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Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L, Awad MM, Haroutounian S. Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024:104532. [PMID: 38599265 DOI: 10.1016/j.jpain.2024.104532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.
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Affiliation(s)
- Harutyun Alaverdyan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jooyoung Maeng
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Peter K Park
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Kavya Narayana Reddy
- Department of Anesthesiology and Pain Management, Arkansas Children Hospital, University of Arkansas Medical Science, Little Rock, Arkansas
| | - Michael P Gaume
- Department of Pain Management, University of Kansas Health System-St Francis Hospital, Topeka, Kansas
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Michael M Awad
- Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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Ungureanu C, Stanculea F, Ginghina O, Cristian DA, Grigorean VT, Popescu R, Georgescu D, Iordache N. Laparoscopic approach of inguinal hernia associated with adult cryptorchidism: case series and literature review. J Surg Case Rep 2024; 2024:rjae232. [PMID: 38605699 PMCID: PMC11007635 DOI: 10.1093/jscr/rjae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/23/2024] [Indexed: 04/13/2024] Open
Abstract
Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management.
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Affiliation(s)
- Claudiu Ungureanu
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13, Vitan Barzesti Street, 042122 Bucharest, Romania
| | - Floris Stanculea
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13, Vitan Barzesti Street, 042122 Bucharest, Romania
| | - Octav Ginghina
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Prof. Dr. Alexandru Trestioreanu” Oncological Institute, 252, Fundeni Street, 022328 Bucharest, Romania
| | - Daniel A Cristian
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Coltea” Clinical Hospital, 1, I.C.Bratianu Street, 030171 Bucharest, Romania
| | - Valentin T Grigorean
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12, Berceni Street, 041915 Bucharest, Romania
| | - Razvan Popescu
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- Urology Department, “Th.Burghele” Clinical Hospital, 20, Panduri Street, 050659 Bucharest, Romania
| | - Dragos Georgescu
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Dr. I. Cantacuzino” Clinical Hospital, 5-7, Ioan-Movila Street, 022904 Bucharest, Romania
| | - Niculae Iordache
- “Carol Davila” University of Medicine and Pharmacy, 37, Dionisie Lupu Street, 020021 Bucharest, Romania
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13, Vitan Barzesti Street, 042122 Bucharest, Romania
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Dams A, Vankeirsbilck J, Poelmans S, Kerschaever I, Borreman P, Berwouts L, De Mulder W, Colle J, Beunis A, Dhooghe V, Van De Winkel N, Allaeys M, Ruyssers M, Haesen D, Van der Speeten K. Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study. Surg Endosc 2023; 37:9105-9115. [PMID: 37798529 DOI: 10.1007/s00464-023-10439-6] [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: 04/06/2023] [Accepted: 09/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond™ for mesh fixation in laparoscopic inguinal hernia repair. METHODS This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond™ (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh® SURG ST (Peters Surgical)/Biomesh® P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh® SURG LI (Peters Surgical)/Premium® Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery. RESULTS Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 ± 10.04; p < 0.0001) and 12-month (3.83 ± 11.26; p < 0.0001) follow-up compared with before surgery (26.96 ± 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 ± 0.19 preoperatively to 0.90 ± 0.15 at 5 weeks (p < 0.0001) and 0.92 ± 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 ± 12.69 preoperatively to 84.31 ± 9.97 at 5-week (p < 0.0001) and 84.16 ± 14.48 at 12-month follow-up (p < 0.0001). CONCLUSIONS Ifabond™ (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature.
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Affiliation(s)
- Anne Dams
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joost Vankeirsbilck
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Stephan Poelmans
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Ivan Kerschaever
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Philippe Borreman
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Luc Berwouts
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Wim De Mulder
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Julien Colle
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Anthony Beunis
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vicky Dhooghe
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Mathias Allaeys
- Department of Abdominal Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Kurt Van der Speeten
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
- Faculty of Medicine, Hasselt University, Diepenbeek, Belgium.
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Meshkati Yazd SM, Kiany F, Shahriarirad R, Kamran H, Karoobi M, Mehri G. Comparison of mesh fixation and non-fixation in transabdominal preperitoneal (TAPP) inguinal hernia repair: a randomized control trial. Surg Endosc 2023:10.1007/s00464-023-10040-x. [PMID: 37067592 DOI: 10.1007/s00464-023-10040-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/18/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Mesh fixation in inguinal hernia repair, has been a controversial subject for many years. Therefore, in this study, we evaluated and compared fixation and non-fixation of mesh in Transabdominal Preperitoneal (TAPP) Inguinal hernia repair. METHODS In this randomized control trial, 100 patients diagnosed with unilateral inguinal hernia were included. We divided the study population into two groups of fifty. For both groups, a 15 × 13 cm Prolene(polypropylene) mesh was used for repair. In the fixation group, mesh was fixed to the abdominal wall by endoscopic tacks, while in the non-fixation group, mesh was secured at the proper place without any fixation. Postoperative outcomes were complications, recurrence, and pain intensity after 1-, 3- and 6-months. RESULTS Postoperative pain intensity in the 1st month [Median of 2 and 0, (P < 0.001)], and 3rd month [Median of 0.5 and 0, (P < 0.001)], in the fixation group were significantly higher than the non-fixation group. However, 6 months after surgery, pain intensity was almost similar for both groups. In the 6th postoperative month, only one patient experienced recurrence who was in the fixation group. The rate of recurrence and urinary retention between the groups was not significant. CONCLUSION It was observed that until 6 months after surgery patients who received the non-fixating method of TAPP repair experienced lower levels of pain in comparison to the fixation group while other complications did not differ between the two groups. This trail was registered at www.irct.ir with Trial Registration Number of IRCT20210224050491N1.
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Affiliation(s)
| | - Fakhroddin Kiany
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ghasem Mehri
- Department of Surgery, Arak University of Medical Sciences, Arāk, Iran
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Alabi A, Haladu N, Scott NW, Imamura M, Ahmed I, Ramsay G, Brazzelli M. Mesh fixation techniques for inguinal hernia repair: an overview of systematic reviews of randomised controlled trials. Hernia 2022; 26:973-987. [PMID: 34905142 PMCID: PMC9334446 DOI: 10.1007/s10029-021-02546-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. METHODS We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. RESULTS We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. CONCLUSION Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.
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Affiliation(s)
- A Alabi
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Luton and Dunstable University Hospital, Luton, UK
| | - N Haladu
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Emergency Department, Southend University Teaching Hospital, Westcliff-on-Sea, UK
| | - N W Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - M Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - I Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - G Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Department of Surgery, NHS Grampian, Aberdeen, UK
| | - M Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
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Techapongsatorn S, Tansawet A, Pattanaprateep O, Attia J, Mckay GJ, Thakkinstian A. Mesh-fixation technique for inguinal hernia repair: umbrella review. BJS Open 2022; 6:6639455. [PMID: 35811449 PMCID: PMC9271883 DOI: 10.1093/bjsopen/zrac084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Mesh-based repair is the standard of surgical care for symptomatic inguinal hernias. Many systematic reviews and meta-analyses (SRMAs) addressed various aspects of these procedures. This umbrella review aimed to report the evidence from all previous SRMAs for open and laparoscopic inguinal hernia repair. Methods SRMAs were identified from MEDLINE, Scopus, Cochrane, Embase, DARE, PROSPERO, CINAHL, JBISRIS, EPPI-Centre, Wiley Online Library and ScienceDirect database according to PRISMA guidelines. Data including mesh-fixation techniques and surgical approach were extracted from selected SRMAs. The corrected covered area was calculated to address study overlap across reviews, and an excess significance test was used to assess potential bias. The outcomes of interest were hernia recurrence, chronic groin pain, operating time, postoperative pain, duration of hospital stay, return to daily life activities, and postoperative complication. Results Thirty SRMAs were included between 2010 and 2019: 16 focused on open repair, and 14 focused on laparoscopic repair, with a high degree of overlap (open repairs, 41 per cent; laparoscopic repairs, 30–57 per cent). Sufficient evidence was available on hernia recurrence, chronic groin pain, and operative time. Effects of glue on hernia recurrence were inconclusive in open and laparoscopy approaches, P = 0.816 and 0.946 respectively. Glue was significantly associated with lower persistent groin pain, in open repair (versus suture) and in laparoscopic repair (versus tack). SRMAs suggested that self-gripping mesh was associated with shorter operating time in open surgery, although with only a few minutes of improvement (0.36–7.85 min, P < 0.001). Conclusion In this umbrella review, chronic groin pain and operating time were the only outcomes for which there was sufficient evidence supporting the effectiveness respectively of glue and self-gripping mesh.
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Affiliation(s)
- Suphakarn Techapongsatorn
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University , Bangkok , Thailand
| | - Amarit Tansawet
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University , Bangkok , Thailand
| | - Oraluck Pattanaprateep
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
| | - John Attia
- School of Medicine and Public Health, and Hunter Medical Research Institute, University of Newcastle , New Lambton, New South Wales , Australia
| | - Gareth J Mckay
- Center for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast , Belfast , UK
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
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Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial. Int J Surg 2020; 83:117-124. [PMID: 32947060 DOI: 10.1016/j.ijsu.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. AIM OF THE WORK to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. PATIENTS AND METHODS Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. RESULTS There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. CONCLUSION Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.
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8
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Kumaralingam K, Syn NL, Wee IJY, Lim KR. Is tacking the lax transversalis fascia an easy, safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty? A propensity score-matched and -adjusted analysis. Hernia 2020; 24:831-838. [PMID: 32170455 DOI: 10.1007/s10029-020-02158-x] [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: 11/02/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-operative seroma formation rate is higher in laparoscopic hernioplasty as compared with open repair. Tacking of lax transversalis fascia of direct inguinal hernia is one of the many methods described to reduce the incidence of seroma after laparoscopic inguinal hernioplasty. Our objective is to investigate whether this technique is simple and reliable in reducing the incidence of seroma. METHODS A retrospective analysis of 548 patients who underwent laparoscopic inguinal hernioplasty between January 2011 and December 2017 was conducted. Patients demographics, operative data and post-operative complications were collected. 38 patients with transversalis fascia tacking were matched using one-to-one propensity score matching with another 38 patients without transversalis fascia tacking. Propensity score-matched analysis and propensity score-adjusted analysis were performed. RESULTS Patients who underwent transversalis fascia tacking (tacking group) had a significant lower incidence of post-operative seroma, compared to the non-tacking group tacking vs non-tacking: 5.6% vs 28.6% (p = 0.0097) in propensity-score matched analysis and 5.6% vs 21.3% (p = 0.0153) in propensity-score adjusted analysis. There was no difference noted in the duration of the operation and post-operative complications, in particular post-operative pain. CONCLUSIONS Tacking of lax transversalis facia to the symphysis pubis and Cooper's ligament is a simple yet safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty.
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Affiliation(s)
- K Kumaralingam
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - N L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - I J-Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K R Lim
- Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
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Techapongsatorn S, Tansawet A, Kasetsermwiriya W, Pattanaprateep O, Thakkinstian A. Mesh fixation technique for inguinal hernia repair: protocol for an umbrella review with integrated and updated network meta-analysis. BMJ Open 2019; 9:e031742. [PMID: 31662397 PMCID: PMC6830711 DOI: 10.1136/bmjopen-2019-031742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Inguinal hernia mesh repair is the standard care for symptomatic inguinal hernia. Mesh fixation is used to keep mesh in place for which various mesh fixation techniques have been used in open and laparoscopic inguinal hernia repair, but their effectiveness has remained inconclusive. Therefore, we developed a protocol for an umbrella review in order to summarise the evidences with integrate and update data of different mesh fixation techniques in both open and laparoscopic inguinal hernia repair. METHODS AND ANALYSIS Previous systematic reviews and meta-analyses will be identified from Medline, Scopus, Cochrane Databases, EMBASE, Database of Abstracts of Reviews of Effects, PROSPERO Register, CINAHL, JBISRIS, EPPI-Centre, Wiley Online Library and Science Direct database. Two reviewers will independently determine studies for eligibility. Disagreement will be solved by consensus and arbitrated by the third reviewer. Data extraction will also be performed by two independent reviewers. For umbrella review, a descriptive analysis will be applied to describe evidence of mesh fixation effectiveness. Overlapping studies and excess significance test will be performed to assess whether previous evidences are bias. In addition, individual studies from meta-analysis and additional published studies will be pooled using network meta-analyses. We will use I2 statistic and Cochran's Q test to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as overall strength of the evidence. ETHICS AND DISSEMINATION This protocol has been registered with PROSPERO and approved with Institutional Review Board, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand (COA 167/2018). The results will be published in peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018111773.
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Affiliation(s)
- Suphakarn Techapongsatorn
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Wisit Kasetsermwiriya
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Silva ANS, Kouroumpas E, Fearnhead N, Morton JR. Adhesional small bowel obstruction related to stapling device from previous laparoscopic inguinal hernia repair. BMJ Case Rep 2019; 12:12/4/e229377. [PMID: 31015251 DOI: 10.1136/bcr-2019-229377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Small bowel obstruction (SBO) is common surgical presenting problem, accounting for roughly 15 000 laparotomies per year in the UK. However, SBO post laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is uncommon with an estimated incidence of 0.2%-0.5%. The common causes for SBO post-TAPP include inadequate closure, port-site herniation and adhesions. Here, we present a case of adhesional SBO related to stapling device from previous laparoscopic inguinal hernia repair and review alternative methods for mesh fixation. This case reports a rare but life-threatening complication from a commonly performed day case procedure and highlights importance of adequate surgical technique when inserting foreign bodies intra-abdominally. The patient required an emergency laparotomy and small bowel resection, developed postoperative ileus which managed with a nasogastric tube, intravenous fluids and parenteral nutrition and was discharged 12 days postoperatively.
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Affiliation(s)
| | - Efstratios Kouroumpas
- The Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nicola Fearnhead
- The Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan R Morton
- The Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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11
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Stabilini C, Cavallaro G, Bocchi P, Campanelli G, Carlucci M, Ceci F, Crovella F, Cuccurullo D, Fei L, Gianetta E, Gossetti F, Greco DP, Iorio O, Ipponi P, Marioni A, Merola G, Negro P, Palombo D, Bracale U. Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences. Int J Surg 2018; 54:222-235. [PMID: 29730074 DOI: 10.1016/j.ijsu.2018.04.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/06/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The terms "Hernia Center" (HC) and Hernia Surgeon" (HS) have gained more and more popularity in recent years. Nevertheless, there is lack of protocols and methods for certification of their activities and results. The Italian Society of Hernia and Abdominal Wall Surgery proposes a method for different levels of certification. METHODS The national board created a commission, with the task to define principles and structure of an accreditation program. The discussion of each topic was preceded by a Systematic Review, according to PRISMA Guidelines and Methodology. In case of lack or inadequate data from literature, the parameter was fixed trough a Commission discussion. RESULTS The Commission defined a certification process including: "FLC - First level Certification": restricted to single surgeon, it is given under request and proof of a formal completion of the learning curve process for the basic procedures and an adequate year volume of operations. "Second level certification": Referral Center for Abdominal Wall Surgery. It is a public or private structure run by at least two already certified and confirmed FLC surgeons. "Third level certification": High Specialization Center for Abdominal Wall Surgery. It is a public or private structure, already confirmed as Referral Centers, run by at least three surgeons (two certified and confirmed with FLC and one research fellow in abdominal wall surgery). Both levels of certification have to meet the Surgical Requirements and facilities criteria fixed by the Commission. CONCLUSION The creation of different types of Hernia Centers is directed to create two different entities offering the same surgical quality with separate mission: the Referral Center being more dedicated to clinical and surgical activity and High Specialization Centers being more directed to scientific tasks.
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Affiliation(s)
| | | | | | | | - Michele Carlucci
- Department of General and Emergency Surgery, IRCCS San Raffaele, Milan, Italy
| | - Francesca Ceci
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | | | - Diego Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Landino Fei
- Department of Anaesthesiological, Surgical and Emergency Sciences, Second University of Naples, Italy
| | - Ezio Gianetta
- Department of Surgical Sciences, University of Genoa, Italy
| | | | | | - Olga Iorio
- General Surgery Unit, Aprilia Hospital, Aprilia (RM), Italy
| | - Pierluigi Ipponi
- General Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | | | - Giovanni Merola
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
| | - Paolo Negro
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | - Denise Palombo
- Department of Surgical Sciences, University of Genoa, Italy
| | - Umberto Bracale
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
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12
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Shahan CP, Stoikes NF, Roan E, Reese P, Webb DL, Voeller GR. Biomechanical Comparison of Fibrin Sealants for Mesh Fixation. Am Surg 2018. [DOI: 10.1177/000313481808400512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adhesive use for fixation in hernia repair allows for complete and immediate mesh surface area adherence. Little is known about the fixation strengths of the products and application methods available. The purpose of this study was to compare the immediate and early strength of fixation of Tisseel™ and Evicel™ using hand and spray application techniques. Sixteen Mongrel swine underwent implantation of large-pore, mid-weight polypropylene mesh fixated with either Tisseel™ or Evicel™, applied by hand or with a spray apparatus. Time points studied were zero and four days. All samples underwent lap shear testing to quantify the strength of the mesh–tissue interface as an indicator of mesh fixation strength. Thirty Day 4 and 16 Day 0 samples were tested. Manually applied Tisseel™ mean fixation strength was 2.05 N/cm at Day 0 and 6.02 N/cm at Day 4. Sprayed Tisseel™ had mean fixation strength of 1.22 N/cm at Day 0 and 7.21 N/cm at Day 4. Manually applied Evicel™ showed mean fixation strength of 0.92 N/cm at Day 0 and 6.73 N/cm at Day 4. Mean fixation strength of sprayed Evicel™ was 0.72 N/cm at Day 0 and 6.70 N/cm at Day 4. Analysis of variance showed no difference between groups at Day 0 or Day 4. Immediate strength of mesh fixation could have significant implications for early recurrence and mesh contraction. This study demonstrates that no difference exists in immediate or early fixation strength between these two brands of sealants or their method of application.
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Affiliation(s)
- Charles P. Shahan
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Nathaniel F. Stoikes
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Esra Roan
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee
| | - Patrick Reese
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee
| | - David L. Webb
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Guy R. Voeller
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
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13
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Shahan CP, Stoikes NN, Roan E, Tatum J, Webb DL, Voeller GR. Biomechanical and Histologic Evaluation of LifeMesh™: A Novel Self-Fixating Mesh Adhesive. Am Surg 2018. [DOI: 10.1177/000313481808400424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mesh fixation with the use of adhesives results in an immediate and total surface area adhesion of the mesh, removing the need for penetrating fixation points. The purpose of this study was to evaluate LifeMesh™, a prototype mesh adhesive technology which coats polypropylene mesh. The strength of the interface between mesh and tissue, inflammatory responses, and histology were measured at varying time points in a swine model, and these results were compared with sutures. Twenty Mongrel swine underwent implantation of LifeMesh™ and one piece of bare polypropylene mesh secured with suture (control). One additional piece of either LifeMesh™ or control was used for histopathologic evaluation. The implants were retrieved at 3, 7, and 14 days. Only 3- and 7-day specimens underwent lap shear testing. On Day 3, LifeMesh™ samples showed considerably less contraction than sutured samples. The interfacial strength of Day 3 LifeMesh™ samples was similar to that of sutured samples. At seven days, LifeMesh™ samples continued to show significantly less contraction than sutured samples. The strength of fixation at seven days was greater in the control samples. The histologic findings were similar in LifeMesh™ and control samples. LifeMesh™ showed significantly less contraction than sutured samples at all measured time points. Although fixation strength was similar at three days, the interfacial strength of LifeMesh™ remained unchanged, whereas sutured controls increased by day 7. With histologic equivalence, considerably less contraction, and similar early fixation strength, LifeMesh™ is a viable mesh fixation technology.
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Affiliation(s)
- Charles P. Shahan
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Nathaniel N. Stoikes
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Esra Roan
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee
| | - James Tatum
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee
| | - David L. Webb
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
| | - Guy R. Voeller
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee and
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What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20,004 patients from the Herniamed Registry. Surg Endosc 2017; 32:1971-1983. [PMID: 29075969 PMCID: PMC5845068 DOI: 10.1007/s00464-017-5893-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/13/2017] [Indexed: 10/26/2022]
Abstract
BACKGROUND In inguinal hernia repair, chronic pain must be expected in 10-12% of cases. Around one-quarter of patients (2-4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perioperative complications, and penetrating mesh fixation. This present analysis of data from the Herniamed Hernia Registry now investigates the influencing factors for chronic pain in male patients after primary, unilateral inguinal hernia repair in TAPP technique. METHODS In total, 20,004 patients from the Herniamed Hernia Registry were included in uni- and multivariable analyses. For all patients, 1-year follow-up data were available. RESULTS Multivariable analysis revealed that onset of pain at rest, on exertion, and requiring treatment was highly significantly influenced, in each case, by younger age (p < 0.001), preoperative pain (p < 0.001), smaller hernia defect (p < 0.001), and higher BMI (p < 0.001). Other influencing factors were postoperative complications (pain at rest p = 0.004 and pain on exertion p = 0.023) and penetrating compared with glue mesh fixation techniques (pain on exertion p = 0.037). CONCLUSIONS The indication for inguinal hernia surgery should be very carefully considered in a young patient with a small hernia and preoperative pain.
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Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures. Surg Endosc 2017; 32:2222-2231. [PMID: 29075973 PMCID: PMC5897456 DOI: 10.1007/s00464-017-5912-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/03/2017] [Indexed: 01/23/2023]
Abstract
Background The reported range of seroma formation in the literature after TEP repair is between 0.5 and 12.2% and for TAPP between 3.0 and 8.0%. Significant clinical factors associated with seroma formation include old age, a large hernia defect, an extension of the hernia sac into the scrotum, as well as the presence of a residual indirect sac. Seroma formation is a frequent complication of laparoendoscopic mesh repair of moderate to large-size direct (medial) inguinal hernia defects. This present analysis of data from the Herniamed Hernia Registry now explores the influencing factors for seroma formation in male patients after TAPP repair of primary unilateral inguinal hernia. Methods In total, 20,004 male patients with TAPP repair of primary unilateral inguinal hernia were included in uni- and multivariable analysis. Results Univariable analysis revealed the highly significant impact of the fixation technique on the seroma rate (non-fixation 0.7% vs. tacks 2.1% vs. glue 3.9%; p < 0.001). Multivariable analysis showed that glue compared to tacks (OR 2.077 [1.650; 2.613]; p < 0.001) and non-fixation (OR 5.448 [4.056; 7.317]; p < 0.001) led to an increased seroma rate. A large hernia defect (III vs. I: OR 2.868 [1.815; 4.531]; p < 0.001; II vs. I: OR 2.157 [1.410; 3.300]; p < 0.001) presented a significantly higher risk of seroma formation. Likewise, medial compared to lateral inguinal hernias had a higher seroma rate (OR 1.272 [1.020; 1.585]; p = 0.032). Conclusions Mesh fixation with tacks or glue, a larger hernia defect, and medial defect localization present a higher risk for seroma development in TAPP inguinal hernia repair.
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Niebuhr H, Köckerling F. Surgical risk factors for recurrence in inguinal hernia repair - a review of the literature. Innov Surg Sci 2017; 2:53-59. [PMID: 31579737 PMCID: PMC6754004 DOI: 10.1515/iss-2017-0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023] Open
Abstract
Despite all the progress made in inguinal hernia surgery driven by the development of meshes and laparoendoscopic operative techniques, the proportion of recurrent inguinal hernias is still from 12% to 13%. Recurrences can present very soon after primary inguinal hernia repair generally because of technical failure. However, they can also develop much later after the primary operation probably due to patient-specific factors. Supported by evidence-based data, this review presents the surgical risk factors for recurrent inguinal hernia after the primary operation. The following factors are implicated here: choice of operative technique and mesh, mesh fixation technique, mesh size, management of medial and lateral hernia sac, sliding hernia, lipoma in the inguinal canal, operating time, type of anesthesia, participation in a register database, femoral hernia, postoperative complications, as well as the center and surgeon volume. If these surgical risk factors are taken into account when performing primary inguinal hernia repair, a good outcome can be expected for the patient. Therefore, they should definitely be observed.
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Affiliation(s)
- Henning Niebuhr
- Hanse-Hernia Center, Alte Holstenstrasse 16, D-21031 Hamburg, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, D-13585 Berlin, Germany
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17
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Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery: a comparison between fibrin sealant and tacks. Surg Endosc 2017; 31:4077-4084. [DOI: 10.1007/s00464-017-5454-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/03/2017] [Indexed: 01/08/2023]
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18
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Shahan CP, Stoikes NN, Roan E, Tatum J, Webb DL, Voeller GR. Short-term strength of non-penetrating mesh fixation: LifeMesh™, Tisseel™, and ProGrip™. Surg Endosc 2016; 31:1350-1353. [DOI: 10.1007/s00464-016-5119-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
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19
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Pommergaard HC, Burcharth J, Andresen K, Fenger AQ, Rosenberg J. No difference in sexual dysfunction after transabdominal preperitoneal (TAPP) approach for inguinal hernia with fibrin sealant or tacks for mesh fixation. Surg Endosc 2016; 31:661-666. [DOI: 10.1007/s00464-016-5017-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
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