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Riccardi J, Benson R, Parvin-Nejad F, Padmanaban V, Jalloh S, Gyakobo M, Sifri Z. Breaking Barriers: Ensuring Gender Neutral Care on Short Term Surgical Missions. J Surg Res 2024; 303:181-188. [PMID: 39366284 DOI: 10.1016/j.jss.2024.09.004] [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: 03/06/2024] [Revised: 08/04/2024] [Accepted: 09/02/2024] [Indexed: 10/06/2024]
Abstract
INTRODUCTION Gender discrimination is prevalent worldwide in medical and surgical care. In the setting of short-term surgical missions (STSMs) conducted to address the global burden of surgical disease, patient selection raises ethical considerations regarding equitable distribution of limited clinical resources. The goal of this study was to examine if equitable distribution of operative care between male and female patients occurs in STSMs. METHODS The International Surgical Health Initiative (ISHI) is a US based nonprofit, nongovernmental organization. Records from surgical missions to Ghana (2014-2023) and Sierra Leone (2013-2023) were analyzed to evaluate for gender equity in inguinal hernia repairs, the most common procedure performed. A control group was created from a literature review inclusive of all studies of inguinal hernia repairs that included over 500 patients and patient gender. RESULTS The review of 26 studies, representing 3,239,043 patients, demonstrated a gender distribution of 13% female. In Sierra Leone 246 inguinal hernia repairs were performed between 2013 and 2023. 28 (11.4%) of the hernia repairs were in females, which was not significantly different from the control group (P = 0.45). In Ghana 150 inguinal hernia repairs were performed between 2014 and 2023. 12 (8%) of the hernia repairs were in females. This was not significantly different from the control group (P = 0.07). CONCLUSIONS This is the first study investigating the gender equity conducted within the context of humanitarian surgical outreach. Equitable patient selection is a paramount consideration in STSMs, particularly to address gender-related disparities in surgical care.
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Affiliation(s)
- Julia Riccardi
- Department of Surgery, University of California Davis, Sacramento, California.
| | - Ryan Benson
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | | | - Samba Jalloh
- University of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - Mawuli Gyakobo
- Department of Internal Medicine and Therapeutics, University of Cape Coast, Cape Coast, Ghana
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Yıldırım MB, Sahiner IT. The effect of mesh fixation on migration and postoperative pain in laparoscopic TEP repair: prospective randomized double-blinded controlled study. Hernia 2023; 27:63-70. [PMID: 35286511 DOI: 10.1007/s10029-022-02587-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The development of chronic pain is one of the major post-surgery problems after inguinal hernia repair. Although the possibility of chronic pain formation decreases with laparoscopic methods, pain may develop due to the staples used. It is thought that absence of mesh fixation in total extra-peritoneal (TEP) repair does not increase the recurrence rate. This study aims to investigate the absence of mesh fixation in the TEP on the development of postoperative pain, mesh displacement, and recurrence rate. METHODS Between December 2019 and December 2020, 100 patients who underwent TEP repair due to unilateral inguinal hernia in the General Surgery Clinic of Hitit University were included in the study. Study was registered at http://Clinicaltrials.gov (NCT05152654). Patients were divided into two groups as repairs in which the mesh was fixed with a tacker and no-fixation (NF) was used. The mesh is marked with radiopaque clips. Patients were compared in terms of postoperative pain, mobilization time, hospital stay, return to work, chronic pain, early-late mesh displacement, and recurrence. RESULTS While there was no significant difference between the groups in terms of mesh displacement and recurrence, it was observed that the NF group developed significantly less pain in the early and late postoperative period compared to the other group. The time-dependent reduction rate of postoperative pain was higher in NF group than in other group. In addition, operation time was shorter in the NF group. CONCLUSION While the absence of mesh fixation in TEP hernia repair does not increase the recurrence rate, it can be used safely, because it causes less acute and chronic pain. TRAIL REGISTRATION Clinicaltrials number: NCT05152654.
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Affiliation(s)
- M B Yıldırım
- Faculty of Medicine, Department of Surgery, Hitit University, Çorum, Turkey.
| | - I T Sahiner
- Faculty of Medicine, Department of Surgery, Hitit University, Çorum, Turkey
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Wu G, Shi D, Chen M, Zhang C, Li H, Luo M, Fan Q. Laparoscopic total extraperitoneal (TEP) inguinal hernia repair with preperitoneal closed-suction drainage reduced postoperative complications. BMC Surg 2023; 23:14. [PMID: 36650526 PMCID: PMC9847164 DOI: 10.1186/s12893-022-01900-9] [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: 09/13/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although laparoscopic total extraperitoneal (TEP) inguinal hernia repair has the advantages of less bleeding, less trauma, less pain, and fast recovery, there are several issues that need to be addressed. This study aims to evaluate the effectiveness of preperitoneal closed‑suction drainage on reducing postoperative complications in TEP inguinal hernia repair. METHODS A retrospective analysis of 122 patients who underwent TEP inguinal hernia repair between June 2018 and June 2021 was performed. The patients were divided into the drainage group and the non-drainage group according to whether the drainage tube was placed or not. Clinical data, surgical procedures and outcome of these patients were collected and analyzed to assess the effectiveness of drainage. RESULTS A total of 122 patients undergoing TEP surgery were screened, of which 22 were excluded. Most of the patients were male with right indirect inguinal hernia. There was no difference in the mean length of hospital stay between the two groups. Postoperative pain was alleviated by preperitoneal closed‑suction drainage 24 h after operation (p = 0.03). The rate of complications such as scrotal edema, seroma and urinary retention in the drainage group was significantly lower than that in the non-drainage group (p < 0.05). Multivariate regression analysis showed that drainage was beneficial to reduce postoperative complications (OR, 0.015; 95% CI, 0.002-0.140; p < 0.01). In addition, it was worth noting that in subgroup analysis, patients with hernia sac volume > 10 cm3 might receive more clinical benefits by placing drainage tube. CONCLUSION In TEP inguinal hernia repair, placing drainage tube is a simple and feasible traditional surgical treatment, which can promote postoperative recovery without increasing the risk of infection, especially in patients with large hernia sac volume.
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Affiliation(s)
- Guangbo Wu
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danli Shi
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Chen
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihao Zhang
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjie Li
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Luo
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Fan
- grid.412523.30000 0004 0386 9086Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chu HC, Hu SW, Wu WL, Tam KW. Comparison of balloon dissection and telescopic dissection of the preperitoneal space in laparoscopic totally extraperitoneal hernia repair: a systematic review and meta-analysis. LANGENBECK'S ARCHIVES OF SURGERY 2023; 408:15. [PMID: 36622474 DOI: 10.1007/s00423-023-02756-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Safety in creating a preperitoneal space is crucial in laparoscopic totally extraperitoneal (TEP) hernia repairs. In this systematic review and meta-analysis, we compared the outcomes of balloon dissection and telescopic dissection in patients with inguinal or femoral hernias who underwent TEP hernia repair. METHODS We searched PubMed, Embase, Web of Science, and Cochrane databases for randomized controlled trials (RCTs) and prospective and retrospective studies published from inception to July 2022. Meta-analysis was performed using a random-effects model. The treatment outcome was measured using operation time, incidence of intraoperative hemorrhage, peritoneal laceration, conversion to other approaches, surgical site infection (SSI), hematoma, seroma formation, hernia recurrence, and postoperative pain. RESULTS Five RCTs, one prospective study, and two retrospective studies (in total, 936 patients) were included. No significant between-group differences were noted in operation time, SSI, hematoma, seroma, recurrence rate, and postoperative pain on days 1 and 7. The conversion rate was significantly lower in the balloon group than in the telescopic group (odds ratio, 0.34; 95% confidence interval, 0.15-0.81). CONCLUSIONS Both balloon dissection and telescopic dissection are viable techniques for creating preperitoneal space in laparoscopic TEP hernia repair and have similar operation time, complication rate, and postoperative pain. Nevertheless, the conversion rate was lower in patients undergoing balloon dissection than in those undergoing telescopic dissection.
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Affiliation(s)
- Hsin-Cheng Chu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Su-Wei Hu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ling Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Khan WF, Rathore YS, Aggarwal S, Chumber S, Arumugaswamy PR, Baig KAM, Patidar A, Rai SK. Endoscopic totally extraperitoneal repair for groin hernia: Experience from a tertiary care centre. J Minim Access Surg 2023; 19:107-111. [PMID: 36722535 PMCID: PMC10034794 DOI: 10.4103/jmas.jmas_364_21] [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: 11/28/2021] [Revised: 04/27/2022] [Accepted: 09/05/2022] [Indexed: 01/20/2023] Open
Abstract
Background Totally extra-peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair are two established minimal access techniques of groin hernia surgery. TEP offers the advantage of avoiding violation of the peritoneal cavity. Aim This study aims to describe the decade-long experience of TEP in groin hernia repair in a tertiary care teaching institute and the feasibility of the same in difficult scenarios. Materials and Methods Retrospective analysis of the database of patients undergoing TEP repair for inguinal hernia in a single surgical unit at a tertiary teaching hospital between January 2008 and December 2019 was performed. Detailed pre-operative clinical details, operative duration, intraoperative and post-operative complications, including pain, length of post-operative hospital stay and hernia recurrence data were analysed. Results Over 12 years' duration, 511 patients underwent endoscopic TEP mesh repair and the total number of hernias repaired was 614. Majority (97.45%) of patients were male. The mean age of the patient population was 51.3 years. Primary hernia was seen in 490 patients. The mean operating time for unilateral inguinal hernia repair was 56.8 ± 16 min and for bilateral repair 80.9 ± 25.2 min. TEP in previous lower abdominal/suprapubic surgical scars was attempted in 17 (3.3%) patients, with only one requiring conversion. The intraoperative peritoneal breach was the most common documented complication (34.8%). Seroma was seen in 9.4% of patients. Seventeen patients required conversion (14 TAPP and 3 open). Recurrence was seen in 4 (0.7) patients. Conclusion TEP repair is an effective method of groin hernia repair and can be attempted in the majority of patients groin hernia, including patients with previous lower abdominal incisions.
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Affiliation(s)
- Washim Firoz Khan
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Yashwant Singh Rathore
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | | | - Khaja Abdul Moin Baig
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Patidar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeet Kumar Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Karabulut M, Donmez T, Sahbaz NA, Akarsu C, Ferahman S, Surek A, Gemici E, Aydin H, Sunamak O, Dural AC. Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty. Surg Laparosc Endosc Percutan Tech 2022; 32:373-379. [PMID: 35583552 DOI: 10.1097/sle.0000000000001058] [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: 11/17/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. MATERIALS AND METHODS We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. RESULTS The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. CONCLUSION Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.
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Affiliation(s)
- Mehmet Karabulut
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Turgut Donmez
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
- Department of General Surgery, Lutfiye Nuri Bulat State Hospital
| | - Nuri A Sahbaz
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Cevher Akarsu
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Sina Ferahman
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Ahmet Surek
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Eyup Gemici
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Husnu Aydin
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Oguzhan Sunamak
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital
| | - Ahmet C Dural
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
- Department of General Surgery, Faculty of Medicine, Istinye University
- Department of General Surgery, Liv Hospital, Istanbul, Turkey
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Laparoscopic Totally Extraperitoneal Hernia Repairs: a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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The learning curve of laparoscopic inguinal hernia repair: a comparison of three inexperienced surgeons. Wideochir Inne Tech Maloinwazyjne 2020; 16:336-346. [PMID: 34136029 PMCID: PMC8193755 DOI: 10.5114/wiitm.2020.100831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/11/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Studies with inexperienced surgeons in terms of the learning curve for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair are limited. Aim To compare three inexperienced surgeons in terms of the learning curve without supervision. Material and methods Patients’ data, which were from consecutive laparoscopic TEP hernioplasties between December 2017 and February 2020, were analysed retrospectively. The primary outcome was to compare the learning curve of three surgeons (Surgeon A, B, and C) in terms of complications, conversion, and duration of surgery. Secondary outcomes were recurrence rates. Results A total of 299 patients were included in the study. Conversion and intraoperative complication rates decreased after the first 60 cases (from 10% to 2.5%, p = 0.013 and from 9% to 2.5%, p = 0.027, respectively). The mean operative time reached a plateau of less than 40 min after 51–81 cases (Surgeon A 51, B 71, and C 81 cases). Ageing was a risk factor for intraoperative complications and recurrence (p < 0.001, p = 0.008, respectively), and higher body mass index (BMI) was a risk factor for conversion (p = 0.004). Age ≥ 60 years compared to age < 60 years increased intraoperative complications five-fold and recurrence six-fold (p = 0.001). On the other hand, BMI ≥ 30 kg/m2 increased the possibility of conversion to open surgery nine-fold (p < 0.001). In addition, a positive correlation was found between the operative time and the BMI and VAS score (p = 0.004, p = 0.015, respectively). Conclusions In order to reach the plateau in the operative time during the TEP learning curve period, more than 50 cases should be experienced, whereas more than 60 cases are needed for conversion, intraoperative complications, and recurrence.
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Coratti F, Trafeli M, Nelli T, Manetti A, Cianchi F. The gauze technique for a rapid dissection of the pre-peritoneal space in laparoscopic inguinal hernia repair - a video vignette. Colorectal Dis 2020; 22:598-599. [PMID: 31925987 DOI: 10.1111/codi.14958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
| | - M Trafeli
- Università degli Studi di Firenze, Firenze, Italy
| | - T Nelli
- Università degli Studi di Firenze, Firenze, Italy
| | | | - F Cianchi
- Università degli Studi di Firenze, Firenze, Italy
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