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Dams A, Vankeirsbilck J, Poelmans S, Kerschaever I, Borreman P, Berwouts L, De Mulder W, Colle J, Beunis A, Dhooghe V, Van De Winkel N, Allaeys M, Ruyssers M, Haesen D, Van der Speeten K. Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study. Surg Endosc 2023; 37:9105-9115. [PMID: 37798529 DOI: 10.1007/s00464-023-10439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond™ for mesh fixation in laparoscopic inguinal hernia repair. METHODS This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond™ (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh® SURG ST (Peters Surgical)/Biomesh® P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh® SURG LI (Peters Surgical)/Premium® Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery. RESULTS Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 ± 10.04; p < 0.0001) and 12-month (3.83 ± 11.26; p < 0.0001) follow-up compared with before surgery (26.96 ± 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 ± 0.19 preoperatively to 0.90 ± 0.15 at 5 weeks (p < 0.0001) and 0.92 ± 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 ± 12.69 preoperatively to 84.31 ± 9.97 at 5-week (p < 0.0001) and 84.16 ± 14.48 at 12-month follow-up (p < 0.0001). CONCLUSIONS Ifabond™ (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature.
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Affiliation(s)
- Anne Dams
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joost Vankeirsbilck
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Stephan Poelmans
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Ivan Kerschaever
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Philippe Borreman
- Department of General and Abdominal Surgery, Regional Hospital Heilig Hart, Tienen, Belgium
| | - Luc Berwouts
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Wim De Mulder
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Julien Colle
- Department of General Surgery, Hospital Sint-Vincentius, Deinze, Belgium
| | - Anthony Beunis
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vicky Dhooghe
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Mathias Allaeys
- Department of Abdominal Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Kurt Van der Speeten
- Department of Abdominal Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
- Faculty of Medicine, Hasselt University, Diepenbeek, Belgium.
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Postoperative MR Imaging of the Pubic Symphysis and Athletic Pubalgia. Magn Reson Imaging Clin N Am 2022; 30:689-702. [DOI: 10.1016/j.mric.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Habib Bedwani NAR, Kelada M, Smart N, Szydlo R, Patten DK, Bhargava A. Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials. Br J Surg 2021; 108:14-23. [PMID: 33640918 DOI: 10.1093/bjs/znaa002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. METHODS A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. RESULTS Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). CONCLUSION Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
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Affiliation(s)
- N A R Habib Bedwani
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - M Kelada
- Imperial College School of Medicine, Imperial College London, London, UK
| | - N Smart
- Department of General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Gastrointestinal Surgery, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - R Szydlo
- Imperial College School of Medicine, Imperial College London, London, UK
| | - D K Patten
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Imperial College School of Medicine, Imperial College London, London, UK.,Deparment of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, UK
| | - A Bhargava
- Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.,Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Pilkington JJ, Davies TW, Schaff O, Alexander MY, Pritchett J, Wilkinson FL, Sheen AJ. Systemic biomarkers currently implicated in the formation of abdominal wall hernia: A systematic review of the literature. Am J Surg 2020; 222:56-66. [PMID: 33189313 DOI: 10.1016/j.amjsurg.2020.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation. METHODS A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis. RESULTS 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies. CONCLUSION We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses.
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Affiliation(s)
- J J Pilkington
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - T W Davies
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK; UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - O Schaff
- Trust Library Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Y Alexander
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - J Pritchett
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - F L Wilkinson
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - A J Sheen
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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Pilkington JJ, Obeidallah R, Baltatzis M, Fullwood C, Jamdar S, Sheen AJ. Totally extraperitoneal repair for the 'sportsman's groin' via 'the Manchester Groin Repair': a comparison of elite versus amateur athletes. Surg Endosc 2020; 35:4371-4379. [PMID: 32909207 DOI: 10.1007/s00464-020-07930-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgery has a recognised role in the treatment of 'sportsman's groin'. This study hypothesises that elite athletes have a superior advantage in both pre- and post-op rehabilitation and therefore will present and resume sporting activities quicker. METHODS A retrospective analysis on a secure database of athletes presenting with groin pain that underwent surgery for 'inguinal disruption'. All data were explored via appropriate descriptive statistics and comparisons made between elite and amateur athletes. RESULTS All patients were male (n = 144). The median age 33 years (range 14-72). The median return to sporting activity was 4.5 weeks (range 2.0-16.0) with one amateur athlete being unable to return to sporting activity. Using the mean of both sides, a comparison of VAS pain scores at pre-operative and 1 month post-operative time points showed a significant reduction (p < 0.001). Comparing 'elite' versus 'amateur' athletes, significant differences were seen in patient age (median 26 vs 40 years; p < 0.001), lead time to clinic presentation (median 62.0 vs 111.5 days; p = 0.004), and time to return to sporting activity (4 vs 5 weeks; p = 0.019). Additional MRI findings within the groin girdle were found in 89 patients (66.4%) and 34 patients (23.6%) had an MRI finding within the adductor tendon. CONCLUSION The Manchester Groin Rrepair is an effective surgical management for 'inguinal disruption'. Elite athletes present quicker and return to sport sooner. Given the prevalence of other findings, a multidisciplinary approach to the 'sportsman's groin' is required.
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Affiliation(s)
- J J Pilkington
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - R Obeidallah
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Baltatzis
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Fullwood
- Research & Innovation, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, Manchester University, Manchester, UK
| | - S Jamdar
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - A J Sheen
- Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK. .,Centre for Bioscience, Manchester Metropolitan University, Manchester, UK. .,Fortius Clinic, 17 Fitzhardinge street, London, UK.
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