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Hayakawa T, Ueno N, Eguchi T, Kawarada Y, Shigemitsu Y, Shimada G, Suwa K, Nakagawa M, Hachisuka T, Hayakawa S, Yamamoto K, Yokoyama T, Wada N, Wada H, Takehara H, Nagae I, Morotomi Y, Idani H, Saijo F, Tsuruma T, Nakano K, Kimura T, Matsumoto S. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Hernia. Asian J Endosc Surg 2024; 17:e13363. [PMID: 39087456 DOI: 10.1111/ases.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Affiliation(s)
| | - Nozomi Ueno
- Hernia Center, Saiseikai Suita Hospital, Toyota, Japan
| | - Toru Eguchi
- Department of Surgery, Harasanshin Hospital, Toyota, Japan
| | - Yo Kawarada
- Department of Surgery, Tonan Hospital, Toyota, Japan
| | | | - Gen Shimada
- Hernia Center, St. Luke's International Hospital, Toyota, Japan
| | - Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Toyota, Japan
| | | | | | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Toyota, Japan
| | - Kaisuke Yamamoto
- Department of Surgery, Inguinal Hernia Surgery Center, Kenseikai Ken Clinic, Toyota, Japan
| | | | - Norihito Wada
- Department of Surgery, Shonan Keiiku Hospital, Toyota, Japan
| | - Hidetoshi Wada
- Department of Surgery, Shimada General Medical Center, Toyota, Japan
| | - Hiroo Takehara
- Department of Hernia Surgery, Okinawa Heart-Life Hospital, Toyota, Japan
| | - Itsuro Nagae
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Toyota, Japan
| | | | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Fumito Saijo
- Department of Surgery, Tohoku University Hospital, Toyota, Japan
| | | | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Taizo Kimura
- Department of Surgery, Fujinomiya City General Hospital, Toyota, Japan
| | - Sumio Matsumoto
- National Hospital Organization, Tokyo Medical Center, Toyota, Japan
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Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L, Awad MM, Haroutounian S. Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2024; 25:104532. [PMID: 38599265 DOI: 10.1016/j.jpain.2024.104532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.
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Affiliation(s)
- Harutyun Alaverdyan
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Jooyoung Maeng
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Peter K Park
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Kavya Narayana Reddy
- Department of Anesthesiology and Pain Management, Arkansas Children Hospital, University of Arkansas Medical Science, Little Rock, Arkansas
| | - Michael P Gaume
- Department of Pain Management, University of Kansas Health System-St Francis Hospital, Topeka, Kansas
| | - Lauren Yaeger
- Bernard Becker Medical Library, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Michael M Awad
- Department of Surgery, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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Pompeu BF, Almiron da Rocha Soares G, Pereira Silva M, Ponte Farias AG, Oliveira de Sousa Silva R, Mazzola Poli de Figueiredo S. Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials. Surg Endosc 2024:10.1007/s00464-024-11138-6. [PMID: 39160308 DOI: 10.1007/s00464-024-11138-6] [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: 01/30/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. METHODS MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). RESULTS Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. CONCLUSION In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week.
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Affiliation(s)
- Bernardo Fontel Pompeu
- Department of Surgery, Heliopolis Hospital, São Paulo, Brazil.
- USCS-Universidade Municipal de São Caetano do Sul, Rua Santo Antônio, 50-Centro, São Caetano do Sul, SP, 09521-160, Brazil.
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4
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Correia de Sá T, Jácome F, Basto T, Costa M, Gonçalves Á, Teixeira N, Castro Neves L, Barros da Silva J. Transabdominal preperitoneal (TAPP) repair for emergency groin hernia: a systematic review. Hernia 2024; 28:1005-1015. [PMID: 38522045 DOI: 10.1007/s10029-024-03018-8] [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: 10/08/2023] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Laparoscopic groin hernia repair has evolved and gained popularity and laparoscopic transabdominal preperitoneal (TAPP) procedure provides an opportunity to evaluate the peritoneal cavity and both inguinal areas without the need for additional dissection. There is still a paucity of evidence to support TAPP repair in the emergency setting. In this systematic review, we aim to evaluate the feasibility and safety of TAPP repair for incarcerated and strangulated groin hernias. METHODS PRISMA guidelines were followed for literature search and established inclusion and exclusion criteria were applied. Data were extracted and analyzed for the outcomes of interest. RESULTS Overall, 8 studies were included in the review, comprising 316 patients. Patients characteristics and outcomes were limitedly reported. Only 3 cases of conversion to open approach were reported and 2 recurrences were diagnosed. Postoperative complications are inconsistently reported but mostly refer to minor complications. There were no mortality cases. Visceral resections were performed in 25 cases due to ischemia, mostly extracorporeally. CONCLUSION Laparoscopy is a game changer and TAPP approach is a feasible, safe, and effective technique for the emergent repair of groin hernias. Further studies and prospective randomized data are needed to establish its role in the emergent groin hernia management.
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Affiliation(s)
- T Correia de Sá
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal.
| | - F Jácome
- Angiology and Vascular Surgery Department, Unidade Local de Saúde de São João, Porto, Portugal
| | - T Basto
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - M Costa
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - Á Gonçalves
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - N Teixeira
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - L Castro Neves
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
| | - J Barros da Silva
- General Surgery Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal
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Lillo-Albert G, Villa EB, Boscà-Robledo A, Carreño-Sáenz O, Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis. Hernia 2024; 28:1427-1439. [PMID: 38837072 DOI: 10.1007/s10029-024-03077-x] [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: 03/22/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia. METHODS Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI). RESULTS Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92). CONCLUSIONS This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
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Affiliation(s)
| | - Elvira Buch Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
| | - Andrea Boscà-Robledo
- Department of HPB Surgery and Transplantation, La Fe University Hospital, University of Valencia, Valencia, Spain
| | - Omar Carreño-Sáenz
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - José Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jesús Martínez-Hoed
- Unit of Abdominal Wall Surgery. R. A. Calderón Guardia Hospital, San José, Costa Rica
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain
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Messias BA, Nicastro RG, Mocchetti ER, Waisberg J, Roll S, Junior MAFR. Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes. Hernia 2024; 28:1467-1476. [PMID: 38900355 PMCID: PMC11297121 DOI: 10.1007/s10029-024-03094-w] [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: 04/04/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. METHODS PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. RESULTS Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. CONCLUSION The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique.
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Affiliation(s)
- Bruno Amantini Messias
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil.
- Department of Surgery, São Camilo University Center, São Paulo, SP, Brazil.
| | | | - Erica Rossi Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, 95 Pedreira Street, Carapicuiba, SP, 06321-665, Brazil
| | - Jaques Waisberg
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil
- Department of Surgery, ABC Medical School, Santo Andre, SP, Brazil
| | - Sergio Roll
- Abdominal Wall Surgery Unit, Santa Casa de São Paulo, São Paulo, SP, Brazil
- Hernia Center, Oswaldo Cruz German Hospital, Sao Paulo, SP, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro Junior
- Division Chair Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
- Department of Surgery, Catholic University of São Paulo, Sorocaba, SP, Brazil
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Bialecki J, Antkowiak R, Adamiecki M, EngD AK, Antkowiak L, Szmit M, Domoslawski P. Incidentally found obturator hernias during totally extraperitoneal (TEP) inguinal hernia repair: a single-center experience. Hernia 2024; 28:1145-1149. [PMID: 38488932 DOI: 10.1007/s10029-024-02991-4] [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: 12/09/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This study aimed to determine the occurrence of incidental obturator hernia and clinical risk factors of their appearance in patients undergoing totally extraperitoneal (TEP) inguinal hernioplasty. METHODS Data were collected retrospectively from patients who underwent TEP inguinal hernioplasty between June 2020 and December 2022. RESULTS A total of 251 patients were included in the study. Obturator hernias were found in 21 patients (8.4%). At admission, no patient presented clinical signs of an obturator hernia. There was a significant predominance of women in the obturator hernia compared to the non-obturator hernia group (28.6% vs. 10.9%, respectively, p=0.018). There was no correlation between age (p=0.479) and BMI (p=0.771) and the occurrence of obturator hernia. Additional obturator hernia repair within the TEP inguinal hernioplasty procedure did not influence the overall length of the surgery (60.86 minutes) compared to the standard TEP inguinal hernioplasty (61.09 minutes, p=0.876). CONCLUSIONS The TEP inguinal hernioplasty allows the detection and repair of incidental obturator hernia. Through thorough inspection of the obturator canal, an asymptomatic obturator hernia can be detected and adequately treated within the same procedure, without the impact on the surgery duration, when performed by an experienced hernia surgeon.
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Affiliation(s)
- Jacek Bialecki
- Department of General Minimally Invasive and Trauma Surgery, Francis Raszeja Municipal Hospital, Mickiewicza 2 Street, 60-834, Poznan, Poland.
| | - Ryszard Antkowiak
- Department of General and Oncologic Surgery, St. Joseph Hospital, Mikolow, Poland
| | - Marcin Adamiecki
- Department of General and Oncologic Surgery, St. Joseph Hospital, Mikolow, Poland
| | - Anna Kasperczuk EngD
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mateusz Szmit
- Department of General Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Domoslawski
- Department of General Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024:10.1007/s13304-024-01944-x. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
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Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
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Lee SR. Characteristics of pantaloon inguinal hernia and evaluation of added laparoscopic iliopubic tract repair to transabdominal preperitoneal hernioplasty: a retrospective observational study. Ann Surg Treat Res 2024; 106:361-368. [PMID: 38868584 PMCID: PMC11164662 DOI: 10.4174/astr.2024.106.6.361] [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: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose Pantaloon hernia (PH), defined as concurrent ipsilateral direct and indirect inguinal hernias, is known for its high postoperative recurrence rate. This study retrospectively investigated the characteristics of PHs and evaluated the safety and efficacy of incorporating laparoscopic iliopubic tract repair (IPTR) into transabdominal preperitoneal (TAPP) hernioplasty. Methods A total of 3,355 patients who underwent TAPP hernioplasty for groin hernias between October 2014 and December 2021 were analyzed. These patients were divided into 2 groups: PH (97 patients) and non-PH (3,258 patients). The PH group was further subdivided based on the surgical technique used: TAPP hernioplasty without IPTR (TAPP group, 39 patients) and TAPP hernioplasty with IPTR for defect closure (TAPP + IPTR group, 58 patients). Results The study included 93 male and 4 female patients with PH. Patients with PH were generally older and predominantly male compared to the non-PH group. The recurrence rate in the PH group was notably higher than in the non-PH group (2.1% [2 of 97] vs. 0.2% [6 of 3,258], respectively; P = 0.007). Among the PH group, reoperations were more frequent in the TAPP group compared to the TAPP + IPTR group (10.3% [4 of 39] vs. 0% [0 of 58], respectively; P = 0.048). The reasons for reoperation in the PH group included recurrences (2 patients), mesh bulge (1 patient), and chronic seroma (1 patient). Conclusion TAPP + IPTR hernioplasty is an acceptable approach in PH treatment, reducing reoperation.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Korea
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Varshney A, Kawatra V, Watal U, Abraham NT, Avinash M, Pugalendhi AS, Rana S. Comparing Laparoscopic Total Extraperitoneal and Lichtenstein Mesh Repair for Inguinal Hernias: A Focus on Patient Outcomes. Cureus 2024; 16:e57373. [PMID: 38694654 PMCID: PMC11061776 DOI: 10.7759/cureus.57373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND This study aimed to evaluate post-operative outcomes by comparing factors such as post-operative pain, duration of hospitalization, time needed to resume normal and full activities, and complications between laparoscopic total extraperitoneal (TEP) and Lichtenstein tension-free mesh hernioplasty or repair (LMR) for inguinal hernias. MATERIALS AND METHODS A prospective study was conducted involving male patients undergoing either LMR or laparoscopic TEP mesh repair, with 30 patients in each group. The study assessed post-operative pain, duration of hospital stay, return to normal activities, and complications. Pain scores were monitored at regular intervals using a visual scale. Before discharge, patients' ability to perform self-care activities was evaluated using the Katz index of independence in activities of daily living. Outpatient follow-up was conducted on day 14, one month, three months, and six months post-surgery. RESULTS Post-operative pain scores were significantly higher among LMR patients compared to TEP patients until the 14th day post-surgery (p < 0.001). However, pain levels became comparable after that. There were no notable differences in pain scores between unilateral and bilateral hernias. TEP patients experienced significantly shorter hospital stays (p < 0.001) and quicker resumptions of self-care (p < 0.001), light work (p < 0.02), and full work (p < 0.03) compared to LMR patients. CONCLUSION Laparoscopic TEP repair offers advantages over Lichtenstein mesh repair in terms of reduced postoperative pain, shorter hospital stays, and faster recovery to normal activities. These findings can guide clinicians and patients in making informed decisions regarding hernia repair techniques.
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Affiliation(s)
- Amar Varshney
- Department of Surgery, 7 Air Force Hospital, Kanpur, IND
| | - Vipin Kawatra
- Department of Surgery, Indian Naval Hospital Ship (INHS) Sanjeevani, Kochi, IND
| | - Unnati Watal
- Department of Surgery, Terna Medical College, Mumbai, IND
| | | | - Manisha Avinash
- Department of Surgery, The Oxford Medical College Hospital and Research Center, Attibele, IND
| | - Arun Shreenivas Pugalendhi
- Department of Surgery, Government Medical College and Employee State Insurance (ESI) Hospital, Coimbatore, IND
| | - Shrey Rana
- Department of Surgery, Tver State Medical University, Tver, RUS
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Venkateswaran R, Ansari K, Bhondve S, Bhandarwar A, Padekar HD, Dandge S, Dashputra AV. Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases. Cureus 2024; 16:e56584. [PMID: 38646218 PMCID: PMC11031193 DOI: 10.7759/cureus.56584] [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: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery. MATERIALS AND METHODS The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed. RESULTS The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison. CONCLUSION The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.
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Affiliation(s)
- Rajalakshmi Venkateswaran
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Kashif Ansari
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Supriya Bhondve
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Ajay Bhandarwar
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Harshal D Padekar
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Snehal Dandge
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Amit V Dashputra
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
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12
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Lomanto D, Tan L, Lee S, Wijerathne S. Robotic Platform: What It Does and Does Not Offer in Hernia Surgery. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12701. [PMID: 38425788 PMCID: PMC10899468 DOI: 10.3389/jaws.2024.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Davide Lomanto
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lydia Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sujith Wijerathne
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
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Sbacco V, Petrucciani N, Lauteri G, Cossa A, Portinari M, Brescia A, Garulli G. Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience. Langenbecks Arch Surg 2024; 409:48. [PMID: 38277083 PMCID: PMC10817833 DOI: 10.1007/s00423-024-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited. The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique. METHODS A retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022. Perioperative variables and short- and long-term outcomes were examined. Statistical analysis was performed using chi-square test for nominal variables and Student's t test for continuous ones. A p value < 0.05 was considered statistically significant. RESULTS Sixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group. Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023). Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate. CONCLUSIONS Emergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.
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Affiliation(s)
- V Sbacco
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - N Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy.
| | - G Lauteri
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - A Cossa
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Portinari
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - A Brescia
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - G Garulli
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
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Messias BA, Almeida PLD, Ichinose TMS, Mocchetti ÉR, Barbosa CA, Waisberg J, Roll S, Ribeiro Junior MF. The Lichtenstein technique is being used adequately in inguinal hernia repair: national analysis and review of the surgical technique. Rev Col Bras Cir 2023; 50:e20233655. [PMID: 38088634 PMCID: PMC10668585 DOI: 10.1590/0100-6991e-20233655-en] [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: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. METHOD Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. RESULT 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). CONCLUSION Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
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Affiliation(s)
- Bruno Amantini Messias
- - Hospital Geral de Carapicuiba, Departamento de Cirurgia Geral - Carapicuiba - SP - Brasil
- - Centro Universitário São Camilo, Faculdade de Medicina - São Paulo - SP - Brasil
| | | | | | - Érica Rossi Mocchetti
- - Hospital Geral de Carapicuiba, Departamento de Cirurgia Geral - Carapicuiba - SP - Brasil
- - Centro Universitário São Camilo, Faculdade de Medicina - São Paulo - SP - Brasil
| | - Cirênio Almeida Barbosa
- - Universidade Federal de Ouro Preto, Departamento de Cirurgia, Ginecologia e Obstetrícia e Propedêutica - Ouro Preto - MG - Brasil
| | - Jaques Waisberg
- - Faculdade de Medicina do ABC, Departamento de Cirurgia - Santo André - SP - Brasil
| | - Sergio Roll
- - Santa Casa de São Paulo, Departamento de Parede Abdominal - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
| | - Marcelo Fontenelle Ribeiro Junior
- - Sheikh Shakhbout Medical City- Mayo Clinic, Critical Care and Acute Care Surgery - Abu Dhab - Emirados Árabes Unidos
- - Pontificia Universidade Católica de São Paulo, Departamento de Cirurgia - Sorocaba - SP - Brasil
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Zhang H, Cao Z, Cao J, Chen J, Liu Y, Wang M. Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study. Asian J Surg 2023; 46:4222-4228. [PMID: 36642546 DOI: 10.1016/j.asjsur.2022.12.040] [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: 08/25/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. MATERIALS AND METHODS The study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. RESULTS There were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). CONCLUSION The hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.
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Affiliation(s)
- Hongming Zhang
- Department of General Surgery, No.1 Hospital of Zhangjiakou, Hebei, Zhangjiakou, PR China
| | - Zhen Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
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Alharthi M, Almontashri AI, Alsharif RH, Mozahim SF, Alyazidi LK, Ghunaim M, Aljiffry M. Outcomes of Open Versus Laparoscopic Technique in Primary Inguinal Hernia Repair: A Retrospective Study. Cureus 2023; 15:e46419. [PMID: 37927671 PMCID: PMC10621758 DOI: 10.7759/cureus.46419] [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: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Inguinal hernia repair is one of the most common surgical procedures worldwide. In clinical practice, there are two different routes to repair inguinal hernias: laparoscopic mesh repair and open. Reducing the hernia and preventing recurrence remains the mainstay treatment option of both procedures. This study aims to compare postoperative outcomes and recurrence rates for patients who had primary, non-recurrent, laparoscopic, or open hernia repair in a single tertiary hospital. A retrospective cohort study was done on 468 patients. The study was conducted at King Abdulaziz University Hospital (KAUH) between 2013 and 2022. The distribution of our study population was divided into open hernia repair 378 participants (80.8%) while the rest did laparoscopic hernia repair 90 (19.2%). Operation duration in minutes was 107.158 ± 41.402 in the open hernia repair group and was noted to be significantly higher in the laparoscopic hernia repair group, with 142.811 ± 52.102 minutes p-value (0.000). The hospital length of stay was shown to be shorter in laparoscopic hernia repair (1.58 ±1.27) compared to open hernia repair (2.05±5.33). The most common postoperative complication was scrotal swelling, commonly associated with laparoscopic (5.55%) compared to 2.11% in open hernia repair. Open repair showed a risk of scrotal hematoma with a percentage of 0.52% compared to 0% in the laparoscopic method with a p-value (0.033). Hernia recurrence was non-related with any specific group, although noted to be higher in the laparoscopic group (7.77%), while in the open group (3.4%) with a p-value (0.081). The study conducted showed no alarming percentages for recurrence in either technique, open or laparoscopic, yet the open approach had a better outcome when it comes to scrotal pain and swelling post-operatively, chronic groin pain, and readmission rate as compared to laparoscopic technique, despite having a longer hospital stay. Future larger studies should be conducted to provide equal population inclusivity.
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Affiliation(s)
| | - Alwa I Almontashri
- General Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Raghad H Alsharif
- General Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Sarah F Mozahim
- Otolaryngology - Head and Neck Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Lujain K Alyazidi
- Anesthesia, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed Ghunaim
- Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Murad Aljiffry
- Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [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: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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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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Hakeem A, Saqib SU, Zafar H. Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair. Cureus 2023; 15:e39202. [PMID: 37378228 PMCID: PMC10292120 DOI: 10.7759/cureus.39202] [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: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657. One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.
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Affiliation(s)
- Abdul Hakeem
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Hasnain Zafar
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
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Belkovsky M, Sarmento EO, Novaes LFC, Passerotti CC, Pontes Junior J, Maximiano LF, Otoch JP, DA-Cruz JAS. Bilateral inguinal transabdominal pre-peritoneal laparoscopic hernioplasty associated to bilateral laparoscopic varicocelectomy in the same intervention: a feasibility study. Rev Col Bras Cir 2023; 50:e20233468. [PMID: 36995836 PMCID: PMC10519696 DOI: 10.1590/0100-6991e-20233468-en] [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: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). METHODS a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. RESULTS there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. CONCLUSIONS simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales.
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Affiliation(s)
- Mikhael Belkovsky
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | | | | | | | - José Pontes Junior
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Centro de Cirurgia Robótica - São Paulo - SP - Brasil
| | - Linda Ferreira Maximiano
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da USP, Técnica Cirúrgica e Cirurgia Experimental - Sâo Paulo - SP - Brasil
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Hidalgo NJ, Guillaumes S, Bachero I, Holguín V, Momblán D. Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study. Surg Endosc 2023:10.1007/s00464-023-09967-y. [PMID: 36914783 DOI: 10.1007/s00464-023-09967-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: 10/06/2022] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND International guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain. METHODS We performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis. RESULTS A total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p < 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p = 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient's region of residence (OR 2.04, 95% CI 1.88-2.21). Other factors were age < 65 years (OR 1.65, 95% CI 1.52-1.79) and recurrent inguinal hernia (OR 1.31, 95% CI 1.15-1.49). The type of approach for BIHR was not independently associated with perioperative complications. CONCLUSIONS Despite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient's region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Victor Holguín
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Niebuhr H, Köckerling F, Fortelny R, Hoffmann H, Conze J, Holzheimer RG, Koch A, Köhler G, Krones C, Kukleta J, Kuthe A, Lammers B, Lorenz R, Mayer F, Pöllath M, Reinpold W, Schwab R, Stechemesser B, Weyhe D, Wiese M, Zarras K, Meyer HJ. [Inguinal hernia operations-Always outpatient?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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Affiliation(s)
- H Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
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Zhong Y, He M, Liu Z, Chen JY, Lv XJ, Liu M, Wen AP, Qin L, Li JS. Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in China: A meta-analysis. Medicine (Baltimore) 2023; 102:e32998. [PMID: 36827043 PMCID: PMC11309654 DOI: 10.1097/md.0000000000032998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In China, laparoscopic inguinal hernia repair (LIHR) under the day surgery mode (DSM) has developed rapidly as an important surgical method for inguinal hernia repair, and it has unique advantages in many aspects. Compared with inpatient surgery mode (ISM), there are some differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction. Many studies have shown that LIHR in DSM can significantly shorten hospital stay, effectively reduce hospitalization costs, and improve patient satisfaction. Accordingly, this study aimed to compare the differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction of LIHR between DSM and ISM in China. METHODS The PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wan Fang databases were searched for randomized controlled trials, cohort studies from the establishment of the database to July 1, 2022. Odds ratio (OR), mean difference, standardized mean difference (SMD), and 95% confidence interval were selected as the effect scale indices for the evaluation of the difference in hospitalization costs, hospital stay, operation time, recovery time, complications, and patient satisfaction. All of these were compared using RevMan 5.3 Software (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS Nine studies involving 1176 patients, 590 in the DSM group and 586 in the ISM group, were included. The hospital stay (d) (SMD = -7.27, 95% confidence interval, CI: -8.68 to -5.87, P < .001), hospitalization costs (SMD = -7.89, 95% CI: -10.25 to -5.53, P < .001) in DSM group were significantly lower than the ISM group. Additionally, the patient dissatisfaction (OR = 0.05, 95% CI: 0.01-0.17, P < .001) in DSM group was significantly lower than the ISM group. Nevertheless, no significant differences were found in the operation time (minute) (mean difference = -0.32, 95% CI: -1.78 to 1.14, P = .67), recovery time (h) (SMD = -3.27, 95% CI: -6.95 to 0.41, P = .08), and postoperative complications (OR = 0.80, 95% CI: 0.47-1.36, P = .41) between the 2 groups. CONCLUSION In China, compared with ISM, LIHR under DSM can significantly shorten hospital stay, greatly reduce hospitalization costs, and significantly improve patient satisfaction. There were no significant differences in operation time, recovery time and postoperative complications.
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Affiliation(s)
- Yang Zhong
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Miao He
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhi Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Jian Yu Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Xiao Jiang Lv
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Mao Liu
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ai Ping Wen
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Long Qin
- Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, China
| | - Jian Shui Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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BELKOVSKY MIKHAEL, SARMENTO EDGAROLIVEIRA, NOVAES LUISFELIPECOUTO, PASSEROTTI CARLOCAMARGO, PONTES JUNIOR JOSÉ, MAXIMIANO LINDAFERREIRA, OTOCH JOSÉPINHATA, DA-CRUZ JOSEARNALDOSHIOMI. Hernioplastia inguinal pré-peritoneal transabdominal bilateral e varicocelectomia laparoscópica bilateral na mesma intervenção: um estudo de viabilidade. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas.
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Fernandez-Alberti J, Mata L, Orrego F, Medina P, Bogetti D, Porto EA, Pirchi DE. Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve. Surg Endosc 2022; 37:2826-2832. [PMID: 36477644 DOI: 10.1007/s00464-022-09807-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240. METHODS We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018. RESULTS Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13 min (SD ± 15.54; range 30-105 min) for the first third (Q1) vs 54.61 min (SD ± 15.38; range 30-100 min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59 min (SD ± 21.89; range 50-160 min) for Q1 vs 84.48 min (SD ± 20.52; range 30-130 min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time. CONCLUSION In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions.
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Affiliation(s)
| | - Lautaro Mata
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Facundo Orrego
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Pablo Medina
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Diego Bogetti
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Eduardo Agustin Porto
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
| | - Daniel Enrique Pirchi
- Director of General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina
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Liu J, Bittner R, Shen Y, Chen J. Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case. Surg Endosc 2022; 37:2712-2718. [PMID: 36451041 DOI: 10.1007/s00464-022-09759-w] [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: 10/26/2021] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. METHODS Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. RESULTS A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0 days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0 days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). CONCLUSIONS Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Reinhard Bittner
- Director of the Surgical Clinic, Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China.
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Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [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: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Zhong Y, Liu Z, He M, Lv XJ, Liu M, Wen AP, Chen JY, Qin L, Li JS. Curative effect of different drainage methods on laparoscopic inguinal hernia repair: A meta-analysis. Medicine (Baltimore) 2022; 101:e30243. [PMID: 36042617 PMCID: PMC9410684 DOI: 10.1097/md.0000000000030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic inguinal hernia repair has developed rapidly as an important surgical method for inguinal hernia repair; however, postoperative complications, especially postoperative seroma, are becoming an important factor hindering its development. Many studies have shown that placing a negative-pressure drainage tube in the preperitoneal space can effectively reduce postoperative seromas. Accordingly, this study aimed to compare differences in postoperative seroma between surgical procedures with drainage tubes (DRG) and those without drainage tubes (nonDRG). METHODS PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from the establishment of the database to May 1, 2021. Odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were selected as the effect scale indices for the evaluation of the difference in seroma, operation time, hospital stay time, blood loss, and recovery time. All of these were compared using RevMan 5.3 Software. RESULTS Sixteen studies involving 4369 patients, 2856 in the DRG group and 1513 in the nonDRG group, were included. The incidence of seroma in the DRG group was lower than that in the nonDRG group (OR = 0.16, 95% CI: 0.07-0.35, P < .001). Additionally, the operation time (min) in the DRG group was longer than that in the nonDRG group (MD = 3.67, 95% CI: 2.18-5.17, P < .001). Nevertheless, no significant differences were found in hospital stay (days) (SMD = 0.22, 95% CI: -0.10-0.54, P = .17), blood loss (mL) (MD = 0.28, 95% CI: -0.14-0.69, P = .19), and recovery time (h) (SMD = 0.54, 95% CI: -0.60-1.69, P = .35) between the 2 groups. CONCLUSION Despite the slightly prolonged operation time, negative pressure drainage in the preperitoneal space during laparoscopic inguinal hernia repair can significantly reduce the occurrence of postoperative seroma without increasing blood loss, recovery, and hospital stay.
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Affiliation(s)
- Yang Zhong
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Zhi Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Miao He
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao Jiang Lv
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Mao Liu
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ai Ping Wen
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jian Yu Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Long Qin
- Department of Gastrointestinal Surgery, Nanchong Central Hospital, Nanchong, China
| | - Jian Shui Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Kefalas C, Karlafti E, Zatagias A, Karakatsanis A, Tsakiris G, Michalopoulos A, Paramythiotis D. Transabdominal Preperitoneal inguinal hernia repair leading to orchiectomy: A case report. Ann Med Surg (Lond) 2022; 80:104288. [PMID: 36045854 PMCID: PMC9422286 DOI: 10.1016/j.amsu.2022.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Charalampos Kefalas
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
- Corresponding author.
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Apostolos Zatagias
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Anestis Karakatsanis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Georgios Tsakiris
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
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Sayadi Shahraki M, Mahmoudieh M, Keleidari B, Melali H, Sharbu Z. The Effect of Internal Mesh Fixation and External Fixation (Inguinal Hernia Truss) on Postoperative Complications in Patients with Inguinal Hernia Undergoing Totally Extraperitoneal Laparoscopic Hernioplasty. Adv Biomed Res 2022; 11:49. [PMID: 35982862 PMCID: PMC9379918 DOI: 10.4103/abr.abr_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background The present study evaluated the effect of internal mesh fixation and external fixation (inguinal hernia truss) on postoperative complications in patients with inguinal hernia. Materials and Methods This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the external fixation for 6 weeks immediately after the surgery. Results The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6.4%, 19.4%, and 3.2% in Group A and 3.3%, 13.3%, and 3.3% in Group B (P > 0.05). Moreover, patients' pain scores 1 week and 1 month after the surgery in Group B were significantly lower than those of Group A (P < 0.05). However, the mean pain score of patients was not different between the two groups 3 and 6 months after the surgery (P > 0.05). Furthermore, the duration of return to work in Group B with an average of 8.07 ± 3.09 days was less than that of Group A with the average of 9.65 ± 5.34 days (P > 0.05). Conclusion The mentioned findings can trigger the use of external fixation and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true.
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Affiliation(s)
- Masoud Sayadi Shahraki
- Department of Surgery and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoudieh
- Department of Surgery and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Keleidari
- Department of Surgery and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Melali
- Department of Surgery and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zakaria Sharbu
- Department of Surgery and Laparoscopic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Zakaria Sharbu, Department of Laparoscopic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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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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Giacone J, Valinoti AC, Sadava EE. Surgical Treatment of Bilateral Hydrocele of the Canal of Nuck: a Rare Entity for Inguinal Swelling in Adult Female. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Pan C, Xu X, Si X, Yu J. Effect of complete reduction of hernia sac and transection of hernia sac during laparoscopic indirect inguinal hernia repair on seroma. BMC Surg 2022; 22:149. [PMID: 35468781 PMCID: PMC9036776 DOI: 10.1186/s12893-022-01599-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction This study investigated the effect of complete reduction and transection of the hernia sac during laparoscopic indirect inguinal hernia repair on seroma. Methods Retrospective analysis was performed on 1763 cases undergoing laparoscopic indirect inguinal hernia repair in three centers from January 2017 to September 2019, among them, 311 patients with transection of hernia sac and 1452 patients with reduction of hernia sac, the data of the two groups were tested by t-test. Logistic univariate analysis was performed on 233 cases of postoperative seroma, and variables p < 0.05 in univariate analysis were included for multivariate analysis. Then, the transection group and the reduction group were matched with 1:1 propensity score matching, and the caliper value was set at 0.05. Finally, 274 patients matched in each group were analyzed by univariate analysis again to evaluate whether the transection of hernia sac had an impact on postoperative seroma. Results The results of univariate analysis of 233 patients with postoperative seroma showed that: ASA-3 p = 0.031, classification-L3 p < 0.001, surgery-TEP p < 0.001, transect group p = 0.005. The results of multivariate analysis show that: ASA-3 p < 0.001, classification-L3 p < 0.001, surgery-TEP p < 0.001, transect group p = 0.020. The results of univariate analysis after propensity score matching showed that transection of the hernia sac is significant for postoperative seroma (p < 0.001). Conclusion Transection of the hernia sac during laparoscopic indirect inguinal hernia repair can significantly lead to postoperative seroma. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01599-8.
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Affiliation(s)
- Chunpeng Pan
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China
| | - Xin Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China
| | - Xianke Si
- Department of Minimally Invasive Surgery, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 164 Lanxi Road, Putuo, Shanghai, 200062, China.
| | - Jiwei Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Huangpu, Shanghai, 200011, China.
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Abstract
Canal of Nuck abnormality is a rare surgical condition. The pathologies are mostly encountered in young girls, less than five years of age. The incidence is even less in adults. Various pathologic conditions related to the failure of processus vaginalis obliteration can occur, involving herniation of intraabdominal structures including intestinal and genital contents such as the uterus, fallopian tube, and ovary and hydrocele of the canal of Nuck. According to its rarity, hydrocele of canal of Nuck is often misdiagnosed for common groin masses. This review summarizes and simplifies embryology, the pathophysiology of the canal of Nuck abnormalities, imaging findings, and treatment options with emphasis on the hydrocele.
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Haladu N, Alabi A, Brazzelli M, Imamura M, Ahmed I, Ramsay G, Scott NW. Open versus laparoscopic repair of inguinal hernia: an overview of systematic reviews of randomised controlled trials. Surg Endosc 2022; 36:4685-4700. [PMID: 35286471 PMCID: PMC9160137 DOI: 10.1007/s00464-022-09161-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023]
Abstract
Background Inguinal hernia has a lifetime incidence of 27% in men and 3% in women. Surgery is the recommended treatment, but there is no consensus on the best method. Open repair is most popular, but there are concerns about the risk of chronic groin pain. Laparoscopic repair is increasingly accepted due to the lower risk of chronic pain, although its recurrence rate is still unclear. The aim of this overview is to compare the risk of recurrence and chronic groin pain in laparoscopic versus open repair for inguinal hernia. Methods We searched Ovid MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses. Only reviews of randomised controlled trials (RCTs) in adults published in English were included. Conference proceedings and editorials were excluded. The quality of the systematic reviews was assessed using the AMSTAR 2 checklist. Two outcomes were considered: hernia recurrence and chronic pain. Results Twenty-one systematic reviews and meta-analyses were included. Laparoscopic repair was associated with a lower risk of chronic groin pain compared with open repair. In the four systematic reviews assessing any laparoscopic versus any open repairs, laparoscopic repair was associated with a statistically significant (range: 26–46%) reduction in the odds or risk of chronic pain. Most reviews showed no difference in recurrence rates between laparoscopic and open repairs, regardless of the types of repair considered or the types of hernia that were studied, but most reviews had wide confidence intervals and we cannot rule out clinically important effects favouring either type of repair. Conclusion Meta-analyses suggest that laparoscopic repairs have a lower incidence of chronic groin pain than open repair, but there is no evidence of differences in recurrence rates between laparoscopic and open repairs.
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Affiliation(s)
- Nafi'u Haladu
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Emergency Department, Southend University Teaching Hospital, Westcliff-on-Sea, UK
| | - Adegoke Alabi
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Luton and Dunstable University Hospital, Luton, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - George Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - Neil W Scott
- Medical Statistics Team, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Hayakawa S, Hayakawa T, Watanabe K, Saito K, Miyai H, Ogawa R, Yamamoto M, Kobayashi K, Takiguchi S, Tanaka M. Evaluation of long‐term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair. Ann Gastroenterol Surg 2022; 6:577-586. [PMID: 35847434 PMCID: PMC9271018 DOI: 10.1002/ags3.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
Aim This study has two aims: to evaluate long‐term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C‐TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases. Methods A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C‐TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10‐point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long‐term chronic pain and complications. Results The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate‐to‐severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest (P = .726), at movement (P = .712), or mesh discomfort (P = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post‐match comparison, no differences in complications with Clavian‐Dindo classification ≥III (U Group 0.7%, B Group 2.1%, P = .622) were detected. Conclusion C‐TAPP, which focuses on the layered structure, showed acceptable results for long‐term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.
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Affiliation(s)
- Shunsuke Hayakawa
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Tetsushi Hayakawa
- Department of Laparoscopic Hernia Surgery CenterKariya Toyota General HospitalKariyaJapan
| | - Kaori Watanabe
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Kenta Saito
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hirotaka Miyai
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Ryo Ogawa
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Minoru Yamamoto
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Kenji Kobayashi
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
| | - Shuji Takiguchi
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Moritsugu Tanaka
- Department of General surgeryKariya Toyota General HospitalKariyaJapan
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Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, Hassan M, Belavadi R, Sange I. Inguinal Hernia Mesh Repair: The Factors to Consider When Deciding Between Open Versus Laparoscopic Repair. Cureus 2021; 13:e19628. [PMID: 34956756 PMCID: PMC8675396 DOI: 10.7759/cureus.19628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. An inguinal hernia occurs due to a defect in the abdominal wall, which allows the abdominal contents to pass through it. Although the placement of mesh over the defect is the gold standard to close the defect, there are various approaches to achieving it, out of which two of the most widely accepted techniques are laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR). However, the approach of choice widely fluctuates with regards to various factors such as patient history, type of hernias, and surgeons' preference. It is imperative to understand the variations in outcomes of different approaches and how best they fit an individual patient in deciding the technique to be undertaken. This article has reviewed many studies and compared the two techniques in terms of chronic pain, the time required to return to activity, rate of recurrence, and cost-effectiveness.
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Affiliation(s)
| | | | - Harini Gajjela
- Research, Our Lady of Fatima University College of Medicine, Metro Manila, PHL
| | - Iljena Kela
- Family Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Chandra L Kakarala
- Internal Medicine, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | - Mohammad Hassan
- Internal Medicine, Mohiuddin Islamic Medical College, Mirpur, PAK
| | - Rishab Belavadi
- Surgery, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Research, K. J. Somaiya Medical College, Mumbai, IND
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Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals. Hernia 2021; 26:225-232. [PMID: 34727286 DOI: 10.1007/s10029-021-02498-2] [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: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to assess patient's Quality of Life (QoL) after open inguinal hernia repair and to identify predictors of low QoL at 3 months after surgery, to guide practice and inform patients at high risk. METHODS Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors. RESULTS 893 patients were included from 33 hospitals. The majority were men [89.9% (800/891)], had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein's repair [52.9% (472/893)]. The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004). CONCLUSION This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.
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Pereira C, Rai R. Open Lichtenstein Hernioplasty Versus Laparoscopic Transabdominal Preperitoneal Mesh Repair: The Pain Factor. Cureus 2021; 13:e18282. [PMID: 34660162 PMCID: PMC8494173 DOI: 10.7759/cureus.18282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction One of the most commonly performed surgery by a general surgeon is inguinal hernia repair. There have been numerous open surgical techniques and two laparoscopic techniques described in the literature for the treatment of inguinal hernias. The treatment outcome of all these surgeries remains the same which is reducing the hernia and preventing recurrence. Our aim was to compare laparoscopic versus open inguinal hernia repair with emphasis on postoperative pain. Methods One hundred and twenty patients with unilateral primary inguinal hernias were randomly divided into two groups. Each group included 60 patients. Group one was treated by open Lichtenstein repair, while the second group was treated by laparoscopic transabdominal preperitoneal (TAPP) mesh repair. The two groups were compared to assess the duration of surgery, postoperative pain, duration of hospital stay, return to normal activity, and work. Results Laparoscopic TAPP repair was found to have a longer operative time as compared to Liechtenstein open repair. In terms of other parameters such as postoperative pain duration of hospital stay, return to normal activity, and work the laparoscopic group was superior. After a one-year follow-up, none of the patients had any chronic pain or evidence of hernia recurrence. Conclusion Laparoscopic TAPP has a clear advantage over the conventional Liechtenstein open surgery especially in terms of reduced early post postoperative pain and return to normal activity.
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Affiliation(s)
- Chirag Pereira
- General Surgery, Father Muller Medical College and Hospital, Mangalore, IND
| | - Rakesh Rai
- General Surgery, Father Muller Medical College and Hospital, Mangalore, IND
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Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre. Hernia 2021; 26:1063-1068. [PMID: 34661771 DOI: 10.1007/s10029-021-02516-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aim of this study was to analyse feasibility, safety and effectiveness of laparoscopic transperitoneal hernia repair (TAPP) approach to inguinal hernias in the emergency setting, with a longer follow-up than the studies present in literature. METHODS We retrospectively analysed all patients who underwent emergency TAPP hernia repair in San Marco Hospital (Zingonia, Italy), from September 2010 to June 2020. A prospectively collected database of 685 consecutive TAPP hernia repair was reviewed. Feasibility and safety were evaluated through operative time, conversion rate, perioperative mortality, morbidity and prosthesis infection rate. Effectiveness was assessed by recurrence and complication rate, acute (during admission) and chronic (during follow-up) pain by Visual Analogic Scale (VAS), and recovery to normal activity in a long-term follow-up (mean period 1718 days). RESULTS The final study group included 47 patients. The mean age was 59.6 years (range 22-89), 29 patients were male and 18 were female. The mean operation time was 64 min. Two cases were converted to open approach (4%). In four cases bowel resection became necessary (8.5%). Appendicectomy and omentectomy occurred once and twice, respectively (2% and 4%), and orchiectomy was required in two patients (4%). Seroma was the only postoperative complication that we registered in four patients. During a mean follow-up period of 1718 days, there was no recurrence of the hernia or other complications. Five patients referred mild occasional groin pain (VAS < 3), with quick relief without taking any pain killers. CONCLUSION TAPP approach is a safe, feasible and effective therapeutic option for groin hernias in emergency setting. No recurrence or severe complications were reported in over 4 years of follow-up.
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Glasgow RE, Mulvihill SJ, Pettit JC, Young J, Smith BK, Vargo DJ, Ray DM, Finlayson SRG. Value Analysis of Methods of Inguinal Hernia Repair. Ann Surg 2021; 274:572-580. [PMID: 34506312 DOI: 10.1097/sla.0000000000005063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Value is defined as health outcomes important to patients relative to cost of achieving those outcomes: Value = Quality/Cost. For inguinal hernia repair, Level 1 evidence shows no differences in long-term functional status or recurrence rates when comparing surgical approaches. Differences in value reside within differences in cost. The aim of this study is to compare the value of different surgical approaches to inguinal hernia repair: Open (Open-IH), Laparoscopic (Lap-IH), and Robotic (R-TAPP). METHODS Variable and fixed hospital costs were compared among consecutive Open-IH, Lap-IH, and R-TAPP repairs (100 each) performed in a university hospital. Variable costs (VC) including direct materials, labor, and variable overhead ($/min operating room [OR] time) were evaluated using Value Driven Outcomes, an internal activity-based costing methodology. Variable and fixed costs were allocated using full absorption costing to evaluate the impact of surgical approach on value. As cost data is proprietary, differences in cost were normalized to Open-IH cost. RESULTS Compared to Open-IH, VC for Lap-IH were 1.02X higher (including a 0.81X reduction in cost for operating room [OR] time). For R-TAPP, VC were 2.11X higher (including 1.36X increased costs for OR time). With allocation of fixed cost, a Lap-IH was 1.03X more costly, whereas R-TAPP was 3.18X more costly than Open-IH. Using equivalent recurrence as the quality metric in the value equation, Lap-IH decreases value by 3% and R-TAPP by 69% compared to Open-IH. CONCLUSIONS Use of higher cost technology to repair inguinal hernias reduces value. Incremental health benefits must be realized to justify increased costs. We expect payors and patients will incorporate value into payment decisions.
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Affiliation(s)
| | | | - Jacob C Pettit
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | - Jeffrey Young
- Department of Decision Support, University of Utah, Salt Lake City, Utah
| | | | - Daniel J Vargo
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - David M Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
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Man Y, Li BS, Zhang X, Huang H, Wang YL. Recurrent abdominal pain due to small bowel volvulus after transabdominal preperitoneal hernioplasty: A case report and review of literature. World J Clin Cases 2021; 9:3696-3703. [PMID: 34046472 PMCID: PMC8130073 DOI: 10.12998/wjcc.v9.i15.3696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/22/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Compared with open mesh repair, transabdominal preperitoneal (TAPP) hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery. However, it may still lead to rare but serious complications. Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom, which occurred 3 mo after TAPP repair for bilateral inguinal hernia.
CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias. After the operation, he experienced recurring pain in his lower right abdomen around the surgical area, which was relieved after symptomatic treatment. Three months after the surgery, the abdominal pain became severe and was aggravated over time. The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography (CT). Laparoscopic exploration confirmed that a barb of the V-Loc™ suture penetrated the peritoneum, which caused the adhesion of the small intestinal wall to the site of peritoneal injury, forming intestinal volvulus. Since there was no closed-loop obstruction or intestinal ischemia, recurrent abdominal pain became the only clinical manifestation in this case. After laparoscopic lysis of adhesions and reduction of intestinal volvulus, the patient recovered and was discharged.
CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum. Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
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Affiliation(s)
- Yi Man
- Department of Hernia Surgery, Tianjin Union Medical Centre, Tianjin 300000, China
| | - Bao-Shan Li
- Department of Hernia Surgery, Tianjin Union Medical Centre, Tianjin 300000, China
| | - Xin Zhang
- Department of Hernia Surgery, Tianjin Union Medical Centre, Tianjin 300000, China
| | - Huang Huang
- Department of Hernia Surgery, Tianjin Union Medical Centre, Tianjin 300000, China
| | - Yin-Long Wang
- Department of Hernia Surgery, Tianjin Union Medical Centre, Tianjin 300000, China
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Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique. Updates Surg 2021; 73:1945-1953. [PMID: 33656696 DOI: 10.1007/s13304-021-01005-7] [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: 07/27/2020] [Accepted: 02/10/2021] [Indexed: 01/30/2023]
Abstract
The aim of this study is to evaluate the cost-effectiveness of different modifications of the trans-abdominal pre-peritoneal (TAPP) repair of groin hernia. Data were collected prospectively for all consecutive patients who underwent TAPP unilateral inguinal hernia repair between November 2017 and March 2019, and who completed a minimum of 1 year of follow-up. Costs and quality adjusted life year (QALY) gained were collected. Three TAPP variations were assessed: mesh fixation and peritoneal closure with staples (group 1); mesh fixation with fibrin glue and peritoneal closure with sutures (group 2); and mesh fixation and peritoneal closure with fibrin glue (group 3). A matched group of open repairs was established. The incremental cost-effectiveness ratio (ICER) and main intra-operative and post-operative outcomes were assessed. Overall 120 patients were included (group 1 n = 31; group 2 n = 27; group 3 n = 33; open group: 29). Operative time was shorter for groups 2 and 3, and the main post-operative outcomes were similar. The overall mean total cost of the open group (1185.95€) was lower compared with the laparoscopic group (group 1: 1682.39; group 2: 1538.54€; group 3: 1510.1€) (p = 0.026). However, the mean ICERs of groups 2 and 3 were significantly higher compared with group 1 (p = 0.021) and the open group (p = 0.032). At simulations analysis, the probability of cost-effectiveness was 33.32%, 36.26%, and 36.7% in TAPP groups 1, 2, and 3. In the long term, laparoscopic repair of groin hernia is cost-effective compared with open surgery. The use of fibrin glue for mesh fixation and/or for closing the peritoneum is the most cost-effective option and shortens operative times.
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Laparoscopic Totally Extraperitoneal Hernia Repairs: a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials. Ann Surg 2021; 274:954-961. [PMID: 33427757 DOI: 10.1097/sla.0000000000004735] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS Systematic review and network meta-analyses of Randomized Controlled Trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk Ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% Credible Intervals (CrI) were used to assess relative inference. RESULTS Thirty-five RCTs (7,777 patients) were included. Overall, 3,496 (44.9%) underwent Lichtenstein, 1,269 (16.3%) TAPP, and 3,012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12-hour, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs. Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs. Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs. Lichtenstein (WMD = -3.3; 95% CrI -4.9; -1.8) and TEP vs. Lichtenstein (WMD = -3.6; 95% CrI -4.9; -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches while no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
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Madion M, Goldblatt MI, Gould JC, Higgins RM. Ten-year trends in minimally invasive hernia repair: a NSQIP database review. Surg Endosc 2021; 35:7200-7208. [PMID: 33398576 DOI: 10.1007/s00464-020-08217-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Utilization of minimally invasive techniques for ventral and inguinal hernia repairs continues to rise. The purpose of this study was to provide updates on national utilization trends and wound complications of minimally invasive versus open ventral and inguinal hernia repairs. METHODS Data were accessed from the 2006 to 2017 National Surgical Quality Improvement Program database. All CPT codes that correlated to laparoscopic and open inguinal and ventral hernia repairs were queried. The total number of cases and wound complications, including superficial surgical site infection (SSI), deep SSI, organ space SSI, and wound dehiscence, was collected for each respective CPT code and compared for each year. IBM SPSS Statistics Software and Microsoft Excel were used to collect and analyze the data. RESULTS Between 2009 and 2017, the percentage of minimally invasive inguinal hernia repairs increased from 23.1 to 37.8%, whereas the percentage of minimally invasive ventral hernias only increased from 31.5 to 36.6%. Open inguinal hernia repairs had a wound complication rate ranging from 0.60 to 0.74%, which was double the rate of minimally invasive repairs (0.24 to 0.49%) for nearly each respective year. Minimally invasive ventral hernia repairs had total wound complication rates ranging from 0.91 to 1.37%, whereas open ventral hernias had the highest total wound complication rates ranging from 5.07 to 6.26%. CONCLUSIONS Over the last ten years, the utilization of minimally invasive inguinal and ventral hernia repair has increased by nearly two-fold. A larger proportion of this increase has been secondary to minimally invasive inguinal compared to ventral hernia repairs. Wound complications across all techniques remained stable or improved, and remained significantly less in the minimally invasive compared to open approaches. This study highlights the continued growth of minimally invasive techniques in hernia repair over the last decade.
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Affiliation(s)
- Matthew Madion
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, Wisconsin, 53226, USA
| | - Matthew I Goldblatt
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, Wisconsin, 53226, USA
| | - Jon C Gould
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, Wisconsin, 53226, USA
| | - Rana M Higgins
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, Wisconsin, 53226, USA.
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Calisir A, Ece I, Yilmaz H, Alptekin H, Colak B, Yormaz S, Gul M, Sahin M. Pain during sexual activity and ejaculation following hernia repair: A retrospective comparison of transabdominal preperitoneal versus Lichtenstein repair. Andrologia 2020; 53:e13947. [PMID: 33368486 DOI: 10.1111/and.13947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022] Open
Abstract
Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.
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Affiliation(s)
- Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Husnu Alptekin
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Bayram Colak
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Murat Gul
- Department of Urology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
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Fikatas P, Megas IF, Mantouvalou K, Alkatout I, Chopra SS, Biebl M, Pratschke J, Raakow J. Hydroceles of the Canal of Nuck in Adults-Diagnostic, Treatment and Results of a Rare Condition in Females. J Clin Med 2020; 9:jcm9124026. [PMID: 33322831 PMCID: PMC7763523 DOI: 10.3390/jcm9124026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 01/11/2023] Open
Abstract
Nuck’s hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain. They appear when this evagination of the parietal peritoneum into the inguinal canal fails to obliterate. Our review of the literature on this topic included several case reports and two case series that presented cases of Nuck hydroceles which underwent surgical therapy. We present six consecutive cases of symptomatic hydroceles of Nuck’s canal from September 2016 to January 2020 at the Department of Surgery of Charité Berlin. Several of these patients had a long history of pain and consecutive consultations to outpatient clinics without diagnosis. These patients underwent laparoscopic or conventional excision and if needed simultaneous hernioplasty in our institution. Ultrasonography and/or Magnetic Resonance Imaging were used to display the cystic lesion in the inguinal area, providing the diagnosis of Nuck’s hydrocele. This finding was confirmed intraoperatively and by histopathological review. Ultrasound and magnetic resonance imaging (MRI) captures, intraoperative pictures and video of minimal invasive treatment are provided. Nuck’s hydroceles should be included in the differential diagnosis of an inguinal swelling. We recommend an open approach to external Type 1 Nuck´s hydroceles and a laparoscopic approach to intra-abdominal Type 2 Nuck hydroceles. Complex hydroceles like Type 3 have to be evaluated individually, as they are challenging and the surgical outcome is dependent on the surgeon’s skills. If inguinal channel has been widened by the presence of a Nuck’s hydrocele, a mesh plasty, as performed in hernia surgery, should be considered.
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Affiliation(s)
- Panagiotis Fikatas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
- Correspondence:
| | - Ioannis-Fivos Megas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Kiriaki Mantouvalou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynecological Endoscopy, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany;
| | - Sascha S. Chopra
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
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50
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Kiriyama M, Seita K. Short- and Long-Term Outcomes of Transabdominal Preperitoneal, Open Mesh Plug and Open Tissue Inguinal Hernia Repair. World J Surg 2020; 45:730-737. [PMID: 33216169 DOI: 10.1007/s00268-020-05864-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There have been few comparisons of the postoperative outcomes of transabdominal preperitoneal (TAPP), open mesh plug (mesh plug) and open tissue (tissue) hernia repair. The objectives of this study were to compare these repair methods. METHODS This was a retrospective study of 1813 inguinal hernia patients between January 2008 and December 2016. Of these patients, 474 underwent TAPP repair, 1293 underwent mesh plug repair, and 46 underwent tissue repair. The short-term and long-term outcomes determined by questionnaire were compared among the three groups. In addition, risk factors for patient dissatisfaction were assessed. RESULTS In the TAPP group, the postoperative complications rate was the lowest at 4.6% (7.4% and 6.5% in the mesh plug and the tissue groups, respectively, P = 0.07), and recurrence rate was lower compared to the mesh plug group (0.8% vs. 3.3%, P = 0.002). As long-term outcomes, 92%, 88% and 75% of patients were satisfied in the TAPP, mesh plug and tissue groups, respectively (P = 0.03). The rate of patients with numbness was 3.1% in the TAPP group, 5.2% in the mesh plug group and 14% in the tissue group (P = 0.04). Predictive independent risk factors for patient dissatisfaction were complications (OR: 3.99, 95% CI: 1.35-11.8, P = 0.012) and infection (OR: 16.9, 95% CI: 1.25-229, P = 0.003). CONCLUSIONS TAPP repair is superior to mesh plug and tissue repairs in terms of complications, satisfaction and numbness, as determined by questionnaire. Complications and infection were independently associated with the patient dissatisfaction.
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Affiliation(s)
- Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan.
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan
| | - Takamasa Takahashi
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan
| | - Muneyasu Kiriyama
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan
| | - Kazuaki Seita
- Department of Surgery, Ogaki Municipal Hospital, 4-86 minaminokawa-cho, Ogaki-shi, Gifu-ken, Japan
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