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Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024:10.1007/s13304-024-01944-x. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
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Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
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Nikolian VC, Camacho D, Earle D, Lehmann R, Nau P, Ramshaw B, Stulberg J. Development and preliminary validation of a new task-based objective procedure-specific assessment of inguinal hernia repair procedural safety. Surg Endosc 2024; 38:1583-1591. [PMID: 38332173 DOI: 10.1007/s00464-024-10677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/30/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Surgical videos coupled with structured assessments enable surgical training programs to provide independent competency evaluations and align with the American Board of Surgery's entrustable professional activities initiative. Existing assessment instruments for minimally invasive inguinal hernia repair (IHR) have limitations with regards to reliability, validity, and usability. A cross-sectional study of six surgeons using a novel objective, procedure-specific, 8-item competency assessment for minimally invasive inguinal hernia repair (IHR-OPSA) was performed to assess inter-rater reliability using a "safe" vs. "unsafe" scoring rubric. METHODS The IHR-OPSA was developed by three expert IHR surgeons, field tested with five IHR surgeons, and revised based upon feedback. The final instrument included: (1) incision/port placement; (2) dissection of peritoneal flap (TAPP) or dissection of peritoneal flap (TEP); (3) exposure; (4) reducing the sac; (5) full dissection of the myopectineal orifice; (6) mesh insertion; (7) mesh fixation; and (8) operation flow. The IHR-OPSA was applied by six expert IHR surgeons to 20 IHR surgical videos selected to include a spectrum of hernia procedures (15 laparoscopic, 5 robotic), anatomy (14 indirect, 5 direct, 1 femoral), and Global Case Difficulty (easy, average, hard). Inter-rater reliability was assessed against Gwet's AC2. RESULTS The IHR-OPSA inter-rater reliability was good to excellent, ranging from 0.65 to 0.97 across the eight items. Assessments of robotic procedures had higher reliability with near perfect agreement for 7 of 8 items. In general, assessments of easier cases had higher levels of agreement than harder cases. CONCLUSIONS A novel 8-item minimally invasive IHR assessment tool was developed and tested for inter-rater reliability using a "safe" vs. "unsafe" rating system with promising results. To promote instrument validity the IHR-OPSA was designed and evaluated within the context of intended use with iterative engagement with experts and testing of constructs against real-world operative videos.
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Affiliation(s)
- Vahagn C Nikolian
- Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Diego Camacho
- Minimally Invasive and Endoscopic Surgery at Montefiore Medical Center, New York, NY, USA
| | - David Earle
- New England Hernia Center, Lowell, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Ryan Lehmann
- Department of Surgery, Section of Bariatric Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Peter Nau
- Department of Surgery, Section of Bariatric Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - Jonah Stulberg
- Department of Surgery, McGovern Medical School University of Texas Health Science Center at Houston, Houston, TX, USA
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Hu Y, Zhang Z, Wang F, Qiu X. Comparison of modified tumescent and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective clinical study. J Int Med Res 2024; 52:3000605231220789. [PMID: 38242865 PMCID: PMC10799600 DOI: 10.1177/03000605231220789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair poses certain challenges to less experienced surgeons. This study was performed to compare the clinical outcomes of modified tumescent laparoscopic TAPP (MT-TAPP) inguinal hernia repair versus conventional laparoscopic TAPP (CL-TAPP) inguinal hernia repair. METHODS We retrospectively analyzed the perioperative data of patients with inguinal hernias who underwent either MT-TAPP repair (n = 57) or CL-TAPP repair (n = 54) at the General Surgery Department of Nanjing Yimin Hospital from November 2019 to June 2023. RESULTS The durations of the total operation and the preperitoneal space dissection were shorter in the MT-TAPP than CL-TAPP group. The estimated blood loss volume was lower in the MT-TAPP than CL-TAPP group. The visual analogue scale scores recorded at the 12- and 24-hour postoperative time points showed significantly greater reductions in the MT-TAPP than CL-TAPP group. CONCLUSIONS Using liquid injection and gauze dissection is both safe and practical. This technique results in a shortened total operation time, less time spent on preperitoneal space dissection, decreased estimated blood loss, and less severe postoperative pain.
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Affiliation(s)
- Yilong Hu
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - Zhengwei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Xinghua People’s Hospital, Yangzhou University, Taizhou, China
| | - Feng Wang
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - Xiewu Qiu
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
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Saini V, R AV, Rathore YS, Chumber S, Kataria K, Garg R. Perioperative complications of laparoscopic inguinal hernia repair in India: a prospective observational study. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:190-197. [PMID: 38098352 PMCID: PMC10728681 DOI: 10.7602/jmis.2023.26.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
Purpose These days laparoscopic inguinal hernia surgery, both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP), is a commonly performed procedure due to advancements in laparoscopic instruments and the availability of skilled laparoscopic surgeons. The purpose of this study was to compare the perioperative complications of these two procedures. Methods This was a prospective observational study between July 2019 and December 2020. Perioperative complications were compared with a 6-month follow-up. It included 144 patients, of whom 71 underwent TAPP repair and 73 underwent TEP repair. The selection was based on the surgeon's choice. Results Early postoperative complications were scrotal edema (12 cases in TEP and 16 in TAPP), urinary retention (one case in TEP), ecchymosis (six cases in TEP and two in TAPP), and scrotal subcutaneous emphysema (two cases in TEP). On follow-up, seroma was found in a total of 22 cases, of which 12 were TEP and 10 were TAPP. While only one case of TAPP developed surgical site infection. There was no statistically significant difference in hospital stay between the two groups (p = 0.58). The pain scores significantly decreased throughout recovery and were comparable between the groups. Neither group experienced a recurrence during the 6-month follow-up. Fifty-eight patients developed Clavien-Dindo grade I complications, one had grade II, and three had grade IIIa complications. Conclusion With the increasing experience of the surgical fraternity in laparoscopic surgery, TEP and TAPP were proven to be comparable in terms of duration of surgery, postoperative complications, hospital stay, pain scores, and recurrence during the 6-month follow-up.
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Affiliation(s)
- Vikram Saini
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
| | - Amrutha Varshini R
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Yashwant Singh Rathore
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Garg
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India
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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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Zhang H, Feng Y, Wang J, Zhao H. Comparison of Laparoscopic Percutaneous Extraperitoneal Internal Ring Closure by Two-Hook Hernia Needle and Open Repair for Pediatric Inguinal Hernia. J Laparoendosc Adv Surg Tech A 2023; 33:821-828. [PMID: 37311201 PMCID: PMC10440662 DOI: 10.1089/lap.2022.0529] [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] Open
Abstract
Purpose: In children, pediatric inguinal hernia (PIH) is a prevalent condition. PIH is currently more frequently managed by laparoscopic closure of the hernia sac. We improved this minimally invasive technique; that is, laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure. Safety and effectiveness were evaluated by comparing the differences between laparoscopic repair (LR) and open repair (OR) in terms of operation time, surgical complications, contralateral metachronous hernia incidence, and recurrence rate. Methods: A retrospective clinical data analysis was performed on pediatric patients who had hernia surgery utilizing the LR or OR method between June 2019 and June 2021. Medical records of all of the children were gathered, and clinical traits, information about the procedure, and follow-up were all analyzed. Results: A total of 370 patients' inguinal hernias were repaired. For 136 patients undergoing OR and 234 patients undergoing LR, all procedures were completed satisfactorily. There were 98 cases of bilateral hernias and 272 cases of unilateral hernias (180 on the right side and 92 on the left). In the LR group, 58 patients who had been initially diagnosed with unilateral hernias developed contralateral occult hernias intraoperatively. Inguinal hernia operations took an average of 13.82 (LR) and 32.07 (OR) minutes for unilateral cases, and 21.00 (LR) and 54.85 (OR) minutes for bilateral cases. For LR and OR, the average follow-up time was 22.41 months and 23.10 months, respectively. The perioperative complications included peritoneal rupture in 3 patients, scrotal edema or hematoma in 5, hydrocele in 3, and groin pain in 6. In the LR group, 1 patient experienced the postoperative recurrence, whereas 8 individuals in the OR group did. Conclusions: Our initial research showed that laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure inguinal hernia repair is a safe and effective procedure. The LR method has the benefits of concealing the incision, a quicker procedure, having a lower risk of complications, and finding contralateral patent processus vaginalis. Therefore, promoting and using this surgical technique in clinical practice are merited. Clinical Trial Registration number: Medical Association of Xiangtan (2022-xtyx-28).
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Affiliation(s)
- Huaixiao Zhang
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Yuan Feng
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Jianguo Wang
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
| | - Hongjun Zhao
- Department of Pediatric Surgery, Xiangtan Central Hospital, Xiangtan, China
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Mills JMZ, Luscombe GM, Hugh TJ. The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up. ANZ J Surg 2023; 93:1758-1762. [PMID: 36876856 DOI: 10.1111/ans.18339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Joanna M Z Mills
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Georgina M Luscombe
- The University of Sydney School of Rural Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Avanaz A. A novel laparoscopic inguinal hernia repair technique: single-port lateral non-abdominal pre-peritoneal approach. Langenbecks Arch Surg 2023; 408:224. [PMID: 37272998 DOI: 10.1007/s00423-023-02964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Open and endoscopic techniques have been described for the treatment of inguinal hernia, but the gold standard treatment method is yet to be defined. Recurrence rates after inguinal hernia surgery vary between 10 and 15%, and chronic pain is seen in 10-12% of patients. This study aimed to introduce a new surgical technique called lateral non-abdominal pre-peritoneal repair for inguinal hernia surgery. METHODS We recorded the data of patients' age, gender, body mass index (BMI), prior hernia surgery, hernia side, type of hernia, postoperative complications, pain scores according to the numeric pain scale, and analgesic consumption. We performed a nearly 2 cm incision from approximately 2 cm medial and superior of the anterior superior iliac spine, then separated the peritoneum from the transverse abdominal muscle by blunt dissection, and perform the surgery by a single-port device. RESULTS Seventeen inguinal hernias were repaired with the new technique in 14 patients. Two of the patients were female. The median age was 59, and the mean BMI was 26.8 kg/m2. The median hospital stays and time passed since the surgery was 1 day and 72 days, respectively. The mean operative time was 64 ± 29 min. The median tramadol consumption was 100 mg, and the mean paracetamol consumption was 1143 mg. The median pain score on POD 1 and current pain score was 4 and 0, respectively. CONCLUSIONS No significant complications occurred intraoperatively. We observed the pain scores were acceptable on POD 1, and excellent in postoperative follow-up. Low pain scores, low analgesic consumption, and the absence of recurrence in a newly developed procedure within the learning curve indicate that satisfactory results can be obtained.
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Affiliation(s)
- Ali Avanaz
- Department of General Surgery, Akdeniz University Faculty of Medicine, Pınarbaşı, 07070, Konyaaltı, Antalya, Turkey.
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Zhao Y, Xu Z, Wang T, Zhou D, Tang N, Zhang S, Chen C. The impact of laparoscopic versus open inguinal hernia repair for inguinal hernia treatment: A retrospective cohort study. Health Sci Rep 2023; 6:e1194. [PMID: 37056467 PMCID: PMC10089615 DOI: 10.1002/hsr2.1194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023] Open
Abstract
Objectives Although laparoscopic inguinal hernia repair (LIHR) has been widely accepted for treating inguinal hernia, the procedure remains very technical and challenging. The present study aimed to assess the effect of LIHR in relation to operation time, intraoperative hemorrhage and postoperative hospitalization. Methods A total of 503 patients with inguinal hernia admitted at the Wuxi Rehabilitation Hospital between June 2019 and July 2021 were included in this retrospective cohort study. Binary logistic and linear regressions were used for categorical and continuous outcomes, respectively. The learning curve was drawn by cumulative sum analysis. Results Multivariate logistic regression analysis identified LIHR as an independent factor associated with prolonging operation time (odd ratio [OR] = 1.750, 95% confidence interval [CI]: 1.215-2.520, p = 0.003) and decreasing intraoperative hemorrhage levels (OR = 0.079, 95 CI: 0.044-0.142, p < 0.001). Multivariate linear regression identified LIHR (Coefficient = -0.702, 95% CI: [-1.050] to [-0.354], p < 0.001) as an independent factor for shortening postoperative hospitalization time. After learning curve, LIHR (OR = 1.409, 95% CI: 0.948 to 2.094, p = 0.090) no longer resulted as a risk factor prolonging operation time. Conclusions LIHR is an important independent predictive factor for decreasing intraoperative hemorrhage levels and shortening postoperative hospitalization time. Additionally, LIHR does not prolong operation time after the learning curve.
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Affiliation(s)
- Yong Zhao
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Zipeng Xu
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
| | - Tao Wang
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Dingxing Zhou
- Department of Emergency SurgeryWuxi Second Hospital of Traditional Chinese MedicineWuxiChina
| | - Neng Tang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Shuo Zhang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Chaobo Chen
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
- Department of Immunology, Ophthalmology & ORLComplutense University School of MedicineMadridSpain
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Kudsi OY, Bou-Ayash N, Kaoukabani G, Gokcal F. Comparison of perioperative and mid-term outcomes between laparoscopic and robotic inguinal hernia repair. Surg Endosc 2023; 37:1508-1514. [PMID: 35851822 DOI: 10.1007/s00464-022-09433-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the advantages of laparoscopic inguinal hernia repair (LIHR) have been described, guidelines regarding robotic inguinal hernia repair (RIHR) have yet to be established, despite its increased adoption as a minimally invasive alternative. This study compares the largest single-center cohorts of LIHR and RIHR and aims to shed light on the differences in outcomes between these two techniques. METHODS Patients who underwent LIHR or RIHR over an 8-year period were included as part of a retrospective analysis. Variables were stratified by preoperative, intraoperative, and postoperative timeframes. Complications were listed according to the Clavien-Dindo classification system and comprehensive complication index (CCI®). Study groups were compared using univariate analyses and Kaplan-Meier's time-to-event analysis. RESULTS A total of 1153 patients were included: 606 patients underwent LIHR, while 547 underwent RIHR. Although demographics and comorbidities were mostly similar between the groups, the RIHR group included a higher proportion of complex hernias. Operative times were in favor of LIHR (42 vs. 53 min, p < 0.001), while RIHR had a smaller number of peritoneal breaches (0.4 vs. 3.8%, p < 0.001) as well as conversions (0.2 vs. 2.8%, p < 0.001). The number of patients lost-to-follow-up and the average follow-up times were similar (p = 0.821 and p = 0.304, respectively). Postoperatively, CCI® scores did not differ between the two groups (median = 0, p = 0.380), but Grade IIIB complications (1.2 vs. 3.3%, p = 0.025) and recurrences (0.8% vs. 2.9%, p = 0.013) were in favor of RIHR. Furthermore, estimated recurrence-free time was higher in the RIHR group [p = 0.032; 99.7 months (95% CI 98.8-100.5) vs. 97.6 months (95% CI 95.9-99.3). CONCLUSION This study demonstrated that RIHR may confer advantages over LIHR in terms of addressing more complex repairs while simultaneously reducing conversion and recurrence rates, at the expense of prolonged operation times. Further large-scale prospective studies and trials are needed to validate these findings and better understand whether RIHR offers substantial clinical benefit compared with LIHR.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA. .,Department of Surgery, Tufts Medical Center, Boston, MA, USA.
| | | | - Georges Kaoukabani
- Department of Surgery, Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
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Robotic versus laparoscopic transabdominal preperitoneal (TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis. Surg Endosc 2023; 37:1188-1193. [PMID: 36156737 PMCID: PMC9943997 DOI: 10.1007/s00464-022-09614-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Since the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP. MATERIALS AND METHODS All consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated. RESULTS In total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001). CONCLUSION In this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.
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Nationwide analysis of laparoscopic groin hernia repair in Italy from 2015 to 2020. Updates Surg 2023; 75:77-84. [PMID: 36070056 PMCID: PMC9450816 DOI: 10.1007/s13304-022-01374-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
Since its introduction, the minimally invasive treatment of groin hernias has become widely accepted as a viable alternative to open surgery. Still, the rates and reasons for its adoption vary highly among countries and the regions within a country. After almost thirty years since its introduction, its spread is still limited. The present study, conducted under the auspices of AGENAS (Italian National Agency for Regional Services), aims at giving a snapshot of the spreading of minimally invasive and robotic techniques for the treatment of groin hernia in Italy. This study is retrospective, with data covering the period from 1st January 2015 to 31st December 2020. AGENAS provided data using the operation and diagnosis codes used at discharge and reported in the International Classification of Diseases 9th revision (ICD9 2002 version). Admissions performed on an outpatient basis, i.e., without an overnight stay of at least one night in hospital, were excluded. A total of 33,925 laparoscopic hernia repairs were performed during the considered period. Overall, a slight increase in the number of procedures performed was observed from 2015 to 2019, with a mean annual change of 8.60% (CI: 6.46-10.74; p < 0.0001). The number of laparoscopic procedures dropped in 2020, and when considering the whole period, the mean annual change was - 0.98% (CI: - 7.41-5.45; p < 0.0001). Urgent procedures ranged from 335 in 2015 to 508 in 2020 referring to absolute frequencies, and from 0.87% to 9.8% in relative frequencies of overall procedures in 2017 and 2020, respectively (mean = 4.51%; CI = 3.02%-6%; p < 0.001). The most relevant observation that could be made according to our analysis was that the adoption of the laparoscopic approach knew a slow but steady increase from 2015 onward.
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Fernandez-Alberti J, Mata L, Orrego F, Medina P, Bogetti D, Porto EA, Pirchi DE. Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve. Surg Endosc 2022; 37:2826-2832. [PMID: 36477644 DOI: 10.1007/s00464-022-09807-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240. METHODS We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018. RESULTS Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13 min (SD ± 15.54; range 30-105 min) for the first third (Q1) vs 54.61 min (SD ± 15.38; range 30-100 min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59 min (SD ± 21.89; range 50-160 min) for Q1 vs 84.48 min (SD ± 20.52; range 30-130 min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time. CONCLUSION In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions.
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Affiliation(s)
| | - Lautaro Mata
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Facundo Orrego
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Pablo Medina
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Diego Bogetti
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Eduardo Agustin Porto
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Daniel Enrique Pirchi
- Director of General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
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14
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Sivakumar J, Chen Q, Hii MW, Cullinan M, Choi J, Steven M, Crosthwaite G. Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression. Surg Endosc 2022; 37:2453-2475. [PMID: 36416945 DOI: 10.1007/s00464-022-09760-3] [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: 04/27/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has a long learning curve. It can be a technically challenging procedure and initially presents an unfamiliar view of inguinal anatomy. The aim of this review was to evaluate published literature relating to the learning curve of laparoscopic inguinal hernia repair and identify the number of cases required for proficiency. The secondary aim was to compare outcomes between surgeons before and after this learning curve threshold had been attained. METHODS A systematic literature search was conducted in databases of PubMed, Medline, Embase, Web of Science, and Cochrane Library, to identify studies that evaluated the learning curve of laparoscopic inguinal hernia repair. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase of the curve. RESULTS Twenty-two studies were included in this review, with 19 studies included in the meta-regression analysis, and 11 studies included in the meta-analysis. Mixed-effects Poisson regression demonstrated that there was a non-linear trend in the number of cases required to achieve surgical proficiency, with a 2.7% year-on-year decrease. The predicted number of cases to achieve surgical proficiency in 2020 was 32.5 (p < 0.01). The meta-analysis determined that surgeons in their learning phase may experience a higher rate of conversions to open (OR 4.43, 95% CI 1.65, 11.88), postoperative complications (OR 1.61, 95% CI 1.07, 2.42), and recurrences (OR 1.32, 95% CI 0.40, 4.30). CONCLUSION Laparoscopic inguinal hernia repair has a well-defined learning curve. While learning surgeons demonstrated reasonable outcomes, supervision during this period may be appropriate given the increased risk of conversion to open surgery. These data may benefit learning surgeons in the skill development of minimally invasive inguinal hernia repairs.
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Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia.
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Australia.
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Qianyu Chen
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Michael W Hii
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Mark Cullinan
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Julian Choi
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Western Health, Melbourne, Australia
| | - Mark Steven
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
| | - Gary Crosthwaite
- Clinical Institute General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Australia
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15
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Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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16
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Defining operative experience targets in surgical training: A systematic review. Surgery 2022; 172:1364-1372. [PMID: 36038374 DOI: 10.1016/j.surg.2022.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence. METHODS A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model. RESULTS Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b). CONCLUSION Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.
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17
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Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Increasing volume but declining resident autonomy in laparoscopic inguinal hernia repair: an inverse relationship. Surg Endosc 2022; 37:3119-3126. [PMID: 35931892 DOI: 10.1007/s00464-022-09476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With improved technology and technique, laparoscopic inguinal hernia repair (LIHR) has become a valid option for repairing both initial and recurrent inguinal hernia. Surgical residents must learn both techniques to prepare for future practice. We examined resident operative autonomy between LIHR and open inguinal hernia repair (OIHR) across the Veterans Affairs (VA) system. METHODS Utilizing the VA Surgical Quality Improvement Program database, we examined inguinal hernia repairs based on the principal procedure code at all teaching VA hospitals from July 2004 to September 2019. All VA cases are coded for level of supervision at the time of surgery: attending primary surgeon (AP); attending scrubbed but resident is a primary surgeon (AR), and resident primary with attending supervising but not scrubbed (RP). Primary outcomes were the proportion of LIHR versus OIHR and resident autonomy over time. RESULTS A total of 127,497 hernia repair cases were examined (106,892 OIHR and 20,605 LIHR). There was a higher proportion of RP (8.7% vs 2.2%) and lower proportion of AP (23.9% vs 28.4%) within OIHR compared to LIHR (p < 0.001). The overall proportion of LIHR repairs increased from 9 to 28% (p < 0.001). RP cases decreased for LIHR from 9 to 1% and for OIHR from 17 to 4%, while AP cases increased for LIHR from 16 to 42% and for OIHR from 18 to 30% (all p < 0.001). For RP cases, mortality (0 vs 0.2%, p > 0.99) and complication rates (1.1% vs. 1.7%, p = 0.35) were no different. CONCLUSIONS LIHR at VA hospitals has tripled over the past 15 years, now compromising nearly one-third of all inguinal hernia repairs; the majority are initial hernias. Despite this increase, resident autonomy in LIHR cases declined alarmingly. The results demonstrate an urgent need to integrate enhanced minimally invasive training into a general surgery curriculum to prepare residents for future independent practice.
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Affiliation(s)
- Alvand J Sehat
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, US
| | - Joseph B Oliver
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, US.,Department of Surgery, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, New Jersey, US
| | - Yasong Yu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, US.,Department of Surgery, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, New Jersey, US
| | - Anastasia Kunac
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, US.,Department of Surgery, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, New Jersey, US
| | - Devashish J Anjaria
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, US. .,Department of Surgery, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, New Jersey, US.
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18
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Tarallo M, Crocetti D, Gurrado A, Iorio O, Iossa A, Caruso D, Bononi M, Stabilini C, Bracale U, Chiappini A, Testini M, Avenia N, Polistena A, Cavallaro G. Achieving the learning curve in total thyroidectomy: a prospective evaluation on resident's training by CUSUM and KPSS analysis. Ann R Coll Surg Engl 2022; 104:414-420. [PMID: 35175830 PMCID: PMC9157995 DOI: 10.1308/rcsann.2021.0318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Total thyroidectomy (TT) is one of the most common procedures among general and endocrine surgeons worldwide. The conventional approach by neck incision is still the most frequently used, despite the growth of mini-invasive approaches. Controversies exist about the optimal learning curve for resident surgeons approaching this procedure. The aim of this study was to compare TT performed by experienced surgeons and residents in two academic hospitals, to define the correct shape of the specific learning curve. METHODS Between January 2016 and December 2018 patients undergoing TT in two academic departments were prospectively enrolled. In each department patients were divided into four groups: a reference group (A), consisting of 50 consecutive patients operated on by a senior surgeon, and three other groups (B, C, D) of 50 patients each where thyroidectomy was carried out by three different general surgery residents in their last 3 years of residency, respectively. Data were analysed by CUSUM and KPSS tests in order to compare operative time (OT) and its stabilisation during the learning curve. RESULTS Data from CUSUM test reported that residents could perform TT with OT similar to the senior surgeon after approximately 25-30 procedures, while the KPSS test showed that residents became more stable after 30 procedures, with no increase in perioperative complications. CONCLUSIONS This prospective study shows how a specific training in thyroid surgery can be reliable thanks to experienced tutors, and confirmed that the effect of dedicated and programmed training may result in positive outcomes for patients requiring thyroidectomy.
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Affiliation(s)
| | | | | | - O Iorio
- A. Spaziani Hospital, Frosinone (FR), Italy
| | - A Iossa
- Sapienza University, Rome, Italy
| | - D Caruso
- Sapienza University, Rome, Italy
| | - M Bononi
- Sapienza University, Rome, Italy
| | | | - U Bracale
- Federico II University Hospital, Naples, Italy
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19
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Marmolejo A, Farell J, Ruiz Funes AP, Ayala S, Sánchez A, Navarro CA, Ramírez NA, García L, Daes J. Critical view of the myopectineal orifice: a scoring system to objectively evaluate transabdominal preperitoneal inguinal hernia repair. Surg Endosc 2021; 36:5094-5103. [PMID: 34846592 DOI: 10.1007/s00464-021-08874-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. METHODS The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. RESULTS Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p < 0.001). The Finn coefficient for inter-rater agreement was 0.97 for the s-CVMPO score and 0.99 for the e-CVMPO score (p < 0.001 for both). Both the s-CVMPO and e-CVMPO scores showed internal consistency with Cronbach's α of 0.89 and 0.87, respectively. The correlation coefficient between the two scores for the average score of each procedure was ρ = 0.96 (p < 0.001). CONCLUSION The CVMPO score is a reliable tool for expert evaluation of TAPP repair. Implementing the CVMPO score facilitates objective assessment of the safety and quality of the procedure.
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Affiliation(s)
- Antonio Marmolejo
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico.
| | - Jorge Farell
- Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Ana Paula Ruiz Funes
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Sergio Ayala
- Department of Clinical Pathology, Hospital Universitario "Dr. José E. González", 1st Floor, Av. Francisco I. Madero Pte. Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico
| | - Alain Sánchez
- Department of Internal Medicine, ABC Medical Center, Sur 136 No. 116, Las Américas, Álvaro Obregón, 01120, Ciudad de México, CDMX, Mexico
| | - Carlos Armando Navarro
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Nubia Andrea Ramírez
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Luis García
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Jorge Daes
- Department of Minimally Invasive Surgery, Clinica Portoazul, 30 Carrera, Corredor Universitario #1-850, Consultorio 411, Barranquilla, Colombia
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20
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Bracale U, Corcione F, Neola D, Castiglioni S, Cavallaro G, Stabilini C, Botteri E, Sodo M, Imperatore N, Peltrini R. Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 2021; 25:1471-1480. [PMID: 34491460 PMCID: PMC8613152 DOI: 10.1007/s10029-021-02487-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/10/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare early postoperative outcomes after transversus abdominis release (TAR) for ventral hernia repair with open (oTAR) and robotic (rTAR) approach. METHODS A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science databases was conducted to identify comparative studies until October 2020. A meta-analysis of postoperative short-term outcomes was performed including complications rate, operative time, length of stay, surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring intervention (SSOPI), systemic complications, readmission, and reoperation rates as measure outcomes. RESULTS Six retrospective studies were included in the analysis with a total of 831 patients who underwent rTAR (n = 237) and oTAR (n = 594). Robotic TAR was associated with lower risk of complications rate (9.3 vs 20.7%, OR 0.358, 95% CI 0.218-0.589, p < 0.001), lower risk of developing SSO (5.3 vs 11.5%, OR 0.669, 95% CI 0.307-1.458, p = 0.02), lower risk of developing systemic complications (6.3 vs 26.5%, OR 0.208, 95% CI 0.100-0.433, p < 0.001), shorter hospital stay (SMD - 4.409, 95% CI - 6.000 to - 2.818, p < 0.001) but longer operative time (SMD 53.115, 95% CI 30.236-75.993, p < 0.01) compared with oTAR. There was no statistically significant difference in terms of SSI, SSOPI, readmission, and reoperation rates. CONCLUSION Robotic TAR improves recovery by adding the benefits of minimally invasive procedures when compared to open surgery. Although postoperative complications appear to decrease with a robotic approach, further studies are needed to support the real long-term and cost-effective advantages.
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Affiliation(s)
- U Bracale
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy
| | - F Corcione
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - D Neola
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy
| | - S Castiglioni
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy.,Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio Chieti-Pescara, Pescara, Italy
| | - G Cavallaro
- Department of Surgery "P. Valdoni", University of Rome "La Sapienza", Rome, Italy
| | - C Stabilini
- Department of Surgical Sciences, University of Genoa, Policlinico San Martino IRCCS, Genoa, Italy
| | - E Botteri
- General Surgery, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - M Sodo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - N Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Peltrini
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy. .,Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. .,Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
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21
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Hannan E, Duggan W, Harding T, Brosnan C, Maguire D, Stafford AT. Laparoscopic totally extraperitoneal hernia repair performed by surgical trainees: Overcoming the learning curve. ANZ J Surg 2021; 91:2047-2053. [PMID: 34374479 DOI: 10.1111/ans.17114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surgical trainees struggle to obtain experience in laparoscopic inguinal hernia repair (LIHR) due to a perceived steep learning curve. The purpose of this study was to compare outcomes in totally extraperitoneal (TEP) repair performed by surgical consultants and trainees under supervision as part of a standardised training regimen to assess the safety of residency training in this technique. METHODS A retrospective review of patients managed by TEP repair by either a consultant or a supervised trainee was performed. Demographic, perioperative and postoperative data were collected and compared. All trainees underwent a standardised approach to teaching TEP repair. RESULTS Trainees performed 133 procedures and consultants performed 121 procedures. Estimated blood loss was minimal in both cohorts. A significant difference was noted in mean operating time between consultants and trainees (33 vs. 50 min). However, it was also observed that the trainee mean operating time reduced significantly with experience (from 61 to 42 min). No statistically significant difference was demonstrated in postoperative complications, recurrence rate or length of stay. All trainees achieved the ability to complete a laparoscopic TEP repair under unscrubbed consultant supervision during a 1-year placement. CONCLUSION With senior supervision and in the presence of a structured training regimen, trainees can safely and effectively perform LIHR, progressing to performing the procedure under unscrubbed consultant supervision. This is valuable information that can serve to inform the structure and direction of surgical training programmes as the ability to offer LIHR is increasingly becoming an expectation of consultant surgeons.
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Affiliation(s)
- Enda Hannan
- St Michael's Hospital, Dun Laoghaire, Dublin, Ireland
| | | | - Tim Harding
- St Michael's Hospital, Dun Laoghaire, Dublin, Ireland
| | - Conor Brosnan
- St Michael's Hospital, Dun Laoghaire, Dublin, Ireland
| | - Donal Maguire
- St Michael's Hospital, Dun Laoghaire, Dublin, Ireland
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22
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Learning curve of robot-assisted transabdominal preperitoneal (rTAPP) inguinal hernia repair: a cumulative sum (CUSUM) analysis. Surg Endosc 2021; 36:1827-1837. [PMID: 33825019 DOI: 10.1007/s00464-021-08462-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP-IHR) is a safe and feasible approach for hernias of varying etiology. We aim to present a single surgeon's learning curve (LC) of this technique based on operative times, while accounting for bilaterality and complexity. METHODS This is a retrospective cohort analysis of patients who underwent rTAPP-IHR over a period of 5 years. Patients who underwent primary, recurrent, and complex (previous posterior repair, previous prostatectomy, scrotal, incarcerated) repairs were included. Cumulative and risk-adjusted cumulative sum analyses (CUSUM and RA-CUSUM) were used to depict the evolution of skin-to-skin times and complications/surgical site events (SSEs) with time, respectively. RESULTS A total of 371 patients were included in the study. Mean skin-to-skin times were stratified according to four subgroups: unilateral non-complex (46.8 min), unilateral complex (63.2 min), bilateral non-complex (70.9 min), and bilateral complex (102 min). A CUSUM-LC was then plotted using each procedures difference in operative time from its subgroup mean. The peak of the plot occurred at case number 138, which was used as a transition between 'early' and 'late' phases. The average operative time for the late phase was 15.9 min shorter than the early phase (p < 0.001). The RA-CUSUM, plotted using the weight of case complexity and unilateral/bilateral status, also showed decreasing SSE rates after the completion of 138 cases (early phase: 8.8% vs. late phase: 2.2%, p = 0.008). Overall complication rates did not differ significantly between the two phases. CONCLUSIONS Our study shows that regardless of bilateral or complex status, rTAPP operative times and SSE rates gradually decreased after completing 138 procedures. Previous laparoscopic experience, robotic team efficiency, and surgical knowledge are important considerations for a surgeon's LC.
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Kara YA, Yağız B, Balcı Ö, Karaman A, Özgüner İF, Karaman İ. Comparison of Open Repair and Laparoscopic Percutaneous Internal Ring Suturing Method in Repairing Inguinal Hernia in Children. Cureus 2021; 13:e14262. [PMID: 33959445 PMCID: PMC8093124 DOI: 10.7759/cureus.14262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction An inguinal indirect hernia is one of the most frequent surgical conditions in children. In this study the experience with laparoscopic percutaneous internal ring suturing (PIRS) and open inguinal hernia surgery and their relations evaluated. Methods All children over 90 days of age and without having prior inguinal region surgery with a diagnosis of indirect inguinal hernia underwent surgical repair with open or laparoscopic PIRS technique. Patients' gender, age at surgery, inguinal hernias side, surgery duration, recurrence, complications, and follow-ups were collected. Results A total of 488 inguinal hernias of 405 patients were repaired. The diagnoses were unilateral inguinal hernia in 360 (88.9%) and it was bilateral in 33 (8.1%) patients. The operative technique was laparoscopic PIRS for 227 and open inguinal hernia surgery for 178 patients. In the PIRS group, a contralateral hernia was found in 48 of 205 children (23.4%). The surgery times were 23.3 (PIRS) and 33.7 (open) min for unilateral and 28 (PIRS) and 53.1 (open) min on average for bilateral inguinal hernia surgery. Mean follow-up was 30.4 months for PIRS and 24.4 months for open technique. Recurrence was observed in seven (3%) patients in PIRS and one (0.5%) in the open group and postoperative complications in three (1.3%) in PIRS and four (2.2%) in the open group. Conclusion PIRS method has the advantage to evaluate contralateral hernia at the same session, minimal scar related to surgery, and preserve the spermatic cord from manipulation. PIRS is an alternative feasible method and easy to perform to repair the inguinal hernia with/without communicating hydrocele in children.
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Affiliation(s)
- Yusuf A Kara
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
| | - Beytullah Yağız
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
| | - Özlem Balcı
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
| | - Ayşe Karaman
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
| | - İsmet F Özgüner
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
| | - İbrahim Karaman
- Pediatric Surgery, Dr. Sami Ulus Health Research and Training Center, Ankara, TUR
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Bracale U, Podda M, Castiglioni S, Peltrini R, Sartori A, Arezzo A, Corcione F, Agresta F. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study. Updates Surg 2021; 73:731-744. [PMID: 33656697 PMCID: PMC7926077 DOI: 10.1007/s13304-021-01010-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. METHODS The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020). RESULTS Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (< 20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices. CONCLUSION This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Policlinico Universitario Di Monserrato, Azienda Ospedaliero-Universitaria Di Cagliari, Cagliari, Italy
| | - Simone Castiglioni
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
- Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Roberto Peltrini
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Alberto Sartori
- Department of General, Oncological and Metabolic Surgery, Castelfranco and Montebelluna Hospitals, Treviso, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialties, University Federico II of Naples, Naples, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ospedale Di Vittorio Veneto, ULSS 2, Marca Trevigiana, Italy
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Morrell ALG, Morrell Junior AC, Mendes JMF, Morrell AG, Morrell A. Robotic TAPP inguinal hernia repair: lessons learned from 97 cases. Rev Col Bras Cir 2021; 48:e20202704. [PMID: 33533825 PMCID: PMC10683431 DOI: 10.1590/0100-6991e-20202704] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES minimally invasive inguinal hernia repair has proven advantages over open procedures including less pain and earlier return to normal activity. Robotic surgery adds ergonomics, a three-dimensional high definition camera and articulating instruments overcoming some laparoscopic limitations. We aimed to report the outcomes of the early experience of over 97 robotic inguinal hernia repairs performed by a referred surgical group in Brazil. METHODS a review of a prospective mantined database was conducted in patients submitted to robotic transabdominal preperitoneal (TAPP) inguinal hernia repairs between March 2016 and February 2020. Descriptive statistics were performed. Surgical outcomes data and patient follow-ups are reported. RESULTS retrospective chart review identified 97 patients submitted to robotic TAPP inguinal hernia repair. Mean age was 36.4 years, with median BMI of 26.9 kg/m2. Mean console time was 58 min (range 40-150) and patients were discharged within 24 hours of their stay in a majority of cases. Mesh was placed in all procedures and there were no conversion rates. Complications were low grade and no recurrence was seen after a mean follow-up of 642 days. CONCLUSION this study represents to-date the first brazilian case series of robotic TAPP inguinal hernia repair. Our results encourage that robotic assisted TAPP inguinal hernia repair appears to be technically feasible and safe in experienced hands, with good outcomes achieving high health-related quality of life and low recurrence rates in the short and long term.
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Affiliation(s)
- Andre Luiz Gioia Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Alexander Charles Morrell Junior
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Jose Mauricio Freitas Mendes
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
| | - Allan Gioia Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Alexander Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
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Proietti F, La Regina D, Pini R, Di Giuseppe M, Cianfarani A, Mongelli F. Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias. Surg Endosc 2020; 35:6643-6649. [PMID: 33258030 DOI: 10.1007/s00464-020-08165-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP. METHODS The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed. RESULTS Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43rd operation, once the 90% proficiency on the logarithmic tendency line was achieved. The corrected operative time resulted 71.1 ± 22.0 vs. 60.8 ± 13.5 min during and after the learning curve (p = 0.011). Only one intraoperative complication occurred during the learning curve and required an orchiectomy. Postoperatively, three complications (one seroma, one hematoma, and one mesh infection) required invasive interventions during the learning curve, while no cases were recorded after it (p = 0.312). CONCLUSION Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time.
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Affiliation(s)
- Francesco Proietti
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland.
| | - Davide La Regina
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Matteo Di Giuseppe
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- Surgery, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Surgery, Ospedale Regionale di Lugano, via Tesserete 46, 6900, Lugano, Switzerland
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Corcione F, Silvestri V, Merola G, Dambra M, Lionetti R, Pirozzi N, Peltrini R, Pontecorvi E, Bracale U. Use of the ORBEYE TM Exoscope in General Surgery: The Advent of Video-Assisted Open Surgery. Surg Innov 2020; 28:79-84. [PMID: 33054634 DOI: 10.1177/1553350620965344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Microsurgery has quickly become the "gold standard" approach for vascular surgical steps during neurosurgery. However, despite its advantages, the microscope has not been widely adopted in general surgery. A new 3D-surgical exoscope, the ORBEYETM, has been developed and introduced to some surgical specialties. Herein, we present our preliminary experience with the ORBEYETM exoscope as applied to a number of general surgical procedures. Method. Throughout February 2020, 7 patients had undergone varying surgical procedures at our institute utilizing the ORBEYETM in some of specific procedural steps where the surgeons felt that the surgery would benefit from more enhanced magnification. Upon completion, all the surgeons who had taken part in the procedure were asked if they had experienced any nausea, dizziness, or eyestrain during its use. Results. The ORBEYETM was employed in a number of surgical steps for the following procedures: throughout an inguinal hernia repair, during a duodeno-cephalo-pancreatectomy, for a subtotal gastrectomy, during para-aortic mass dissection, and during Ivor Lewis procedure. None of the surgeons involved in the procedures reported experiencing any nausea, dizziness nor eyestrain, nor any other physical discomforts. Conclusion. To the best of our knowledge, ours is the very first report on the employment of the ORBEYE exoscope during general surgery. Our experience assures us that this highly ergonomic technology with its high-resolution 4K 3D optical system allows the surgeon to perform safe and precise surgery in several dedicated steps in which adequate magnification is required with no adverse effects to the surgeon or the surgical procedure itself.
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Affiliation(s)
- Francesco Corcione
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Giovanni Merola
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Michele Dambra
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Ruggero Lionetti
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Nello Pirozzi
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Roberto Peltrini
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Umberto Bracale
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
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Aghayeva A, Aytac E, Dinc T, Mutlu AU, Sahin I, Bilgin IA, Hamzaoglu I, Baca B. Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair. Int J Med Robot 2020; 16:1-5. [PMID: 33289228 DOI: 10.1002/rcs.2150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/01/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the learning curve (LC) for inguinal hernia repair with robotic transabdominal preperitoneal (R-TAPP) approach. METHODS Between April 2016 and October 2019, patients who underwent R-TAPP were retrieved. Patient demographics, operative variables and postoperative outcomes were assessed. The moving average method and cumulative sum of operation times (OT) were used to evaluate the LC. The surgeon (BB) in this study had completed his laparoscopic (Lap) TAPP experience. RESULTS There were 50 (two females) consecutive patients (mean age was 51.7 ± 16.9 years). The first phase (learning phase) included initial 35 operations. The second phase included the next 15 operations. It was observed that, with increasing experience, a statistically significant shortening in the average OT by about 25 min was achieved (p = 0.041). CONCLUSION The LC phase for R-TAPP, for surgeon with previous experience in Lap TAPP, seems to be very quick without compromising the operative morbidity.
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Affiliation(s)
- Afag Aghayeva
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Taha Dinc
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - Inci Sahin
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ismail Ahmet Bilgin
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Nazari T, Dankbaar MEW, Sanders DL, Anderegg MCJ, Wiggers T, Simons MP. Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents. Hernia 2020; 24:995-1002. [PMID: 32889641 PMCID: PMC7520418 DOI: 10.1007/s10029-020-02270-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022]
Abstract
Purpose During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR. Electronic supplementary material The online version of this article (10.1007/s10029-020-02270-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Nazari
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M E W Dankbaar
- The Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands
- Department of Education, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D L Sanders
- North Devon District Hospital, Barnstaple, UK
| | - M C J Anderegg
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Wiggers
- Incision Academy, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Amsterdam, The Netherlands
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Sartori A, De Luca M, Noaro G, Piatto G, Pignata G, Di Leo A, Lauro E, Andreuccetti J. Rare Intraoperative and Postoperative Complications After Transabdominal Laparoscopic Hernia Repair: Results from the Multicenter Wall Hernia Group Registry. J Laparoendosc Adv Surg Tech A 2020; 31:290-295. [PMID: 32808863 DOI: 10.1089/lap.2020.0459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence.
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Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giulia Noaro
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giacomo Piatto
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili, Brescia, Italy
| | - Alberto Di Leo
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
| | - Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Jacopo Andreuccetti
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
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Barbato G, Rollo S, Maggioni C, Cianchi F, Coratti F. Laparoscopic diastasis recti abdominis and midline hernia repair. Minerva Surg 2020; 76:187-191. [PMID: 32773750 DOI: 10.23736/s2724-5691.20.08404-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diastasis recti abdominis (DRA) is defined as an abnormally wide distance separates the two rectus muscles. Thinning and widening of the linea alba is an important risk factor for development midline hernia. In patient with DRA there is an increase rate of hernia recurrence. METHODS We perform a retrospective study to assess the outcome of laparoscopic intraperitoneal hernia repair and linea alba plication combined with mesh placement to obtain an adequate overlap of midline hernia associated to an abdominal wall support. The inclusion criteria were patients who has a clinical diagnosis of primary midline hernias of any size with associated diastasis recti. The exclusion criteria were incisional hernias, hernias outside of the midline. A total of 12 patients fulfilled the inclusion criteria. No complication was observed over the follow-up period. The rates for recurrence were 0% over the follow-up period. RESULTS Despite the limited data some assumptions can be drawn from this study. The presence of DRA and coexisting hernia involves a challenging choice of the surgical treatment. Whichever approach is taken, in order to achieve an effective correction, plication of the linea alba is required. The major goal of any abdominal wall repair is not only reduction of hernia sac and prevention of further herniation but also restoration of the integrity and restitution of abdominal wall functionality. CONCLUSIONS A laparoscopic approach to midline hernias associated to DRA is feasible and reproducible. It is necessary future prospective studies on larger numbers to improve knowledge on the management of DRA.
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Affiliation(s)
- Giuseppe Barbato
- Careggi University Hospital, University of Florence, Florence, Italy -
| | - Silvia Rollo
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Coratti
- Division of Gastrointestinal Surgery, Careggi University Hospital, Florence, Italy
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Gao C, Zeng R, Xiong Y, Ruze R, Yan Z, Zhang G. The Learning Curve for Laparoscopic Inguinal Hernia Repair: an Analysis of the First 109 Cases. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Coratti F, Trafeli M, Barbato G, Maggioni C, Manetti A, Cianchi F. The Gauze technique: a simple method of dissection in laparoscopic inguinal hernia repair. MINERVA CHIR 2020; 75:426-429. [PMID: 32456400 DOI: 10.23736/s0026-4733.20.08335-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hernia repair is one of the most frequent operation in general surgery. The aim of this is study is to present a new preperitoneal atraumatic dissection of peritoneal flap during laparoscopic transabdominal preperitoneal inguinal hernia repair. METHODS From January 2019 to December 2019, 30 patients (19 male, 11 female) attended TAPP inguinal hernia repairs. The inclusion's criteria were: patients from 32 to 88 years; male and woman; bilateral inguinal hernia. RESULTS The median age of patients was 46,46 (32-88). The median time of operation was 63,8 (45-100) minutes. All procedures were performed without complications and convertions. CONCLUSIONS Based on our experience the soft technique is a safe and feasible way to create a preperitoneal flap. Operating time is drastically reduced and the learning curve is reduced even for less experienced surgeons.
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Affiliation(s)
- Francesco Coratti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy -
| | - Martina Trafeli
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Giuseppe Barbato
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Andrea Manetti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
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Merola G, Cavallaro G, Iorio O, Frascio M, Pontecorvi E, Corcione F, Andreuccetti J, Pignata G, Stabilini C, Bracale U. Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique. Hernia 2019; 24:651-659. [DOI: 10.1007/s10029-019-02064-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/27/2019] [Indexed: 01/01/2023]
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Richmond BK, Totten C, Roth JS, Tsai J, Madabhushi V. Current strategies for the management of inguinal hernia: What are the available approaches and the key considerations? Curr Probl Surg 2019; 56:100645. [PMID: 31581983 DOI: 10.1016/j.cpsurg.2019.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan K Richmond
- Division of General Surgery, West Virginia University - Charleston Division, Charleston, WV.
| | - Crystal Totten
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, University of Kentucky, Lexington, KY
| | - John Scott Roth
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Center for Advanced Training and Simulation, University of Kentucky, Lexington, KY
| | - Jonathon Tsai
- Charleston Area Medical Center, West Virginia University - Charleston Division, Charleston, WV
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Huerta S, Timmerman C, Argo M, Favela J, Pham T, Kukreja S, Yan J, Zhu H. Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications. J Surg Res 2019; 241:119-127. [PMID: 31022677 DOI: 10.1016/j.jss.2019.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The robotic approach to an inguinal hernia has not been compared head to head with the open and laparoscopic techniques in randomized controlled trials. Furthermore, long-term outcomes for robotic inguinal hernia repair (RHR) are lacking. In this study, we compared laparoscopic inguinal hernia repair (LHR) and RHR with open inguinal hernia repair (OHR) in veteran patients performed by surgeons most familiar with each approach. METHODS A retrospective single-institution analysis of 1299 inguinal hernia repairs performed at the VA North Texas Health Care System between 2005 and 2017 was undertaken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed. Univariable analysis was undertaken to determine associations between techniques and outcomes (OHR versus LHR; OHR versus RHR; LHR versus RHR). Setting complications as a dependent variable, multivariable analyses were undertaken to determine an association with complications as well as independent predictors of complications. RESULTS Patient demographics were similar among groups except for age that was higher in the OHR cohort. The average follow-up was 5.2 ± 3.4 y. In the present report, recurrence was associated with a higher rate in the RHR versus OHR (5.6% versus 1.7%; P < 0.02), but not in the LHR versus OHR (3.9% versus 1.9%; P = 0.09). Inguinodynia was more likely to occur in both the LHR and RHR compared with the OHR (9.4% and 14.1 versus 1.5%; both P's < 0.001). Urinary retention was also more common in the LHR and RHR than in the OHR (5.5% and 5.6% versus 1.8%, both P's < 0.05) as was the rate of overall complications (34.4% and 38.0% versus 11.2%, both P's < 0.001). Multivariable regression analysis showed femoral hernias, ASA, serum albumin, operative room time, a recurrent hernia, and the minimally invasive approaches were independent predictors of overall complications. CONCLUSIONS Outcomes in the OHR cohort were, in general, superior compared with both the LHR and RHR. However, these strategies should be viewed as complementary. The best approach to an inguinal hernia repair rests on the specific expertise of the surgeon.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
| | - Corey Timmerman
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Thai Pham
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Sachin Kukreja
- Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Jingsheng Yan
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hong Zhu
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Faylona J. Teaching and learning laparoendoscopic hernia in the Philippines problems and solutions. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gorjanc J, Jakomin T, Hubad A, Golob K. How to teach and learn transabdominal preperitoneal effectively – Experience with introducing transabdominal preperitoneal repair in ten general hospitals in Slovenia (2013–2018). INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_29_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Poole GH, Hill AG. What's left on the list? 'Just a hernia...'. ANZ J Surg 2018; 88:1225-1226. [PMID: 30516018 DOI: 10.1111/ans.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/04/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Garth H Poole
- Department of Surgery, Counties Manukau Health, The University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, Counties Manukau Health, The University of Auckland, Auckland, New Zealand
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Köckerling F. What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair?-A Systematic Review. Front Surg 2018; 5:57. [PMID: 30324107 PMCID: PMC6172312 DOI: 10.3389/fsurg.2018.00057] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: In hernia surgery, too, the influence of the surgeon on the outcome can be demonstrated. Therefore the role of the learning curve, supervised procedures by surgeons in training, simulation-based training courses and surgeon volume on patient outcome must be identified. Materials and Methods: A systematic search of the available literature was carried out in June 2018 using Medline, PubMed, and the Cochrane Library. For the present analysis 81 publications were identified as relevant. Results: Well-structured simulation-based training courses was found to be associated with a reduced perioperative complication rate for patients operated on by trainees. Open as well as, in particular, laparo-endoscopic hernia surgery procedures have a long learning curve. Its negative impact on the patient can be virtually eliminated through consistent supervision by experienced hernia surgeons. However, this presupposes availability of an adequate trainee caseload and of well-trained hernia surgeons and calls for a certain degree of centralization in hernia surgery. Conclusion: Training courses, learning curve, supervision, and surgeon volume are important aspects in training and outcomes in hernia surgery.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
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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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