior randomized trial, patients scheduled for TAPP were randomly allocated to either 3D or two-dimensional (2D) TAPP laparoscopic approaches. Patients were excluded if secondary operation was planned, the risk of conversion was high, or the surgeon had less than five previous 3D laparoscopic procedures. Patients were operated on by 13 residents and 3 attendings. The primary endpoint was operation time. The study was registered in ClinicalTrials.gov (NCT02367573). RESULTS Total 278 patients were randomized between 5th February 2015 and 23rd October 2017. Median operation time was shorter in the 3D group (56.0 min vs. 68.0 min, p < 0.001). 10 (8%) patients in 3D group and 6 (5%) patients in 2D group had clinically significant complications (Clavien-Dindo 2 or higher) (p = 0.440). Rate of hernia recurrence was similar between groups at 1-year follow-up. In the subgroup analyses, operation time was shorter in 3D laparoscopy among attendings, residents, female surgeons, surgeons with perfect stereovision, surgeons with > 50 3D laparoscopic procedures, surgeons with any experience in TAPP, patients with body mass indices < 30, and bilateral inguinal hernia repairs. CONCLUSION 3D laparoscopy is beneficial and shortens operation time but does not affect safety or long-term outcomes of TAPP.
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Affiliation(s)
- Hanna E Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Jukka I Harju
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Jukka E Sirén
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Panu J Mentula
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Tom M Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Ville J Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland. .,Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Pure tissue repairs: a timely and critical revival. Hernia 2019; 23:493-502. [DOI: 10.1007/s10029-019-01972-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 12/18/2022]
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Mesh erosion into urinary bladder, rare condition but important to know. Hernia 2019; 23:709-716. [PMID: 31073962 DOI: 10.1007/s10029-019-01966-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although rare, mesh migration or erosion into viscera has been reported as case report, and most of the cases involved with the urinary bladder. With the increasing use of prosthetic mesh in hernia repair, this severe complication would increase in the future; thus, we feel that it is necessary to analyze the clinical patterns of mesh erosion into the urinary bladder, and to discuss the prevention and treatment of this severe complication. METHOD In the present study, we made a thorough identification of all published reports on mesh migration or erosion into the urinary bladder, and the data were summarized, analysed, and discussed. RESULTS A total of 23 cases of mesh erosion into urinary bladder were reported since 1994. Among them, two cases were from incisional hernia repairs, and 21 cases were following inguinal hernia repairs. The most frequently reported procedures were TAPP, followed by TEP. The duration from initial hernia repair to the onset of mesh erosion into bladder varied greatly (3 months-20 years), and most of cases occurred in 1-5 years after the initial hernia repair (10/23, 43.5%), while a certain number of cases occurred 10 years after hernia repair (6/23, 26.1%). Most of these cases were treated with mesh removal via a open procedure (12/22, 54.5%), and in 7 cases (7/22, 31.8%), the partial cystectomy was performed as well as mesh removal. Laparoscopic or robotic treatment procedures were performed in three cases. CONCLUSION Mesh erosion into the urinary bladder can occur after both open and laparoscopic inguinal hernia repairs in a wide range of duration. This complication most frequently happened following laparoscopic inguinal hernia repair. It was usually treated with partial or complete mesh removal, with or without partial cystectomy. A registry system is necessary for monitoring this complication.
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Bracale U, Merola G, Sciuto A, Cavallaro G, Andreuccetti J, Pignata G. Achieving the Learning Curve in Laparoscopic Inguinal Hernia Repair by Tapp: A Quality Improvement Study. J INVEST SURG 2018; 32:738-745. [DOI: 10.1080/08941939.2018.1468944] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Umberto Bracale
- Department of Surgical Specialities and Nephrology, University Federico II Naples Italy
| | - Giovanni Merola
- Department of Surgical Specialities and Nephrology, University Federico II Naples Italy
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
| | - Antonio Sciuto
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | | | - Jacopo Andreuccetti
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
| | - Giusto Pignata
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
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Proportion of femoral hernia repairs performed for recurrence in the United States. Hernia 2018; 22:593-602. [PMID: 29411165 DOI: 10.1007/s10029-018-1743-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Recurrence rates after femoral hernia repair (FHR) have not been reliably established in the USA. We sought to determine this trend over time. METHODS The proportion of primary and recurrent FHRs was determined for patients age ≥ 18 from: ACS-NSQIP (1/2005-12/2014), Premier (1/2010-09/2015), and institutional (1/2005-12/2014) data. Trends were analyzed using a one-tailed Cochran-Armitage test. RESULTS In the NSQIP database, 6649 patients underwent a FHR. In females, the proportion of FHRs performed for recurrence decreased from 14.0% in 2005 to 6.2% in 2014, p = 0.02. In males, there was no change: 16.7-16.1% 2005-2014 (p = 0.18). The Premier database included 4495 FHRs and our institution 315 FHRs. There was no difference for either gender over time in either data source, all p > 0.05. CONCLUSIONS The proportion of femoral hernia repairs performed for recurrence in the USA remained relatively constant in males in two large national databases between 2005 and 2015. In females, a decrease was seen in one of the large national databases.
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