Early Experience with Laparoscopic Inguinal Hernia Repair in a District General National Health Services Hospital

Recurrence Rates After Repair of Inguinal Hernia in Women: A Systematic Review

Importance

To our knowledge, a systematic review has not yet been performed that specifically addresses the management of inguinal hernia in women. Recurrence after repair of inguinal hernia is not unusual in women and may be a previously undiagnosed femoral hernia, which is rarely seen in men.

Objective

To investigate rates and types of recurrences in women who had undergone repair of primary inguinal hernia.

Evidence Review

PubMed, Embase, and the Cochrane databases were searched in September 2017 for studies reporting recurrences after repair of primary inguinal hernia in women. Crude rates of recurrence (number of recurrences/number of women) were calculated after open and laparoscopic repairs, and the type of recurrent hernia was registered, if noted in the studies. This review is reported according to the PRISMA guideline.

Findings

A total of 55 studies were included, comprising 43 870 women (mean age, 42-69 years; median age, 57 years). Five studies were randomized clinical trials, 14 were prospective cohort studies, 7 were prospective database studies, and 29 were retrospective cohort studies. Twenty studies reported recurrence after laparoscopic repair, with a crude recurrence rate of 1.2% (27 of 2257) (range, 0%-5%) and a median follow-up of 24 months. Thirty-seven studies reported open repair, with a crude recurrence rate of 2.4% (818 of 33 971) (range, 0%-12.5%) and a median follow-up of 36 months. The crude recurrence rate in randomized clinical trials and prospective studies was 1.2% (18 of 1525) after laparoscopic repair compared with 4.9% (490 of 10 058) after open repair. The recurrent inguinal hernia was a femoral hernia in 203 of 496 patients (40.9%) after open repair, compared with 0% of patients after laparoscopic repair. Recurrence rates were similar when open mesh vs nonmesh techniques were used.

Conclusions and Relevance

Recurrence rates after repair of primary inguinal hernia in women are lower after laparoscopic repair compared with open repair. Intraoperative findings during repair of recurrent inguinal hernia are often femoral hernias in women.

Laparoscopic inguinal hernia repair: over a thousand convincing reasons to go on

BACKGROUND

Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. The ability to provide this service as day surgery or short-stay (23-h stay) treatment makes it an attractive method in this age of resource limitations. The technique is cost-effective when the use of disposable instruments is kept to a minimum.

METHODS

Our team performed laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair on 1,389 patients in the period from September 1999 to March 2007. We take this opportunity to discuss the lessons we have learnt and our experience and views with regards to certain procedure-specific problems encountered by many of our peers.

RESULTS

A variety of commonly encountered inguinal and groin hernias were treated by TAPP with good results, minimal morbidity (4.39%) and one mortality. We have discussed our views on technical aspects of the procedure, such as the extent of pre-peritoneal dissection, methods of treating the hernia sac, the size and number of pre-peritoneal prosthetic meshes deployed, fixation of the mesh and reconstitution of the peritoneum. Our views on the causes and our strategies for managing complications such as seroma formation (3.09%), recurrence (0.29%), bleeding (0.36%) and mesh infection (0.14%) have been outlined. We believe that incidental hernias (N=150) discovered during initial laparoscopy can be safely treated with no added morbidity, provided the patients' views and consent regarding the treatment are given due consideration.

CONCLUSION

Laparoscopic TAPP hernia repair has proven to be an efficient method of providing treatment for groin hernias. Our experience over the last eight years has given us over a thousand convincing reasons to continue working and improving upon this service.

The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial

For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair (1,200 dollars less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair (125 dollars more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics.