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Sarno G, Iacone B, Tedesco A, Gargiulo A, Ranieri A, Giordano A, Tramontano S, Bracale U. End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches. Hernia 2024; 28:723-743. [PMID: 38625435 PMCID: PMC11249463 DOI: 10.1007/s10029-024-03026-8] [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: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes. MATERIALS AND METHODS A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy. RESULTS 603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons' expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications. CONCLUSION End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.
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Affiliation(s)
- G Sarno
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy.
| | - B Iacone
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Tedesco
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Gargiulo
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Ranieri
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Giordano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - S Tramontano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - U Bracale
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
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Kritharides N, Papaconstantinou D, Kykalos S, Machairas N, Schizas D, Nikiteas NI, Dimitroulis D. Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:448. [PMID: 38017096 PMCID: PMC10684625 DOI: 10.1007/s00423-023-03177-9] [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: 09/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Parastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques. METHODS A systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included. RESULTS Thirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days). CONCLUSION Each technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient.
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Affiliation(s)
- Nicos Kritharides
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece.
- Department of Surgery, General Hospital of Athens «Elpis», 11522, Athens, Greece.
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462, Chaidari, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Nikolaos I Nikiteas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Ag. Thoma 17, 11527, Athens, Greece
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Hatsuzawa Y, Tsujinaka S, Kakizawa N, Maemoto R, Kimura Y, Nagamori M, Toyama N, Rikiyama T. Modified keyhole plus technique with partial release of posterior rectus sheath for parastomal hernia repair after ileal conduit. Asian J Endosc Surg 2022; 15:850-853. [PMID: 35778983 DOI: 10.1111/ases.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
Parastomal hernia (PH) is a common complication of ileal conduit diversions. The Sugarbaker technique has a lower recurrence rate than the keyhole (KH) technique and is typically preferred. However, it may not be feasible in some cases because of anatomical features including the length of the conduit and torsion of the ureter. An 80-year-old woman with complaints of abdominal distention was diagnosed with PH 5 years after radical cystectomy. Computed tomography revealed a 90 × 20-mm muscular layer defect on the cranial side of the ileal conduit. Therefore, we performed the KH technique with intracorporeal closure of the defect using a relief incision of the posterior rectus sheath, avoiding the possibility of torsion of the ureteral ileal anastomosis. No hernia recurrence was observed at postoperative 10 months. The proposed KH plus technique may be an effective method for PH after ileal conduit diversion, thus preventing urinary complications.
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Affiliation(s)
- Yuuri Hatsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Yasuaki Kimura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Masakazu Nagamori
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Nobuyuki Toyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan
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Dewulf M, Hildebrand ND, Bouwense SAW, Bouvy ND, Muysoms F. Parastomal hernias after cystectomy and ileal conduit urinary diversion: surgical treatment and the use of prophylactic mesh: a systematic review. BMC Surg 2022; 22:118. [PMID: 35351086 PMCID: PMC8966280 DOI: 10.1186/s12893-022-01509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Parastomal hernia after ileal conduit urinary diversion is an underestimated and undertreated clinical entity, which heavily impairs patients’ quality of life due to symptoms of pain, leakage, application or skin problems. As for all gastrointestinal stomata the best surgical repair technique has yet to be determined. Thereby, surgery for ileal conduit parastomal hernias poses some specific perioperative challenges. This review aims to give an overview of current evidence on the surgical treatment of parastomal hernia after cystectomy and ileal conduit urinary diversion, and on the use of prophylactic mesh at index surgery in its prevention. Methods A systematic review was performed according to PRISMA-guidelines. The electronic databases Embase, PubMed, Cochrane Library, and Web of Science were searched. Studies were included if they presented postoperative outcomes of patients undergoing surgical treatment of parastomal hernia at the ileal conduit site, irrespective of the technique used. A search was performed to identify additional studies on prophylactic mesh in the prevention of ileal conduit parastomal hernia, that were not identified by the initial search. Results Eight retrospective case-series were included for analysis, reporting different surgical techniques. If reported, highest complication rate was 45%. Recurrence rates varied highly, ranging from 0 to 80%. Notably, lower recurrence rates were reported in studies with shorter follow-up. Overall, available data suggest significant morbidity after the surgical treatment of ileal conduit parastomal hernias. Data from five conference abstracts on the matter were retrieved, and systematically reported. Regarding prophylactic mesh in the prevention of ileal conduit parastomal hernia, 5 communications were identified. All of them used keyhole mesh in a retromuscular position, and reported on favorable results in the mesh group without an increase in mesh-related complications. Conclusion Data on the surgical treatment of ileal conduit parastomal hernias and the use of prophylactic mesh in its prevention is scarce. Given the specific perioperative challenges and the paucity of reported results, more high-quality evidence is needed to determine the optimal treatment of this specific surgical problem. Initial results on the use of prophylactic mesh in the prevention of ileal conduit parastomal hernias seem promising. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01509-y.
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Affiliation(s)
- M Dewulf
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. .,Department of Surgery, Maria Middelares, Gent, Belgium.
| | - N D Hildebrand
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - S A W Bouwense
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - F Muysoms
- Department of Surgery, Maria Middelares, Gent, Belgium
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How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias. Langenbecks Arch Surg 2022; 407:1291-1301. [PMID: 35088143 DOI: 10.1007/s00423-021-02393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to complications and the optimal surgical treatment of this condition remains to be determined. METHODS In this article, we describe our surgical techniques in the minimally invasive treatment of ileal conduit parastomal hernia and present our preliminary results. In a retrospective single-center design, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. RESULTS Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit. Details on the surgical approach are provided, along with a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings. The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66.7%). Median postoperative hospital stay was 5 days. One-third of patients developed a postoperative urinary infection. Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, treated with intraperitoneal mesh. CONCLUSION The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. Preliminary results confirm a significant morbidity after this type of surgery.
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Mäkäräinen-Uhlbäck E, Vironen J, Vaarala M, Nordström P, Välikoski A, Kössi J, Falenius V, Kechagias A, Mattila A, Ohtonen P, Scheinin T, Rautio T. Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study. BMC Surg 2021; 21:231. [PMID: 33941154 PMCID: PMC8094461 DOI: 10.1186/s12893-021-01228-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. METHOD All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007-2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days' follow-up. RESULTS The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21-64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days' follow-up. CONCLUSION The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.
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Affiliation(s)
- Elisa Mäkäräinen-Uhlbäck
- Division of Surgery, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Jaana Vironen
- Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Vaarala
- Division of Surgery, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pia Nordström
- Division of Surgery, Gastroenterology, and Oncology, Tampere University Hospital, Tampere, Finland
| | - Anu Välikoski
- Division of Surgery, Gastroenterology, and Oncology, Tampere University Hospital, Tampere, Finland
| | - Jyrki Kössi
- Division of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Ville Falenius
- Division of Surgery, University of Turku, Turku, Finland
| | | | - Anne Mattila
- Division of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital, Oulu, Finland.,The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
| | - Tom Scheinin
- Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Tero Rautio
- Division of Surgery, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
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Gameza VA, Bell Lybecker M, Wara P. Laparoscopic Keyhole Versus Sugarbaker Repair in Parastomal Hernia: A Long-Term Case-Controlled Prospective Study of Consecutive Patients. J Laparoendosc Adv Surg Tech A 2020; 30:783-789. [DOI: 10.1089/lap.2020.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Vitaly A. Gameza
- Surgical Department, Colorectal Division, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Bell Lybecker
- Surgical Department, Colorectal Division, Aarhus University Hospital, Aarhus, Denmark
| | - Paul Wara
- Surgical Department, Colorectal Division, Aarhus University Hospital, Aarhus, Denmark
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From keyhole to sandwich: change in laparoscopic repair of parastomal hernias at a single centre. Surg Endosc 2020; 35:1863-1871. [PMID: 32342214 DOI: 10.1007/s00464-020-07589-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nearly 50% of patients with an ostomy will develop a parastomal hernia (PSH). Its repair remains a surgical challenge. Both laparoscopic "modified Sugarbaker" (SB) and Keyhole (KH) repair are currently in use, frequently with unsatisfactory results.''Sandwich Repair'' (SR) may be an alternative to reduce recurrence rates. We present the change of our technique from KH to SR. METHODS We collected data from all consecutive laparoscopic PSH repairs at our institution from 2004 until now (from 2004 to 2013 treated with KH, from 2014 with SR) and compared the results of the two groups. Primary endpoint was recurrence rate at 1 year. Secondary outcomes were operative time, PO length of hospital stay (LOS), and short and long-term complications. RESULTS 13 patients underwent SR. Main changes in surgical technique concerned primary defect closure, no stay sutures, use of glue for first mesh fixation, and partial lateral covering of the underlying mesh with a peritoneal flap. Early postoperative course after SR was uneventful and no recurrence at 1 year was recorded. In the KH group (19 patients), short-term complications occurred in two cases (10%), with one parietal hematoma and one case of intensive pain; we had four recurrences at 1 year (21%). LOS was shorter in the SR group (mean 4 days vs 6, p = 0.004). The KH group had 2 (10%) occurrences of chronic seroma and one bowel perforation (5%), while the SR group had one (8%) occurrence of chronic pain. Median follow-up was 26 months (range 13-78) for the SR group and 47 months (12-105) for the KH group. CONCLUSION SR is safe and effective in expert hands and provides promising preliminary results.
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