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Lozano-Carrillo LC, Meléndez-Mondragón H, Alvarez-Lozada LA, Quiroga-Garza A, Valdivia-Balderas JM. An Unusual Postoperative Complication Following Bilateral Inguinal Hernioplasty: A Pocket Hernia Case Report. Cureus 2024; 16:e61589. [PMID: 38962612 PMCID: PMC11221494 DOI: 10.7759/cureus.61589] [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] [Accepted: 06/01/2024] [Indexed: 07/05/2024] Open
Abstract
Inguinal hernias are the most common type of hernias in the groin, affecting 27% of the population, with a nine to 12 times higher incidence in men. The primary treatment for this condition typically involves a surgical procedure, with most surgeons opting for mesh placement through a laparoscopic approach. While this procedure is generally associated with low complication rates (primarily hematomas, seromas, and scrotal edema), there are some highly infrequent complications reported such as postoperative small bowel obstruction (SBO), estimated to occur in approximately 0.1%-0.5% of cases, most commonly during transabdominal preperitoneal (TAPP) repair. It is crucial to emphasize the importance of using skilled surgical techniques and adhering to established guidelines in postoperative patient care to minimize the risk of these complications. We describe a case of a 47-year-old male patient who underwent bilateral TAPP repair for inguinal hernias and subsequently experienced postoperative complications, including the development of a hematoma and SBO, requiring a re-intervention that evidenced a peritoneal pocket hernia.
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Affiliation(s)
- Luis Carlos Lozano-Carrillo
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
- Department of Human Anatomy, Anatomy Research Group (GIA) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
| | - Humberto Meléndez-Mondragón
- Department of Human Anatomy, Anatomy Research Group (GIA) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
| | - Luis Adrian Alvarez-Lozada
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
- Department of Human Anatomy, Anatomy Research Group (GIA) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
| | - Alejandro Quiroga-Garza
- General Surgery Division, Mexican Social Security Institute, Nuevo Leon Delegation, Monterrey, MEX
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
- Department of Human Anatomy, Anatomy Research Group (GIA) Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, MEX
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Khewater T, Al Madshush AM, Altidlawi MI, Faya H, Alanazi M, Alqahtani MMM, Alghamdi IA, Almotawa MA, Mirdad MT, Alqahtani BA, Sleem Y, Mirdad R. Comparing Robot-Assisted and Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e60959. [PMID: 38910645 PMCID: PMC11193849 DOI: 10.7759/cureus.60959] [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] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Inguinal hernia repair is a common surgical intervention. Advancements in minimally invasive techniques, specifically laparoscopic (LR) and robot-assisted (RR) approaches, have reshaped the landscape of surgical options. This meta-analysis aimed to systematically assess and compare the effectiveness and safety of laparoscopic and robot-assisted inguinal hernia repair through a comprehensive review of the literature. A systematic search of databases was conducted to identify relevant studies published up to November 30, 2023. Fifteen studies, encompassing a total of 64,568 participants, met the inclusion criteria. Pooled estimates for key outcomes, including duration of operation, overall complications, and surgical site infection (SSI), were calculated using random-effects models. This meta-analysis revealed a statistically significant difference in the duration of surgery, favoring laparoscopic repair over robot-assisted techniques (mean difference: 26.85 minutes, 95% CI (1.16, 52.54)). Overall complications did not significantly differ between the two approaches (odds ratio: 1.54, 95% CI (0.83, 2.85)). However, a significantly greater risk of SSI was identified for robot-assisted procedures (odds ratio: 3.32, 95% CI (2.63, 4.19)). This meta-analysis provides insights into the comparative effectiveness of laparoscopic and robot-assisted inguinal hernia repair. While laparoscopy has shorter operative times and comparable overall complication rates, the increased risk of SSI during robot-assisted procedures necessitates careful consideration in clinical decision-making. Surgeons and healthcare providers should weigh these findings according to patient characteristics, emphasizing a personalized approach to surgical decision-making. The evolving landscape of inguinal hernia repair warrants ongoing research to refine techniques and optimize outcomes for the benefit of patients undergoing these procedures.
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Affiliation(s)
- Talal Khewater
- Bariatric and Advanced Laparoscopic Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | | | - Hamad Faya
- Medicine, Faculty of Medicine, King Khalid University, Abha, SAU
| | - Maryam Alanazi
- General Surgery, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | | | | | | | | | | | - Yasmeen Sleem
- College of Medicine, University of Tabuk, Tabuk, SAU
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Mir Mohammad Sadeghi P, Naseri AH, Shishegar A, Melali H, Ashjaei A. Comparison of single absorbable tacker vs. conventional method in fixating the mesh in bilateral inguinal hernia undergoing laparoscopic transabdominal preperitoneal (TAPP): A randomized control trial study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:25. [PMID: 38855564 PMCID: PMC11162083 DOI: 10.4103/jrms.jrms_161_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 06/11/2024]
Abstract
Background The current study aims to investigate the superior mesh fixation method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach. Materials and Methods The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbable tacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All patients were assessed during the hospital stay and 1 month postoperatively to assess the surgery-associated complications and days for return to daily activity. Eura-Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12-month follow-up. Results The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P < 0.001). Only a patient in Group C represented hematoma (P = 0.494). Seroma incidence was not statistically different between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P < 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P > 0.05); however, a pain subscale was significantly less in Group S (P = 0.002). Conclusion Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre- and postoperative complications. However, the two methods did not differ regarding 1-year follow-up QOL.
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Affiliation(s)
- Pouya Mir Mohammad Sadeghi
- Department of General Surgery, Aja University of Medical Sciences, Tehran, Iran
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hosein Naseri
- Department of General Surgery, Aja University of Medical Sciences, Tehran, Iran
| | - Azita Shishegar
- Department of General Surgery, Aja University of Medical Sciences, Tehran, Iran
| | - Hamid Melali
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Ashjaei
- Department of General Surgery, Aja University of Medical Sciences, Tehran, Iran
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Halpern AI, Klein M, McSweeney B, Tran HV, Ganguli S, Haney V, Noureldine SI, Vaziri K, Jackson HT, Lee J. Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs. Surg Endosc 2024:10.1007/s00464-024-10805-y. [PMID: 38632119 DOI: 10.1007/s00464-024-10805-y] [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: 02/17/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. METHODS Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). RESULTS From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). CONCLUSIONS ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.
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Affiliation(s)
- Alex I Halpern
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
| | - Margaret Klein
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Benjamin McSweeney
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hoang-Viet Tran
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Sangrag Ganguli
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Victoria Haney
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Salem I Noureldine
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
| | - Hope T Jackson
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Juliet Lee
- Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA
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Jain Y, Gianchandani Gyani SG, Chauhan S, Nayak K, Jain Y, Malhotra G, Rekavari SG. Comparative Analysis of Bilateral Open Inguinal Hernia Repair and Rives-Stoppa Repair: A Comprehensive Review. Cureus 2024; 16:e57431. [PMID: 38699116 PMCID: PMC11063569 DOI: 10.7759/cureus.57431] [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: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Inguinal hernias present a significant healthcare burden globally, necessitating effective surgical management. This comprehensive review evaluates two primary surgical techniques for managing bilateral inguinal hernias: bilateral open inguinal hernia and Rives-Stoppa repair. This review aims to provide insights into optimal surgical approaches through a comparative analysis of these techniques, including examining advantages, disadvantages, outcomes, and factors influencing technique selection. Bilateral open inguinal hernia repair offers simplicity and familiarity, while Rives-Stoppa repair may provide advantages such as reduced recurrence rates and postoperative complications. The findings underscore the importance of considering patient-specific factors, surgeon expertise, and hospital resources when selecting the optimal approach. Further research is warranted to conduct long-term comparative studies and explore innovations in surgical techniques and materials, ultimately enhancing patient outcomes and advancing inguinal hernia repair practices.
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Affiliation(s)
| | - Sanjeev G Gianchandani Gyani
- Minimal Access And Robotic Surgery, Anglia Ruskin University, Chelmsford, GBR
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Simran Chauhan
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krushank Nayak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yuvraj Jain
- Surgery, Bharti vidyapeeth medical college and hospital, Sangli, IND
| | - Geetika Malhotra
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sai Goutham Rekavari
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sánchez A, Rodríguez O, Medina M, Vegas L, Couto F, Mogollon I, Inchausti C, Galvis L. Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources. Cir Esp 2024; 102:188-193. [PMID: 38224772 DOI: 10.1016/j.cireng.2023.08.007] [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: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.
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Affiliation(s)
- Alexis Sánchez
- Director Programa de Cirugía Robótica. Orlando Health, Orlando, USA
| | - Omaira Rodríguez
- Programa de Cirugía Robótica, Hospital de Clínicas Caracas. Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Manuel Medina
- Departamento de Cirugía, Hospital Universitario del Henares, Madrid, Spain
| | - Liumariel Vegas
- Departamento de Cirugía, Hospital de Linares, Linares, Chile
| | - Francisco Couto
- Cirujano General, Grupo de Cirugía General. Orlando Health, Orlando, USA
| | - Ivan Mogollon
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU
| | - Cristina Inchausti
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU.
| | - Luz Galvis
- Unidad de Cirugía Robótica e Invasión minima, Caracas, Venezuela
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Chao TC, Tung HY, Tsai CH, Pen CM, Wu CC, Liao CH, Ou YC, Tsai CC, Yang SD, Tsai YC. Laparoscopic versus robotic TAPP/TEP inguinal hernia repair: a multicenter, propensity score weighted study. Hernia 2024; 28:199-209. [PMID: 37934377 DOI: 10.1007/s10029-023-02916-7] [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: 06/28/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE The objective of this retrospective study was to assess safety and comparative clinical effectiveness of laparoscopic inguinal hernia repair (LIHR) and robot-assisted inguinal hernia repair (RIHR) from multi-institutional experience in Taiwan. METHODS Medical records from a total of eight hospitals were retrospectively collected and analyzed. Patients primarily diagnosed of inguinal hernia, recurrent inguinal hernia or incarceration groin hernia patients who either underwent laparoscopic or robot-assisted inguinal hernia repair between January 2018 and December 2022 were included in the study. Baseline characteristics, intra-operative and post-operative results were analyzed. To compare two cohorts, overlap weighting was employed to balance the significant inter-group differences. We also conducted subgroup analyses by state of a hernia (primary or recurrent/incarceration) and laterality (unilateral or bilateral) that indicated complexity of surgery. RESULTS A total of 1,080 patients who underwent minimally invasive inguinal hernia repair from 8 hospitals across Taiwan were collected. Following the application of inclusion criteria, there were 279 patients received RIHR and 763 patients received LIHR. In the baseline analysis, RIHR was more often performed in recurrent/incarceration (RIHR 18.6% vs LIHR 10.3%, p = 0.001) and bilateral cases (RIHR 81.4 vs LIHR 58.3, p < 0.001). Suturing was dominant mesh fixation method in RIHR (RIHR 81% vs LIHR 35.8%, p < 0.001). More overweight patients were treated with RIHR (RIHR 58.8% vs LIHR 48.9%, p = 0.006). After overlap weighting, there were no significant difference in intraoperative and post-operative complications between RIHR and LIHR. Reoperation and prescription rates of pain medication (opioid) were significantly lower in RIHR than LIHR in overall group comparison (reoperation: RIHR 0% vs. LIHR 2.9%, p = 0.016) (Opioid prescription: RIHR 3.34 mg vs LIHR 10.82 mg, p = 0.001) while operation time was significantly longer in RIHR (OR time: RIHR 155.27 min vs LIHR 95.30 min, p < 0.001). CONCLUSIONS This real-world experience suggested that RIHR is a safe, and feasible option with comparable intra-operative and post-operative outcomes to LHIR. In our study, RIHR showed technical advantages in more complicated hernia cases with yielding to lower reoperation rates, and less opioid use.
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Affiliation(s)
- T-C Chao
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, JianGuo Road, Xindian District, New Taipei City, Taiwan
| | - H-Y Tung
- Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - C-H Tsai
- Taichung Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - C-M Pen
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C-C Wu
- Shuang Ho Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - C-H Liao
- Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Y-C Ou
- Tungs' Taichung Metro Harbor Hospital, New Taipei City, Taiwan
| | - C-C Tsai
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S-D Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, JianGuo Road, Xindian District, New Taipei City, Taiwan
| | - Y-C Tsai
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, JianGuo Road, Xindian District, New Taipei City, Taiwan.
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Willms AG, Schaaf S, Schwab R. Analysis of surgical quality indicators after certification as a Hernia Center. Updates Surg 2024; 76:255-264. [PMID: 36811182 PMCID: PMC10805962 DOI: 10.1007/s13304-023-01449-z] [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: 07/07/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Certifications are an increasingly used tool of quality management in the health care system. The primary goal is to improve the quality of treatment due to implemented measures based on a defined catalog of criteria and standardization of the treatment processes. However, the extent to which this affects medical and health-economic indicators is unknown. Therefore, the study aims to examine the possible effects of the certification as a Reference Center for Hernia Surgery on the treatment quality and reimbursement dimensions. The observation and recording periods were defined as 3 years before (2013-2015) and 3 years after certification as a "Reference Center for Hernia Surgery" (2016-2018). Possible changes due to the certification were examined based on multidimensional data collection and analysis. In addition, the aspects of structure, process and result quality, and the reimbursement situation were reported. One thousand three hundred and nineteen cases before and one thousand four hundred and three cases after certification were included. After the certification, the patients were older (58.1 ± 16.1 vs. 64.0 ± 16.1 years, p < 0.01), had a higher CMI (1.01 vs. 1.06), and a higher ASA score (< III 86.9 vs. 85.5%, p < 0.01). The interventions became more complex (e.g., recurrent incisional hernias 0.5% vs. 1.9%, p < 0.01). The mean length of hospital stay was significantly reduced for incisional hernias (8.8 ± 5.8 vs. 6.7 ± 4.1 days, p < 0.001). The reoperation rate for incisional hernias also decreased significantly from 8.24 to 3.66% (p = 0.04). The postoperative complication rate for inguinal hernias was significantly reduced (3.1 vs. 1.1%, p = 0.002). The reimbursement of the hernia center increased by 27.6%. There were positive changes in process and outcome quality and reimbursement after the certification, which supports the effectivity of certifications in hernia surgery.
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Affiliation(s)
- Arnulf Gregor Willms
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
- Department of General and Visceral Surgery, German Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
| | - Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, Hernia Reference Center of the German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
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Dong H, Li L, Feng HH, Wang DC. Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci 2023; 16:138-147. [PMID: 37964861 PMCID: PMC10641249 DOI: 10.1016/j.sopen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Background Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.
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Affiliation(s)
- Hui Dong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Li Li
- Department of Pediatric Surgery, Zigong First People's Hospital, Zigong 643000, Sichuan, China
| | - Hui-He Feng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
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Jiao Y, Li X, Liu X, Li C, Yang X, Sun X, Wang F, Wang L. Cobweb-Inspired Micro/Nanostructured Scaffolds for Soft Tissue Regeneration with Inhibition Effect of Fibrosis under Dynamic Environment. Adv Healthc Mater 2023; 12:e2300997. [PMID: 37713107 DOI: 10.1002/adhm.202300997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Indexed: 09/16/2023]
Abstract
In soft tissue repair, fibrosis can lead to repair failure and long-term chronic pain in patients. Excessive mechanical stimulation of fibroblasts is one of the causes of fibrosis during abdominal wall regeneration. Inspired by the cobweb, a polycaprolactone beaded fiber is prepared by electrospinning. The cobweb-inspired structure attenuates the mechanical stimulation of cells under a dynamic environment. Nano-protrusions are introduced into the scaffold for further inhibition of fibrosis by self-induced crystallization. A machine is built for in vitro dynamic culture and rat abdominal subcutaneous embedding experiments are performed to verify the inhibiting effect of fibrosis in a dynamic environment in vivo. Results show that the expression of integrin β1 and α-smooth muscle actin is inhibited by the cobweb-inspired structure under dynamic culture. The results of hematoxylin and eosin and Masson's trichrome indicate that the cobweb-inspired structure has a good inhibitory effect on fibrosis in a dynamic environment in vivo. In general, the cobweb-inspired scaffold with nano-protrusions has a good ability to inhibit fibrosis under both static and dynamic environments. It is believed that the scaffold has promising applications in the field of inhibiting fibrosis caused by mechanical stimulation.
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Affiliation(s)
- Yongjie Jiao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xingxing Liu
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiao Yang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xuwei Sun
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
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11
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Marcolin P, Mazzola Poli de Figueiredo S, Moura Fé de Melo V, Walmir de Araújo S, Mota Constante M, Mao RMD, Villasante-Tezanos A, Lu R. Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis. Hernia 2023; 27:1397-1413. [PMID: 37679548 DOI: 10.1007/s10029-023-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. METHODS We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR - 1.02; 95% CI - 1.87, - 0.17; P = 0.02; I2 = 94%) and operative time (OR - 9.21; 95% CI - 16.82, - 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). CONCLUSIONS Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.
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Affiliation(s)
- P Marcolin
- School of Medicine, Universidade Federal da Fronteira Sul, 20 Capitão Araújo St, Passo Fundo, RS, 99010121, Brazil.
| | | | | | - Sérgio Walmir de Araújo
- Department of Vascular Surgery, Hospital Regional Hans Dieter Schimidt, Joinville, SC, Brazil
| | | | - Rui-Min Diana Mao
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - A Villasante-Tezanos
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - R Lu
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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12
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Zarbaliyev E, Turhan N, Dündar F, Sevmiş M, Çelik S, Çağlikülekçi M. The Relationship Between Small Peritoneal Flap Defects and Postoperative Seroma in TAPP Repair of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2023; 33:493-498. [PMID: 37796240 DOI: 10.1097/sle.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Total abdominal preperitoneal (TAPP) is one of the most frequently used surgical treatment methods in the treatment of inguinal hernia (IH). One of the most common early postoperative complications after hernia repair is seroma/hematoma. In this study, we aimed to study the role of unclosed peritoneal flap defects on the development of postoperative seroma. MATERIAL AND METHODS The study was performed retrospectively in 2 university hospitals. All patients over the age of 18 years who underwent laparoscopic TAPP surgery in Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital General Surgery Clinic and Van Yüzüncü Yıl University Faculty of Medicine General Surgery Clinic between January 1, 2018, and December 31, 2021, were included. Patients were divided into those with peritoneal defects (group 1) and those without (group 2). Whether there was a peritoneal defect or not was compiled from video recordings. In addition, risk factors affecting the development of seroma were determined. RESULTS A total of 250 patients, 16 (6.4%) women and 234 (93.6%) men, were included in the study. There were bilateral hernias in 35 (14%) patients, and a total of 320 hernias were analyzed in the study. It was determined that an American Society of Anaesthesiologists (ASA) III score increased the risk of seroma 15.97 fold (P<0.001, 95% CI, 4.94 to 51.56), direct hernia type increased risk 7.1 fold (P<0.03, 95% CI, 1.204 to 42.422), hernia descending into scrotum increased risk 22.48 fold (P<0.001, 95% CI, 6.66 to 75.84) and closure of the peritoneal flap completely without leaving any defect increased the risk of seroma 8.67 fold (P<0.001, 95% CI, 3.254 to 23.115). CONCLUSIONS The presence or leaving of small-diameter defects on the peritoneal flap may reduce seroma development without increasing the risk of complications. Prospective randomized studies are required to reach definitive conclusions.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, İstanbul
| | - Faruk Dündar
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Murat Sevmiş
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Sebahattain Çelik
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Mehmet Çağlikülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
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13
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Ghafoor S, Tognella A, Stocker D, Hötker AM, Kaniewska M, Sartoretti T, Euler A, Vonlanthen R, Bueter M, Alkadhi H. Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Hernia 2023; 27:1253-1261. [PMID: 37410196 PMCID: PMC10533612 DOI: 10.1007/s10029-023-02830-y] [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: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. METHODS This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader. RESULTS The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia. CONCLUSION Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.
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Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - A Tognella
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Stocker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A M Hötker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Kaniewska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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14
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Hu Q, Du YX, Wang DC, Yang YJ, Lei YH, Wei J. Efficacy and safety of ilioinguinal neurectomy in open tension-free inguinal hernia repair: A meta-analysis of randomized controlled trials. Am J Surg 2023; 226:531-541. [PMID: 37451939 DOI: 10.1016/j.amjsurg.2023.06.027] [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: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND There is still controversy surrounding routine ilioinguinal neurectomy in open tension-free inguinal hernia repair. METHOD PubMed, Cochrane Library and EMBASE databases were searched for randomized controlled trials of ilioinguinal neurectomy in open tension-free inguinal hernia repair. Revman 5.3 software was used for meta-analysis. RESULT Meta-analysis revealed that the incidence of severe pain on the first postoperative day was lower in the ilioinguinal neurectomy group (ING) than in the ilioinguinal nerve preservation group (INPG) [P < 0.0001]. The incidence of no pain in the first month postoperatively [P = 0.0004], the incidence of no pain in the sixth months postoperatively [P < 0.00001], and the numbness incidence in the first month postoperatively [P = 0.001] in the ING was higher than that in the INPG. There was no significant difference in the incidence of severe pain in the first month postoperatively [P = 0.20], the numbness incidence in the sixth postoperative month [P = 0.05], the hypoesthesia incidence in the first [P = 0.15] and sixth [P = 0.85] postoperative months between the two groups. CONCLUSION Ilioinguinal neurectomy in open tension-free inguinal hernia repair can better prevent postoperative pain.
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Affiliation(s)
- Qiang Hu
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Ying-Xiu Du
- Department of Obstetrics and Gynecology, Zigong First People's Hospital, Zigong, 643000, Sichuan, China.
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Yong-Jun Yang
- Department of Anorectal, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Yue-Hua Lei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
| | - Jian Wei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China
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15
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Rasmussen L, Farooqui W, Ries A, Stadeager MW. Synchronic development of hydrocele and groin hernia during pregnancy: a case report. J Med Case Rep 2023; 17:433. [PMID: 37752576 PMCID: PMC10523710 DOI: 10.1186/s13256-023-04099-2] [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: 07/22/2021] [Accepted: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Hydroceles of the canal of Nuck are rare, and have not been described in relation to pregnancy. CASE PRESENTATION A 34-year-old Caucasian female patient had bilateral groin swelling debuted during her pregnancy. A preoperative magnetic resonance imaging scan found bilateral hydroceles of the canal of Nuck. Operative findings and histological examinations revealed a left-sided inguinal hernia and a right-sided hydrocele. The patient was discharged well and without signs of postoperative complications or hernia recurrence. DISCUSSION In this case, a hydrocele and a hernia sac were morphologically identical in terms of preoperative appearance and development. Given the morphological correlation, it was surprising to find different operative findings confirmed by the histopathological examination. CONCLUSION This is the first ever report of the synchronic development of two morphologically identical cystic processes, with one being a hydrocele and the other a hernia sac. In addition, the hydrocele developed during pregnancy, making this case even more unique.
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Affiliation(s)
- Lise Rasmussen
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, 2650, Hvidovre, Denmark.
| | - Waqas Farooqui
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, 2650, Hvidovre, Denmark
| | - Annedorte Ries
- Department of Pathorlogy, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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16
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Lin R, Lin X, Yang Y, Wang C, Fang H, Chen Y, Huang H, Lu F. Laparoscopic transabdominal preperitoneal repair for female patients with groin hernias. BMC Womens Health 2023; 23:422. [PMID: 37559009 PMCID: PMC10413729 DOI: 10.1186/s12905-023-02527-5] [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: 11/11/2022] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Laparoscopic transabdominal preperitoneal repair (TAPP) was recommended for female patients with groin hernias. Whereas, only a few studies focused on whether and how to preserve the round ligament of the uterus in TAPP. METHODS Clinical data of 159 female patients with 181 groin hernias who underwent TAPP at a single institution in China from January 2016 to June 2022 were retrospectively reviewed and collected. RESULTS All the patients underwent the operation smoothly without conversion. Division of the round ligament was performed for 33 hernias. Preservation of the round ligament was adopted for 148 hernias, 51 with the "keyhole" technique, 86 with the "longitudinal incision of peritoneum" method, and 11 with total dissection of the round ligament. The mean operative time was 55.6 ± 8.7 min for unilateral TAPP and 99.1 ± 15.8 min for bilateral TAPP. The mean estimated blood loss was 7.1 ± 4.5 mL. The postoperative complications included 6 (3.3%) cases of seroma, 1 (0.5%) case of hematoma, and 3 (1.6%) cases of mild chronic pain. The incidences of chronic pelvic pain and genital prolapse seemed to be higher in the division group than in the preservation groups (6.1% vs. 0.6% and 3.0% vs. 0%, separately). However, no statistical difference was observed (p > 0.05). CONCLUSIONS TAPP is feasible and effective for female patients with groin hernias, especially in preserving the round ligament of the uterus.
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Affiliation(s)
- Ronggui Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Xianchao Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Yuanyuan Yang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Congfei Wang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Haizong Fang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Yanchang Chen
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Heguang Huang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Fengchun Lu
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
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17
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Dumitrescu V, Serban D, Costea DO, Dumitrescu D, Bobirca F, Geavlete B, Bratu DG, Tribus L, Serboiu C, Alius C, Tudor C, Dascalu AM, Tudosie MS, Serban B, Moga DF. Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes. Cureus 2023; 15:e41886. [PMID: 37581138 PMCID: PMC10423624 DOI: 10.7759/cureus.41886] [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] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Inguinal hernia repairs are one of the most common procedures in general surgery. In addition to classical open surgery, laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) hernia repair, have gained acceptance and are increasingly used for inguinal hernia repairs, and these three techniques are the only standards for inguinal hernia repairs. This study aimed to compare the results of inguinal hernia repairs in adult patients using the TAPP patch technique and Lichtenstein techniques regarding the level of pain perceived one day after surgery and the number of days of hospitalization. A two-year study was performed on 129 patients who underwent TAPP vs. 109 patients who underwent Liechtenstein hernia repair. Our results revealed statistical significance for both variables (Tpain(233) = -7.12, p< 0.001, d=2.92; Tdays of hospitalization(233) = -31.34, p< 0.001, d=4.01). TAPP is a safe method for inguinal hernia repairs, allowing quick recovery and less postoperative pain than the classical Liechtenstein technique.
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Affiliation(s)
- Victor Dumitrescu
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Dragos Serban
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Dan Dumitrescu
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Florin Bobirca
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Bogdan Geavlete
- Department of Urology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Laura Tribus
- Department of Internal Medicine, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Crenguta Serboiu
- Department of Radiology, Oncology and Hematology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Catalin Alius
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Corneliu Tudor
- Department of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Ana Maria Dascalu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, ROU
| | - Mihail Silviu Tudosie
- Department of Clinical Toxicology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Bogdan Serban
- Department of Orthopaedics, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Doru Florian Moga
- Faculty of Medicine, "Lucian Blaga" University of Sibiu, Bucharest, ROU
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18
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Mills JMZ, Luscombe GM, Hugh TJ. The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up. ANZ J Surg 2023; 93:1758-1762. [PMID: 36876856 DOI: 10.1111/ans.18339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Joanna M Z Mills
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Georgina M Luscombe
- The University of Sydney School of Rural Health, Sydney Medical School, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Grantham DW, Doerhoff CR, Linn JG, Mallico EJ, Washington RG. Evaluation of Long-term Performance of the GORE SYNECOR Intraperitoneal Biomaterial in the Treatment of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2023; 33:231-234. [PMID: 36971525 PMCID: PMC10234318 DOI: 10.1097/sle.0000000000001166] [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: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The objective of this study was to analyze device safety and clinical outcomes of inguinal hernia repair with the GORE SYNECOR Intraperitoneal Biomaterial device, a hybrid composite mesh. METHODS This retrospective case review analyzed device/procedure endpoints beyond 1 year in patients treated for inguinal hernia repair with the device. Three objectives were evaluated: procedural endpoint-incidence through 30 days of surgical site infection, surgical site occurrence (SSO), ileus, readmission, reoperation, and death; device endpoint-serious device incidence of mesh erosion, infection, excision/removal, exposure, migration, shrinkage, device-related bowel obstruction and fistula, and hernia recurrence through 12 months; and patient-reported outcomes of the bulge, physical symptoms, and pain. RESULTS A total of 157 patients (mean age: 67±13 y) with 201 inguinal hernias (mean size: 5.1±5 cm 2 ) were included. Laparoscopic approach and bridging repair were performed in 99.4% of patients. All device location was preperitoneal. No procedure-related adverse events within 30 days were reported. No surgical site infection or SSO events or device-related hernia recurrence occurred through 12 months. Procedure-related serious adverse events occurred in 6 patients; 5 recurrent inguinal hernias (at 1 and 2 y) and 1 scrotal hematoma (at 6 mo). Through 24 months, no SSO events requiring procedural intervention occurred. Through 50 months, 6 (2.98%) patients had confirmed hernia recurrence and 4 (1.99%) patients had hernia reoperation. The patient-reported outcome for pain was reported by 7.9% (10/126) of patients who completed the questionnaire. CONCLUSIONS In this study, inguinal hernia repair with the hybrid composite mesh was successful in most patients and the rate of recurrence was low, further supporting the long-term safety and device performance.
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Pietrogiovanna L, Janczak J, Pfeifer N, Strahm R, Brunner W. Incarerated femoral hernia in women - A critical view on approach options. Int J Surg Case Rep 2023; 106:108149. [PMID: 37094416 PMCID: PMC10149270 DOI: 10.1016/j.ijscr.2023.108149] [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: 01/25/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE In the literature there is few information on femoral hernias while best surgical approach to groin hernia in women is in recent discussion ([1], [2]). Focused on femoral hernia our purpose is to present a possible pathway for incarcerated female hernia approach demonstrated on four cases. CASE PRESENTATION Four female patients (77-90 y) with suspected incarcerated inguinal unilateral hernia undergoing repair at our department between December 2017 and December 2018 are presented. In three patients emergency laparoscopy by single port approach confirmed incarceration. Bowel was reduced and femoral hernia diagnosed. A TAPP repair was performed. The fourth patient had multiple previous abdominal operations due to anal carcinoma, so laparoscopic approach was not recommended. A transinguinal open approach also showed an incarcerated femoral hernia. CLINICAL DISCUSSION In case of suspected incarcerated inguinal hernia accurate identification of a femoral hernia is necessary especially in female elderly patients. If possible endoscopic approach is preferred and offers exploration of both sides, checking bowel for vitality and fixing the hernia. If bilateral hernia is present, both sides should be addressed. Surgeons not used to TAPP should perform diagnostic laparoscopy with reduction of hernia sac and check of content and switch to TEP if experienced or open procedure. If open approach is necessary checking for femoral hernia is also mandatory and preperitoneal mesh placement is recommended with or without ligation of inferior epigastric vessels. CONCLUSION Femoral hernias in women are not rare and in open repair techniques easily overseen. The endoscopic approach is preferred. With open approach the exploration via transversalis fascia is mandatory.
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Affiliation(s)
- Laura Pietrogiovanna
- Department of General Visceral and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, 95 9007 St. Gallen, Switzerland.
| | - Joanna Janczak
- Department of General Visceral and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, 95 9007 St. Gallen, Switzerland
| | - Nina Pfeifer
- Department of General Visceral and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, 95 9007 St. Gallen, Switzerland
| | - Raphael Strahm
- Department of General Visceral and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, 95 9007 St. Gallen, Switzerland
| | - Walter Brunner
- Department of General Visceral and Transplantation Surgery, Kantonsspital St. Gallen, Rorschacherstrasse, 95 9007 St. Gallen, Switzerland
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Olugbemi M, Athisayaraj T, Lorejo E, Coveney E. The Impact of Body Mass Index on Local Anaesthetic Inguinal Hernia Repair. Cureus 2023; 15:e36163. [PMID: 37065380 PMCID: PMC10102715 DOI: 10.7759/cureus.36163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Open mesh repair of inguinal hernia is acceptable and can be performed under local anaesthesia (LA). Individuals with high BMI (Body Mass Index) have often been excluded from LA repairs for varying reasons including safety concerns. Open repair of unilateral inguinal hernia (UIH) amongst individuals with different BMI groups was studied. Its safety profile was investigated using LA volume and length of operation (LO) as endpoints. Operative pain and patient satisfaction were also evaluated. PATIENTS AND METHODS A total of 438 adult patients were studied having excluded underweight patients, those requiring any additional intra-operative analgesia, multiple procedures, or records with incomplete data. Operative pain, patient satisfaction, LO and LA volume were retrospectively studied from the existing data from clinical and operative notes. RESULTS It was a predominantly male population (93.2% males) with an age range of 17-94 years peaking in the 60-69 years age group. BMI ranged 19-39 kg/m2 with BMI above normal at 62.8%. LO was 13-100 minutes (average 37 mins {SD = 12}) utilising an average LA volume of 45 ml (SD = 11) per patient. Across BMI groups, no significant difference in LO (P = 0.168) or patient satisfaction (P = 0.388) was seen. Although LA volume (P = 0.011) and pain score (P<0.001) demonstrated statistically significant differences, these did not appear to be clinically relevant. Over 90% in each BMI group experienced mild or no pain and with severe pain reported in only one patient in the entire population. Overall, LA volume required per patient was low and dosage was safe in all BMI groups with significant proportion (89%) of patients evaluated for satisfaction rating their experience ≥ 90 out of 100. CONCLUSION LA repair is safe and well tolerated irrespective of BMI. BMI is not a viable reason for exclusion of obese/overweight individuals from LA repair.
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Cabrera‐Vargas LF, Mendoza‐Zuchini A, Aparicio BS, Pedraza M, Sajona‐Leguia WA, Arias JSR, Lozada‐Martinez ID, Picón‐Jaimes YA, Narvaez‐Rojas AR. Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1-year follow-up. Health Sci Rep 2023; 6:e1151. [PMID: 36938140 PMCID: PMC10018801 DOI: 10.1002/hsr2.1151] [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: 01/05/2023] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Aim Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium- or long-term studies that have compared outcomes between these two techniques. Methods This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques. Results A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died. Conclusions Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alexis R. Narvaez‐Rojas
- Division of Breast Surgical Oncology, DeWitt Daughtry Family Department of SurgeryJackson Health System / University of Miami Miller School of MedicineFloridaMiamiUSA
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Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis. Hernia 2023; 27:157-172. [PMID: 36066755 DOI: 10.1007/s10029-022-02669-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.
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Philipp M, Leuchter M, Lorenz R, Grambow E, Schafmayer C, Wiessner R. Quality of Life after Desarda Technique for Inguinal Hernia Repair-A Comparative Retrospective Multicenter Study of 120 Patients. J Clin Med 2023; 12:jcm12031001. [PMID: 36769652 PMCID: PMC9917682 DOI: 10.3390/jcm12031001] [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: 12/02/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Inguinal hernia repair, according to Desarda, is a pure tissue surgical technique using external oblique fascia to reinforce the posterior wall of the inguinal canal. This has provided an impetus for the rethinking of guideline adherence toward minimally invasive and mesh-based surgery of inguinal hernia. In this study, a retrospective analysis of this technique was conducted in two German hospitals. Between 6/2013 and 12/2020, 120 operations were performed. Analysis included patient characteristics, duration of operation, length of hospital stay, and perioperative complications. Data were used to achieve a matched-pair analysis comparing Desarda to laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Propensity scores were calculated based on five preoperative variables, including sex, age, American Society of Anesthesiology classification, localization, and width of the inguinal hernia in order to achieve comparability. Additionally, we assessed pain level and quality of life (QoL) 12 months postoperatively. The focus of our study was a comparison of QoL to a reference population and TAPP cohort. The study population consisted of 106 male and 14 female patients, and the median age was 37.5 years. The median operation time was 50 min, and the median length of hospital stay was 2 days. At a follow-up of 17 months, the median recurrence rate was 0.8%, and two cases of chronic postoperative pain were recorded. Postoperative QoL does not significantly differ between Desarda and TAPP. In contrast, Desarda patients had a significantly higher QoL compared with the reference population. In summary, Desarda's procedure is a good option as a pure tissue method for inguinal hernia repair.
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Affiliation(s)
- Mark Philipp
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Correspondence:
| | - Matthias Leuchter
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, 18119 Warnemuende, Germany
| | - Ralph Lorenz
- 3+ Chirurgen, Berlin-Spandau, 13581 Berlin, Germany
| | - Eberhard Grambow
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Clemens Schafmayer
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany
| | - Reiko Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, 18311 Ribnitz-Damgarten, Germany
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Carhuallanqui-Ciocca EI, Echevarría-Quispe JY, Hernández-Vásquez A, Díaz-Ruiz R, Azañedo D. Bibliometric analysis of the scientific production on inguinal hernia surgery in the web of science. Front Surg 2023; 10:1138805. [PMID: 37035575 PMCID: PMC10073695 DOI: 10.3389/fsurg.2023.1138805] [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: 01/06/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives To describe the bibliometric characteristics of the world scientific production in inguinal hernia surgery using the Web of Science Core Collection (WoS) database. Materials and methods A search for original articles published in the WoS up to December 2021 was carried out. Bibliometric analysis was performed using the Bibliometrix data package in R and VOSviewer, version 1.6.17. Results A total of 3,795 articles were identified in the database, with an annual average of 81 published articles and sustained growth with the highest number of publications in 2021. The article "Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures" published in 2017 was the most cited (517 citations). The United States was the country of the corresponding author with the highest number of published articles (725 articles). The author with the highest number of published articles was Rosenberg J., affiliated with the University of Copenhagen, with 52 articles and 765 citations. The journal "Hernia" had the highest number of articles published on inguinal hernias in the WoS, representing 18% of the total number of articles. Finally, the keywords most used were "herniorrhaphy" and "hernioplasty" in 2008, and more recently: "single incision" "society guidelines" and "single port". Conclusions The scientific production of original articles on inguinal hernia surgery has increased. There is currently great interest in research on minimally invasive surgical methods and standardization of procedures based on clinical practice guidelines.
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Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Correspondence: Akram Hernández-Vásquez
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Perez AJ, Petro CC, Higgins RM, Huang LC, Phillips S, Warren J, Dews T, Reinhorn M. Predictors of low and high opioid tablet consumption after inguinal hernia repair: an ACHQC opioid reduction task force analysis. Hernia 2022; 26:1625-1633. [PMID: 36036822 DOI: 10.1007/s10029-022-02661-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/30/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Prescribing and consumption of opioids remain highly variable. Using a national hernia registry, we aimed to identify patient and surgery specific factors associated with low and high opioid tablet consumption after inguinal hernia repair. METHODS This was a retrospective cross-sectional study evaluating patients undergoing elective inguinal hernia repair with 30-day follow-up and patient-reported opioid consumption from March 2019 to March 2021 using the Abdominal Core Health Quality Collaborative. Clinically significant patient demographics, comorbidities, operative details, quality-of-life measurements, and surgeon prescribing data were entered into a multivariable logistic regression model to identify statistically significant predictors of patients who took no opioid tablets or >10 tablets. RESULTS A total of 1937 patients were analyzed. Operations included 59% laparoscopic or robotic, 35% open mesh, and 6% open non-mesh repairs. Of these patients, 50% reported taking zero, 42% took 1-10, and 8% took ≥10 opioid tablets at 30-day follow-up. Patients who were older (OR 1.55, 95% CI 1.34-1.79, p-value <0.001), ASA ≤ 2 (OR 1.56, 95% CI 1.2-2.01, p-value <0.001), had no preoperative opioid use at baseline (OR 2.29, 95% CI 1.31-4.03, p-value = 0.004), had local anesthetic with general anesthesia (OR 1.39, 95% CI 1.0.5-1.85, p-value = 0.022), or prescribed <7 opioid tablets (OR 2.27, 95% CI 1.96-2.62, p-value <0.001) were more likely to take no opioid tablets. CONCLUSION Older, healthier, opioid naïve patients with local anesthetic administered during elective inguinal hernia repair are most likely to not require opioids. Surgeon prescribing-arguably the most modifiable factor-independently correlates with both low and high opioid consumption.
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Affiliation(s)
- A J Perez
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.
| | - C C Petro
- Center for Abdominal Core Health, Cleveland Clinic, Cleveland, OH, USA
| | - R M Higgins
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.,Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - L-C Huang
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Warren
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.,Department of Surgery, Division of Minimal Access, and Bariatric Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - T Dews
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.,Pain Management Department, Cleveland Clinic Euclid Hospital, Cleveland, OH, USA
| | - M Reinhorn
- Division of General, Acute Care and Trauma Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, 4008 Burnett Womack, Campus Box 7228, Chapel Hill, NC, 27599-7228, USA.,Mass General Brigham - Newton Wellesley Hospital, Boston Hernia and Pilonidal Center, Newton, MA, USA
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Chen J, Glasgow RE. What is the Best Inguinal Hernia Repair? Adv Surg 2022; 56:247-258. [PMID: 36096570 DOI: 10.1016/j.yasu.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the management of inguinal hernias have evolved over hundreds of years, so too has our paradigm of what constitutes the "best repair." To best answer what the ideal inguinal hernia repair is, the authors take an in-depth look at considerations to the patient, the provider, and the health care system.
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Affiliation(s)
- Jennwood Chen
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Veterans Affairs, Department of Surgery, 550 Foothill Dr, Salt Lake City, UT 84113, USA.
| | - Robert E Glasgow
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, 1950 Circle of Hope, Salt Lake City, UT 84112, USA.
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Ahmadinejad M, Bahri MH, Tajik A, Taherzadeh-ghahfarokhi N, Zebarjadi Bagherpour J. Bowel obstruction secondary to gallstone ileus within a strangulated inguinal hernia: Report of a rare diagnosis. Int J Surg Case Rep 2022; 97:107445. [PMID: 35952570 PMCID: PMC9403281 DOI: 10.1016/j.ijscr.2022.107445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gallstone ileus is rare and inguinal hernias are common causes of intestinal obstruction but combination of them is a very rare cause of intestinal obstruction. It is accepted that in patients with severe comorbidities surgeons can manage inguinal hernias and gallstone conservatively. In this article we report a patient with gallstone and inguinal hernia that managed with conservatively management because of heart failure but admitted with complication of gallstone and hernia and treated successfully. CASE PRESENTATION An 80-year-old woman with a history of heart failure and two bouts of acute cholecystitis, who presented with pain and swelling in the inguinal region and obstructive symptoms. And due to the urgent nature of the condition, she underwent surgery. CONCLUSION One of the rare complications of gallstones is cholecystoduodenal fistulas, especially in patients whose episodes of cholecystitis are treated medically. Early diagnosis and appropriate surgical management in these circumstances reduce the mortality and morbidity.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran
| | - Mohammad Hadi Bahri
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran
| | - Armin Tajik
- Research students committee, Alborz University of Medical Sciences, Alborz, Iran
| | | | - Javad Zebarjadi Bagherpour
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran,Corresponding author.
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Shah MY, Raut P, Wilkinson T, Agrawal V. Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study. Medicine (Baltimore) 2022; 101:e29746. [PMID: 35777031 PMCID: PMC9239617 DOI: 10.1097/md.0000000000029746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome. One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain. Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001). Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.
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Affiliation(s)
- Mohammed Yunus Shah
- Department of Minimal Access, Bariatric and General Surgery, Al Ahli Hospital, Qatar University, Doha, Qatar
- *Correspondence: Mohammed Yunus Shah, Department of Minimal Access, Bariatric and General Surgery, Al Ahli Hospital, Qatar University, P.O Box 6401, Doha, Qatar (e-mail: )
| | - Pratik Raut
- Maharashtra University of Health Sciences, Maharashtra, India
| | - T.R.V. Wilkinson
- Department of Surgery, NKP Salve Medical College and Research Centre, Nagpur, Maharashtra, India
| | - Vijay Agrawal
- Maharashtra University of Health Sciences, Maharashtra, India
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Doneva M, Kamusheva M, Petrova G, Sopotensky S, Gerasimov N. Evaluation of the quality of life after implantation of light or standard polypropylene hernia meshes. Folia Med (Plovdiv) 2022; 64:459-466. [PMID: 35856108 DOI: 10.3897/folmed.64.e65709] [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: 03/09/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract.
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Ma G, Jiang P, Mo B, Luo Y, Zhao Y, Wang X, Shi C, Huang Y. Take-Home Video Shortens the Time to First Ambulation in Patients With Inguinal Hernia Repair Under General Anesthesia: A Retrospective Observational Study. Front Med (Lausanne) 2022; 9:848280. [PMID: 35847805 PMCID: PMC9278018 DOI: 10.3389/fmed.2022.848280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Data on the relationship between take-home video and the time to first ambulation remains scant. Here, we aimed to investigate whether viewed take-home video during pre-hospitalization is independently associated with the time to first ambulation in postoperative patients with inguinal hernia repair under general anesthesia. Methods We retrospectively reviewed and analyzed the relationship between viewed take-home video and the time to first ambulation between September 2020 and October 2021.The independent t-tests or Mann-Whitney U-tests was used to compare the means of two groups (viewed take-home video and non-viewed take-home video). Chi-square test was used to compare the rates between the two groups. We used a linear regression model to see if there was a difference between exposure and outcome variable. Both models were used to observe the effect size of the exposed variable. Subgroup analysis was employed to assess the impact of various factors. Results This study included a total of 120 patients with inguinal hernia repair under general anesthesia following day surgery. The average age of the participants in the two groups was 43.16 and 44.83 years, respectively, and about 82.5% of the patients were male. Our fully adjusted linear regression results showed that individuals in the viewed video group were associated with a decreased time to first ambulation (h) after adjusting for confounders (β = −0.50, 95%CI: −0.83, −0.17; P = 0.004). In addition, the linear regression analysis of the relationship between viewed video and length of stay showed that β = −2.10 (95%CI:CI: −3.85, −0.34; P = 0.021). Similarly, subgroup analysis yielded similar results for the viewed video group patients compared to those in the non-viewed video group. Conclusion Taken together, our findings demonstrated that viewed video could shorten the time to first ambulation, which in turn reduce the length of stay in postoperative patients under general anesthesia.
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Affiliation(s)
- Guozhen Ma
- Day Surgery Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- School of Nursing, Philippine Women's University, Manila, Philippines
| | - Pengjun Jiang
- Department of Anorectal Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Beirong Mo
- Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- *Correspondence: Beirong Mo
| | - Yijun Luo
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yongling Zhao
- Department of Gastrointestinal Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Xingguang Wang
- Day Surgery Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Chunmiao Shi
- Day Surgery Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yanhui Huang
- Day Surgery Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Gallyamov EA, Agapov MA, Wu Z, Kakotkin VV, Kuznetsova AA, Wang Y, Wang Y, Zhang X, Zhang J. LAPAROSCOPIC APPROACH IN THE TREATMENT OF INGUINAL HERNIAS IN PATIENTS AFTER RADICAL PROSTATECTOMY: COMPARISON OF TARR AND TER RESULTS. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-43-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: To compare and evaluate the immediate and long-term results of performing transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP) for the treatment of inguinal hernias after surgical treatment of prostate cancer;Material and method: the study is a clinical analytical prospective study, with the use of randomization. The study included 88 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 44) and group B (n = 44)). Patients in group A received TEP, those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups.Results: Group A: one patient had a scrotal hematoma, in 2 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 6.8%. In group B, the following postoperative complications were reported: in one case, intestinal injury, 1 case of acute urinary retention, 2 cases of scrotal hematoma. The overall incidence of early postoperative complications was 9.1%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ = 0.009, P > 0.05).Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss and the severity of the pain syndrome (P> 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was longer than in group B. (P<0.05).
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Affiliation(s)
- E. A. Gallyamov
- Sechenov University; Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | | | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
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Agapov MA, Kakotkin VV, Yudina VD, Kadrev AV, Garmanova TN. DEVELOPMENT OF THE TAILORED APPROACH IN INGUINAL HERNIA REPAIR. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the study is to evaluate the effectiveness of a personalized algorithm for determining the technique of surgical treatment of inguinal hernias, which allows choosing the optimal operational tactics (its modifications) depending on the anthropometric, clinical, instrumental data of the patient.In the course of the study, the results of the application of a clinical algorithm in the Medical research and Educational center of Lomonosov Moscow State University for patients with unilateral non-incarcerated symptomatic inguinal hernias were analyzed. The frequencies of the main postoperative adverse outcomes of the research group were compared using the algorithm and patients of the German Herniamed Hernia Register, for whom only standard principles of surgical intervention selection are applied, the main provisions of the recommendations of the international HerniaSurge Group of experts. In some cases individual exceptional factors of patients were taken into account.The frequency of chronic pain and pain requiring repeated surgery was significantly lower than the average frequencies of the German Herniamed register (13.8% vs 28.7% (p<0.00001) and 0.99% vs 3.8% (p=0.0103) respectively). At the same time, the frequency of adverse outcomes, such as relapses and early postoperative complications, is similar to international population data.
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Affiliation(s)
- M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. D. Yudina
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - A. V. Kadrev
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - T. N. Garmanova
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
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Trawa M, Albrecht HC, Köckerling F, Riediger H, Adolf D, Gretschel S. Outcome of inguinal hernia repair after previous radical prostatectomy: a registry-based analysis with 12,465 patients. Hernia 2022; 26:1143-1152. [PMID: 35731311 PMCID: PMC9334414 DOI: 10.1007/s10029-022-02635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Following radical prostatectomy, the rate of inguinal hernias is fourfold higher compared to controls. Laparo-endoscopic repair after previous radical prostatectomy is considered complex. Therefore, the guidelines recommend open Lichtenstein repair. To date, there are limited data on inguinal hernia repair after prior prostatectomy. METHODS In a retrospective analysis from the Herniamed Registry, the outcomes of 255,182 primary elective unilateral inguinal hernia repairs were compared with those of 12,465 patients with previous radical prostatectomy in relation to the surgical technique. Furthermore, the outcomes of laparo-endoscopic versus open Lichtenstein repair techniques in the 12,465 patients after previous radical prostatectomy were directly compared. RESULTS Comparison of the perioperative complication rates for primary elective unilateral inguinal hernia repair with and without previous radical prostatectomy demonstrated for the laparo-endoscopic techniques significantly higher intraoperative complications (2.1% vs 0.9%; p < 0.001), postoperative complications (3.2% vs 1.9%; p < 0.001) and complication-related reoperations (1.1% vs 0.7%; p = 0.0442) to the disadvantage of previous prostatectomy. No significant differences were identified for Lichtenstein repair. Direct comparison of the laparo-endoscopic with the open Lichtenstein technique for inguinal hernia repair after previous radical prostatectomy revealed significantly more intraoperative complications for TEP and TAPP (2.1% vs 0.6%; p < 0.001), but more postoperative complications (4.8% vs 3.2%; p < 0.001) and complication-related reoperations (1.8% vs 1.1%; p = 0.003) for open Lichtenstein repair. CONCLUSION Since there are no clear advantages for the laparo-endoscopic vs the open Lichtenstein technique in inguinal hernia repair after previous radical prostatectomy, the surgeon can opt for one or the other technique in accordance with their experience.
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Affiliation(s)
- M Trawa
- Department of General, Visceral, Thoracic and Vascular Surgery, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Germany.,Faculty of Health Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - H C Albrecht
- Department of General, Visceral, Thoracic and Vascular Surgery, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Germany.,Faculty of Health Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - F Köckerling
- Department of Surgery, Hernia Center, Academic Teaching Hospital of Charité Medical School, Vivantes Humboldt-Hospital Berlin, Berlin, Germany
| | - H Riediger
- Department of Surgery, Hernia Center, Academic Teaching Hospital of Charité Medical School, Vivantes Humboldt-Hospital Berlin, Berlin, Germany
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - S Gretschel
- Department of General, Visceral, Thoracic and Vascular Surgery, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Germany. .,Faculty of Health Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
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de la Garza MA, Hegge SR, Bakker J. Inguinal Hernia in Nonhuman Primates: From Asymptomatic to Life-Threatening Events. Vet Sci 2022; 9:vetsci9060280. [PMID: 35737332 PMCID: PMC9228773 DOI: 10.3390/vetsci9060280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
In this study, a review of available data and literature on the epidemiology and anamnesis of inguinal hernias in nonhuman primates, as well as on their clinical evaluation and surgical management, was conducted. Inguinal hernias are assumed to be relatively common in male nonhuman primates. Clinical signs are usually limited to a visible or palpable mass in the groin region without pain or systemic illness. Most hernias contain omentum. Careful monitoring is an acceptable treatment option for those animals. Size, the danger of incarceration, and the presence of strangulation are important factors when considering surgical repair. A strangulated inguinal hernia is an emergency, requiring prompt surgery to avoid tissue necrosis and death. Imaging techniques, as well as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), provide information about the anatomical characteristics of the suspected region, allowing for a diagnosis and treatment. An inguinal hernia repair can be performed with either open surgery or laparoscopic surgery. The hernia repair can be achieved by mesh or suture. Decisions regarding which repair technique to use depend on the surgeon′s skill level and preference. Complication and recurrence rates are generally low. The most common postsurgical complication is a recurrence of the hernia. Contraceptive measures are not indicated in breeders, as there is no known hereditary component, and the presence of hernia does not appear to affect fertility, nor does it predispose to occurrence, recurrence, or incarceration.
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Affiliation(s)
| | | | - Jaco Bakker
- Animal Science Department (ASD), Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands
- Correspondence: ; Tel.: +31-15-284 2579
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Sekhon Inderjit Singh HK, Massey LH, Arulampalam T, Motson RW, Pawa N. Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis. Am J Surg 2022; 224:1135-1149. [DOI: 10.1016/j.amjsurg.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
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Tansawet A, Rodsakan T, Kasetsermwiriya W, Lerdsirisopon S, Techapongsatorn S. The Myopectineal Orifice: A Study of Thai Cadavers. Front Surg 2022; 9:843344. [PMID: 35449553 PMCID: PMC9018102 DOI: 10.3389/fsurg.2022.843344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to determine the myopectineal orifice size measured in Thai human cadavers. Materials and Methods A total of 30 human cadavers, comprising 55 groins, were assessed. Myopectineal orifices (MPOs) were measured in two dimensions: height from the lower border of the conjoined tendon to the upper border of the pectineal ligament and width from the lateral border of pubic tubercle to the medial border of the iliopsoas muscle. Results The mean MPO size is 7.13 + 0.14 cm in width and 6.66 + 0.32 m in height. The mean width and height in male cadavers are 7.16 + 0.14 and 6.84 + 0.27 cm, respectively. The mean width and height in female cadavers are 7.09 + 0.12 and 6.45 + 0.24 cm, respectively. The mean MPO area is 37.26 ± 0.027 cm2, compared with the area of mesh graft 10 cm × 15 cm, 150 cm2. Although the shrinkage of cadaveric tissue and mesh size were adjusted, which were 39.56 ± 0.029 and 81 cm2, respectively, they were found to be sufficient for the mean MPO area. It was found that the mesh size was sufficient for the mean MPO area. Conclusion A mesh size of 10 cm × 15 cm is found to be the appropriate size to cover the MPO among Thais.
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Congenital collagenopathies increased the risk of inguinal hernia developing and repair: analysis from a nationwide population-based cohort study. Sci Rep 2022; 12:2360. [PMID: 35149748 PMCID: PMC8837651 DOI: 10.1038/s41598-022-06367-5] [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: 05/10/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022] Open
Abstract
Herein, we aimed to explore whether male patients with congenital collagen diseases had a higher risk of inguinal herniation than patients without these diseases. Data were retrospectively collected from the National Health Insurance Research Database of Taiwan. The study cohort included 1,801 male patients diagnosed with congenital collagen diseases based on the ICD-9 CM diagnostic codes; after propensity score matching, the control group comprised 6,493 men without congenital collagen diseases. The primary endpoint was inguinal hernia repair during the observation period. During a median follow-up period of 133.9 months, the risk of inguinal herniation in the collagen group was significantly higher than that in the control group (HR = 2.237, 95% CI 1.646-3.291, p < 0.001). This phenomenon was observed in patients younger than 18 years (HR: 3.040, 95% CI 1.819-5.083, p < 0.001) and in those aged 18-80 years (HR: 1.909, 95% CI 1.186-3.073, p < 0.001). Asian men with congenital collagen diseases are at a high risk of developing inguinal hernias, regardless of age. Detailed physical examination and patient education should be performed for these patients to prevent inguinal herniation.
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Costa F, Pascarella G, Luffarelli P, Strumia A, Biondo G, Piliego C, Alloni R, Agrò FE. Selective spinal anesthesia with hyperbaric prilocaine provides better perioperative pain control than local anesthesia for ambulatory inguinal hernia repair without affecting discharging time: a randomized controlled trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:6. [PMID: 37386519 DOI: 10.1186/s44158-022-00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 07/01/2023]
Abstract
PURPOSE Local anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local anesthetic guarantees rapid recovery, predictable duration and low incidence of side effects. We tried to assess the efficacy of this neuraxial technique in ambulatory setting. METHODS One hundred thirty-two ASA I-III, aged > 18 patients scheduled for inguinal hernia repair have been randomized into two groups receiving unilateral spinal anesthesia with 40 mg of hyperbaric prilocaine (group A) or local anesthesia with mepivacaine (group B). PRIMARY ENDPOINT intraoperative and post-operative NRS. Other outcomes: sensory block onset, need for opiates and deep sedation, surgery duration, and time to discharge. RESULTS Group A: intraoperative NRS was 0 in 100% of patients; post-operative maximum NRS was > 3 in 12.12% of patients. Group B: mean intraoperative NRS was 4; mean post-operative NRS was 2.5. Spinal anesthesia resulted superior in controlling both intraoperative and post-operative pain (p < 0.00001; p = 0.008). Mean time of the motor block resolution in group A was 98 ± 2 min. Mean time to discharge was not significantly different between groups. Surgical time was significantly different between the two groups (mean time of 37 ± 3.2 min group A; 54 ± 6 min group B-p < 0.00001). CONCLUSION Spinal anesthesia group patients had significantly less pain than local anesthesia group, both intraoperatively and post-operatively, without differences in time to discharge, incidence of complications and with improvement of surgical time. More randomized controlled trials are needed to confirm this hypothesis. TRIAL REGISTRATION NCT05136534 . Registered November 29, 2021-Retrospectively registered.
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Affiliation(s)
- Fabio Costa
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Giuseppe Pascarella
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Paolo Luffarelli
- Department of Pelvic Floor Surgery and Proctology, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Alessandro Strumia
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Gaspare Biondo
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Chiara Piliego
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Rossana Alloni
- Department of Specialistic General Surgery, Campus Bio-Medico of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Felice E Agrò
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, via Álvaro del Portillo 21, 00128, Rome, Italy
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Xu D, Fang M, Wang Q, Qiao Y, Li Y, Wang L. Latest Trends on the Attenuation of Systemic Foreign Body Response and Infectious Complications of Synthetic Hernia Meshes. ACS APPLIED BIO MATERIALS 2022; 5:1-19. [PMID: 35014826 DOI: 10.1021/acsabm.1c00841] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Throughout the past few years, hernia incidence has remained at a high level worldwide, with more than 20 million people requiring hernia surgery each year. Synthetic hernia meshes play an important role, providing a microenvironment that attracts and harbors host cells and acting as a permanent roadmap for intact abdominal wall reconstruction. Nevertheless, it is still inevitable to cause not-so-trivial complications, especially chronic pain and adhesion. In long-term studies, it was found that the complications are mainly caused by excessive fibrosis from the foreign body reaction (FBR) and infection resulting from bacterial colonization. For a thorough understanding of their complex mechanism and providing a richer background for mesh development, herein, we discuss different clinical mesh products and explore the interactions between their structure and complications. We further explored progress in reducing mesh complications to provide varied strategies that are informative and instructive for mesh modification in different research directions. We hope that this work will spur hernia mesh designers to step up their efforts to develop more practical and accessible meshes by improving the physical structure and chemical properties of meshes to combat the increasing risk of adhesions, infections, and inflammatory reactions. We conclude that further work is needed to solve this pressing problem, especially in the analysis and functionalization of mesh materials, provided of course that the initial performance of the mesh is guaranteed.
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Affiliation(s)
- Danyao Xu
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Meiqi Fang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Qian Wang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yansha Qiao
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
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Agapov MA, Kakotkin VV, Gallyamov EA, Kubyshkin VA. [Pain and quality of life after laparoscopic transabdominal preperitoneal hernioplasty with different ways of fixing the peritoneum. Results of early completion randomized clinical trial]. Khirurgiia (Mosk) 2022:14-20. [PMID: 36073578 DOI: 10.17116/hirurgia202209114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation). METHODS A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum. RESULTS At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol. CONCLUSION The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.
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Affiliation(s)
- M A Agapov
- Lomonosov Moscow State University, Moscow, Russian Federation
| | - V V Kakotkin
- Lomonosov Moscow State University, Moscow, Russian Federation
| | - E A Gallyamov
- Lomonosov Moscow State University, Moscow, Russian Federation
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - V A Kubyshkin
- Lomonosov Moscow State University, Moscow, Russian Federation
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Dumitrescu D, Serban D, Comandasu M, Dumitrescu V. Peritoneal Pocket Hernia—Avoidable Complication Following TAPP with Meticulous Closure Technique of Peritoneal Flaps. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Thalheimer A, Vonlanthen R, Ivanova S, Stoupis C, Bueter M. Mind the gap - Small bowel obstruction due to preperitoneal herniation following laparoscopic inguinal hernia repair - A case report. Int J Surg Case Rep 2021; 88:106532. [PMID: 34688071 PMCID: PMC8536528 DOI: 10.1016/j.ijscr.2021.106532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Inguinal hernia repair is a very frequent operation in general and visceral surgery worldwide. The laparo-endoscopic approaches such as TAPP have gained increasing acceptance among specialists and many consider them as standard of care due to perioperative safety and excellent postoperative results. Knowledge of specific complications after minimally invasive inguinal hernia surgery, however, is important for the successful management of these patients. CASE PRESENTATION We herein present the case of a 75-year-old female patient who electively underwent laparoscopic repair of combined inguinal and femoral hernia. During the postoperative course a small bowel obstruction occurred requiring emergency re-laparoscopy revealing a preperitoneal herniation of small bowel through a peritoneal defect. CLINICAL DISCUSSION Small bowel obstruction due to preperitoneal herniation of small bowel through a peritoneal defect after laparoscopic hernia repair is extremely rare. In such cases, emergency laparoscopic revision is necessary to avoid bowel ischaemia. Adequate closure of the peritoneum during the primary procedure along with the necessary attention to detail seems mandatory to avoid preperitoneal herniation after TAPP. CONCLUSION Inadequate peritoneal closure after TAPP may lead to preperitoneal herniation of the small bowel leading to postoperative intestinal obstruction. All hernia surgeons should be aware of this rare, but potentially life-threatening complication and should close all peritoneal defects with greatest care and accuracy.
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Affiliation(s)
- Andreas Thalheimer
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland; Department of Surgery, Spital Männedorf, Männedorf, Switzerland.
| | - Rene Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Silviya Ivanova
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | | | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland; Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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Alomar OSK. Modified Halsted's operation for inguinal hernia repair: A new technique. Ann Med Surg (Lond) 2021; 71:102968. [PMID: 34712482 PMCID: PMC8529394 DOI: 10.1016/j.amsu.2021.102968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia is a frequent problem presented to surgical clinic in Iraq. Surgical treatment options for inguinal hernia are numerous, selecting the appropriate method or technique depends on different factors. Aim of study To find a new technique for open inguinal hernia repair with no recurrence even in recurrent cases, without major complications during or after surgery, and can be used even by new surgeons with little experience. Patients & methods A retrospective cross sectional study conducted in the Medical City teaching hospital and Private Hospitals in Baghdad, during the period from January 1, 2000, to December 30, 2016 on convenient sample of 408 Iraqi patients with inguinal hernia. The patients were treated by modified Halsted's technique by open surgery applying polypropylene mesh. The patients were followed up through frequent visits and phone calls to assess the recurrence and complications. Results No recurrence of inguinal hernia was reported after 5-10 years follow up, while 94.9% of patients reported postoperative complications commonly oedema of spermatic cord. There was a highly significant association between male gender hernia patients and post Modified Halsted operation complications (p < 0.001). A highly significant association was observed between direct hernia and post Modified Halsted operation complications (p < 0.001). The significant risk factors related to complications were anemia and collagen disease. Conclusions The modified Halsted's operation for inguinal hernia repair is effective in treatment of inguinal hernia with low recurrence and complications rate.
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Inguinal hernia – epidemiology, risk factors, treatment methods (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.
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Lin ADY, Tung MC, Lu CH. The hernia sac-A suitable source for obtaining mesenchymal stem cells. Surg Open Sci 2021; 6:40-44. [PMID: 34632354 PMCID: PMC8487083 DOI: 10.1016/j.sopen.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Inguinal hernia sac, extended tissue from peritoneum, gradually enlarged in size with hernia disease time and prolapsed tissue volume. We hypothesize that mesenchymal stem cells are present in the development of hernia sac. The current study aimed to test the hypothesis that hernia sac, which is often resected and discarded as medical waste, contains mesenchymal stem cells and thus might be a suitable source to harvest mesenchymal stem cells. Methods Between July 2019 and June 2020, 4 hernia sacs were resected during hernia surgery and then obtained for mesenchymal extraction using the Miltenyi gentleMACS Dissociator. The presence of mesenchymal stem cells was determined by the markers CD105, CD73, and CD90, with assessment of the expressions ≥ 95%, whereas markers CD45, CD34, CD11b, CD19, and HLA-DR were used to assess lack expression (≤ 2%). Moreover, von Kossa staining, Alcian blue staining, and Oil Red O staining were used to verify the cells' ability for differentiation. Results Cells retrieved from the hernia sacs displayed a spindle-shaped morphology and exhibited adherence to plastics. The cell surface immunophenotypic profile was confirmed using surface markers APC-A (CD73), FITC-A (CD90), and PerCP-Cy5-5-A (CD105), with results showing 100%, 100%, and 99.2%, respectively, strongly indicating the presence of mesenchymal stem cells. Moreover, staining of in vitro cell cultures showed in vitro differentiation of precursor cells into osteoblasts, adipocytes, and chondroblasts, suggesting positive differentiation ability and identification of mesenchymal stem cells. Conclusion Inguinal hernia sac is a novel source of mesenchymal stem cells that can be easily obtained and stored for future usage.
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Affiliation(s)
- Alpha Dian-Yu Lin
- Joshua Taipei Hernia Center, Central Clinic & Hospital, Taipei, Taiwan.,Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Chin-Heng Lu
- Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
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Forrest E, Fletcher C, Budge M, Lee JC, Grodski S, Serpell JW. Amyand hernia with acute appendicitis: management considerations. ANZ J Surg 2021; 92:2690-2691. [PMID: 34613650 DOI: 10.1111/ans.17259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Edward Forrest
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Calvin Fletcher
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Melissa Budge
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - James C Lee
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Simon Grodski
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Jonathan W Serpell
- Department of Surgery, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
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Kohno S, Hasegawa T, Aoki H, Ogawa M, Yoshida K, Yanaga K, Ikegami T. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults. Asian J Surg 2021; 45:1001-1006. [PMID: 34598841 DOI: 10.1016/j.asjsur.2021.08.019] [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: 06/22/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the causes of complications following surgery for inguinal and femoral hernia, using surgical site infection (SSI) and recurrence rate as indicators of outcomes to consider appropriate treatments. METHODS We retrospectively assessed the medical histories of 1,098 patients with adult inguinal and femoral hernias who underwent herniorrhaphy between July 2010 and March 2019. Using SSI and recurrence rate as indicators of outcomes, we statistically assessed the influence of preoperative and operative conditions on surgical outcomes. RESULTS The occurrence of postoperative SSI was significantly more frequent in patients who experienced a long surgical duration, excessive blood loss, and incarceration; underwent emergency surgery and bowel resection; and in whom no mesh sheet insertion was performed. There was no correlation between mesh use and SSI in cases that did not require emergency incarceration repair. For cases involving hernia incarceration, the use of a mesh sheet was avoided to prevent potential infection, which could explain the high incidence of SSI in cases where mesh was not used. The hernia may have recurred due to technical issues during the procedure, as well as failure to ligate the hernia sac. CONCLUSIONS Selecting the appropriate surgical method for hernia repair may reduce the incidence of SSI. If manual reduction of inguinal hernias is not possible, an appropriate surgical procedure should be determined based on laparoscopic findings in facilities where laparoscopic hernia surgeries are frequently performed. Moreover, in cases without infection and bowel resection, mesh use may be beneficial. Recurrence can be prevented by ligating the hernia sac during surgery and solving relevant technical problems.
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Affiliation(s)
- Shuzo Kohno
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan.
| | - Takuo Hasegawa
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Hiroaki Aoki
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Masaichi Ogawa
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Surgery, The Jikei University Katsushika Medical Center, 125-8061, Tokyo, Japan
| | - Katsuhiko Yanaga
- International University of Health and Welfare, 814-0001, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery, The Jikei University School of Medicine, 105-8461, Tokyo, Japan
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O'Brien J, Sinha S, Turner R. Inguinal hernia repair: a global perspective. ANZ J Surg 2021; 91:2288-2295. [PMID: 34553473 DOI: 10.1111/ans.17174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal hernia repair is one of the most common operations performed worldwide with most of the burden of these occurring in low- or middle-income countries (LMICs). There has been much research investigating the most effective method of hernia repair in resource-rich countries, however very little has been done to determine the most cost-beneficial method of hernia repair in LMICs. METHODS A systematic review of the English literature through PubMed and Scopus was conducted according to the PRISMA statement. RESULTS Twenty-eight studies met the inclusion criteria of which 17 were randomised controlled trials and 11 were systematic reviews. Three areas of investigation were established from the literature search, namely operative method and type of mesh used (where applicable). Open-mesh procedures were shown to be less costly and have shorter operative times than laparoscopic methods. People who underwent laparoscopic hernia repair regularly returned to normal activities earlier than those who had open-mesh procedures. However, there was no other difference in complication rates between these two methods. Recent investigations have revealed that sterilised synthetic mosquito net was similar to hernia-specific meshes whilst significantly reducing cost. CONCLUSION We postulate that the most cost-beneficial method of hernia repair for implementation in LMICs is using open-mesh procedures with sterilised mosquito net under local anaesthetic. Further cost-benefit research is required in this area.
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Affiliation(s)
- James O'Brien
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sankar Sinha
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Turner
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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50
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Tanasescu C, Moisin A, Mihetiu A, Serban D, Costache A, Bratu DG. The use of polypropylene mesh in inguinal hernia surgery: A retrospective study. Exp Ther Med 2021; 22:1193. [PMID: 34475983 PMCID: PMC8406872 DOI: 10.3892/etm.2021.10627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 01/18/2023] Open
Abstract
Previously, inguinal hernia surgery was based exclusively on repairing the abdominal wall defects using the patient's own tissues, which were put in contact with and tensioned to recalibrate the natural orifices. At present, inguinal hernia surgery is based almost solely on mounting an allograft, which has the role of strengthening the weakened groin region that allowed the herniation. This modern method of operation on inguinal hernia can be performed in a classic or laparoscopic manner. The mesh is made of polypropylene, which is a polymer of cyclic hydrocarbons. The aim of the present study was to evaluate the effectiveness, biocompatibility, as well as the immediate and long-term complications in textile allografts used in open surgery of inguinal hernia repair. Another aim was to demonstrate once again the superiority of low-weight meshes with large pores by decreasing the number of complications caused by the synthetic material used, but also by a decrease in the tension on the tissues to which it was fixed. The present study included 255 cases submitted to inguinal hernia surgery. Only 1.5% required immediate reintervention before discharge to evacuate hematoma. The short duration of hospitalization, the quality-price ratio, the good postoperative results, as well as the rapid socio-professional reintegration, render the use of polypropylene mesh in inguinal hernia surgery very attractive for patients.
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Affiliation(s)
- Ciprian Tanasescu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
| | - Andrei Moisin
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania
| | - Alin Mihetiu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
| | - Dragos Serban
- The 4th Surgery Department, Emergency University Hospital, 050098 Bucharest, Romania
| | - Adrian Costache
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dan Georgian Bratu
- Department of Surgery, Sibiu County Clinical Emergency Hospital, 550245 Sibiu, Romania.,Clinic Surgical Department, Faculty of Medicine, 'Lucian Blaga' University, 550169 Sibiu, Romania
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