1
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Chen T, Zhou C, Zhu X, Jiao J, Xue H, Li J, Wang P. Comparison of transumbilical single-incision laparoscopic TAPP versus conventional laparoscopic TAPP in the elderly: A retrospective analysis. Asian J Surg 2023; 46:3620-3626. [PMID: 36914474 DOI: 10.1016/j.asjsur.2023.03.009] [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: 11/15/2022] [Revised: 01/25/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND To analyze and compare the clinical efficacy of transumbilical single-incision laparoscopic surgery TAPP(SILS-TAPP) and conventional laparoscopic TAPP(CL-TAPP) in the treatment of senile inguinal hernia. METHODS From January 2019 to June 2021, a total of 221 elderly patients (≥60 years old) with inguinal hernia received SILS-TAPP and CL-TAPP in General Surgery Department of Affiliated Hospital of Nantong University. The perioperative indicators, postoperative complications and follow-up of the two groups were compared to explore the feasibility and superiority of SILS-TAPP in the treatment of inguinal hernia in the elderly. RESULTS There was no difference in demographic characteristics between the two groups. The mean operation time (28.6 ± 4.2 min vs 28.2 ± 5.3 min) in the SILS-TAPP group was not significantly different from that in the CL-TAPP group (Ρ = 0.623), and there was no significant increase in hospital costs(Ρ = 0.748). The intraoperative blood loss (7.4 ± 3.4 ml), VAS score on the postoperative day (2.2 ± 0.7), mean time of resuming activity (8.2 ± 1.9 h) and mean postoperative hospital stay (0.8 ± 0.2 d) in the SILS-TAPP group were better than those in the CL-TAPP group (Ρ < 0. 05).There was no statistical difference in the overall incidence of intraoperative (Ρ = 0.128) and postoperative complications (Ρ = 0.125) between the two groups. CONCLUSION Single-incision laparoscopic surgery TAPP (SILS-TAPP) is feasible and effective in elderly patients, providing a new alternative surgical method for patients who can tolerate general anesthesia.
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Affiliation(s)
- Tao Chen
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Chun Zhou
- Department of General Practice, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaojun Zhu
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Jingyi Jiao
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Huimin Xue
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Jianfang Li
- Department of Hernia and Abdominal Wall Surgery, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
| | - Peng Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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2
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Muacevic A, Adler JR, B R. A Systematic Review of Fibonacci Sequence in the Human Abdominal Wall: Facts and Reality. Cureus 2022; 14:e33072. [PMID: 36721618 PMCID: PMC9883531 DOI: 10.7759/cureus.33072] [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: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
The Fibonacci sequence is undoubtedly found in nature such as in the spiral of galaxies and flower petals. Fibonacci numbers are a sequence in which each number is the sum of the two preceding ones. The ratio of two consecutive Fibonacci numbers, also called the golden proportion, approximately equals 1.618. We analyzed the existence of Fibonacci numbers and golden ratios in the field of hernia and abdominal wall reconstruction. We found substantial evidence of the use of the golden ratio in siting of the umbilicus. The Fibonacci numbers also showed up frequently in the anatomy of the abdominal wall. However, this was not as appropriate as the other instances in the human body or in nature.
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3
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Samy AM, Anandhi A, Sreenath GS, Sureshkumar S, Swaminathan S. Effect of perineural bupivacaine infiltration on reducing inguinodynia in patients undergoing inguinal meshplasty - a randomized controlled trial. Acta Chir Belg 2022; 122:85-91. [PMID: 33497295 DOI: 10.1080/00015458.2020.1860401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Inguinodynia after inguinal meshplasty is a notable complication with an incidence of 13-37%. We wanted to determine if a perineural infiltration of bupivacaine given intraoperatively would reduce the incidence of immediate postoperative pain and inguinodynia. METHODOLOGY We have conducted a single-blinded randomized controlled trial including 100 patients with inguinal hernia. Patients in the control group received only spinal anaesthesia. The intervention group received perineural bupivacaine infiltration in addition to spinal anaesthesia. Intraoperatively Ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerve was identified and 2 mL of 0.5% bupivacaine was given perineurally along these identified nerves. Presence of inguinodynia, immediate post-operative pain scores using the Wong-Baker faces pain scale, duration of analgesics use, use of additional analgesics along with Paracetamol 500 mg tablet, and the length of hospital stay between the groups were recorded. RESULTS 100 patients were randomized in the study, 49 in control and 51 in the intervention group. Both the group was comparable in terms of demographic characteristics. The intervention group had significantly lower median pain score at 3 h [4 ± 1.662 vs. 6 ± 1.55; p = .0001] and 6 h [4 ± 1.33 vs. 6 ± 1.307; p = .0001]. The incidence of inguinodynia did not significantly differ between the two groups (p-value = .12). CONCLUSION Intraoperative Perineural bupivacaine infiltration significantly reduces the immediate postoperative pain. However, there was no significant reduction in the incidence of inguinodynia or additional analgesic requirement.
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Affiliation(s)
- Angeline Mary Samy
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Amaranathan Anandhi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Gubbi Shamanna Sreenath
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Sathasivam Sureshkumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Srinivasan Swaminathan
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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4
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Krishna Prasad BP, Joy B, Raghavendra VA, Toms A, George D, Ray B. Ultrasound-guided peripheral nerve interventions for common pain disorders. Indian J Radiol Imaging 2021; 28:85-92. [PMID: 29692534 PMCID: PMC5894327 DOI: 10.4103/ijri.ijri_108_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.
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Affiliation(s)
| | - Binu Joy
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | | | - Ajith Toms
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Danny George
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Brijesh Ray
- Department of Imaging and Interventional Radiology, Aster Medcity Hospital, Cheranelloor, Ernakulam, Kerala, India
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5
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Barth CW, Shah VM, Wang LG, Antaris AL, Klaassen A, Sorger J, Rao DA, Kerr DA, Henderson ER, Alani AW, Gibbs SL. Clinically translatable formulation strategies for systemic administration of nerve-specific probes. ADVANCED THERAPEUTICS 2021; 4:2100002. [PMID: 34423111 PMCID: PMC8372234 DOI: 10.1002/adtp.202100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nerves are extremely difficult to identify and are often accidently damaged during surgery, leaving patients with lasting pain and numbness. Herein, a novel near-infrared (NIR) nerve-specific fluorophore, LGW01-08, was utilized for enhanced nerve identification using fluorescence guided surgery (FGS), formulated using clinical translatable strategies. Formulated LGW01-08 was examined for toxicology, pharmacokinetics (PK), and pharmacodynamics (PD) parameters in preparation for future clinical translation. Optimal LGW01-08 imaging doses were identified in each formulation resulting in a 10x difference between the toxicity to imaging dose window. Laparoscopic swine surgery completed using the da Vinci surgical robot (Intuitive Surgical) demonstrated the efficacy of formulated LGW01-08 for enhanced nerve identification. NIR fluorescence imaging enabled clear identification of nerves buried beneath ~3 mm of tissue that were unidentifiable by white light imaging. These studies provide a strong basis for future clinical translation of NIR nerve-specific fluorophores for utility during FGS to improve patient outcomes.
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Affiliation(s)
- Connor W. Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - Vidhi M. Shah
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University/OHSU, Portland, OR, 97201
| | - Lei G. Wang
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | | | | | | | - Deepa A. Rao
- School of Pharmacy, Pacific University, Hillsboro, OR 97123
| | - Darcy A. Kerr
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.,Geisel School of Mdicine at Dartmouth College, Hanover, NH 03755
| | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Adam W.G. Alani
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201.,Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University/OHSU, Portland, OR, 97201
| | - Summer L. Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201.,Corresponding Author: Summer L. Gibbs, Ph.D., Oregon Health & Science University, Collaborative Life Sciences Building, 2730 S Moody Ave, Mail Code: CL3SG, Portland, OR 97201, , Phone: 503-494-8940
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6
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Milne DM, Naraynsingh V, Goolcharan S. Severe Mental Illness: A Contraindication to Watchful Waiting in Hernia Management? Cureus 2021; 13:e14915. [PMID: 34123615 PMCID: PMC8189269 DOI: 10.7759/cureus.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Watchful waiting (WW) is a strategy that can be used to manage hernias whereby patients who are asymptomatic or minimally symptomatic are observed until symptoms worsen or complications develop, prompting surgical intervention. The successful implementation of a WW strategy requires patients to report changes in their clinical condition to receive timely care. Patients who have severe mental illness may defer seeking care when appropriate. This case report describes our experience treating a patient with severe mental illness who had a primary ventral hernia managed by WW. She was lost to follow-up and subsequently presented with a strangulated epigastric hernia which fistulized to the skin. The case report highlights the challenges of attempting WW in patients with severe mental illness. We suggest that poorly controlled severe mental illness should be considered a relative contraindication to WW.
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Affiliation(s)
- David M Milne
- General Surgery, Port of Spain General Hospital, Port of Spain, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.,Surgery, Medical Associates Hospital, St. Joseph, TTO
| | - Shivan Goolcharan
- Department of Surgery, Eric Williams Medical Sciences Complex, Mount Hope, TTO
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7
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Rutegård M, Lindqvist M, Svensson J, Nordin P, Haapamäki MM. Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh. Br J Surg 2021; 108:138-144. [PMID: 33711123 PMCID: PMC10364858 DOI: 10.1093/bjs/znaa049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain. METHODS An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9-12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat. RESULTS A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group. CONCLUSION A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - M Lindqvist
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - J Svensson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences, Surgery, Östersund Research Unit, Umeå University, Östersund, Sweden
| | - M M Haapamäki
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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8
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Cirocchi R, Mercurio I, Nazzaro C, De Sol A, Boselli C, Rettagliata G, Vanacore N, Santoro A, Mascagni D, Renzi C, Lancia M, Suadoni F, Zanghì G, Palumbo P, Bruzzone P, Tellan G, Fedeli P, Marsilio F, D'Andrea V. Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair. BMC Surg 2020; 20:319. [PMID: 33287793 PMCID: PMC7720581 DOI: 10.1186/s12893-020-00988-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Isabella Mercurio
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy. .,Inguinal NerveWorking Group, Terni, Italy.
| | - Claudio Nazzaro
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Angelo De Sol
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Carlo Boselli
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | | | | | - Alberto Santoro
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Domenico Mascagni
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Claudio Renzi
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Fabio Suadoni
- Department of Surgical Science, University of Perugia, Piazza dell' Università 1, 06100, Perugia, Italy.,Inguinal NerveWorking Group, Terni, Italy
| | - Guido Zanghì
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgery, Policlinico Vittorio Emanuele University Hospital-General Surgery and Oncology Unit, University of Catania, Catania, Sicily, Italy
| | - Piergaspare Palumbo
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Paolo Bruzzone
- Inguinal NerveWorking Group, Terni, Italy.,Dipartimento Di Chirurgia Generale E Specialistica "Paride Stefanini", Viale del Policlinico, 155, 00186, Rome, Italy
| | - Guglielmo Tellan
- Inguinal NerveWorking Group, Terni, Italy.,Department of Emergency and Acceptance, Critical Areas and Trauma, "Umberto I" University Hospital, Sapienza University of Rome, 00161, Rome, Italy
| | - Piergiorgio Fedeli
- Inguinal NerveWorking Group, Terni, Italy.,Legal Medicine, School of Law, University of Camerino, Camerino, Italy
| | - Francucci Marsilio
- Inguinal NerveWorking Group, Terni, Italy.,General Surgery and Day Surgery, Azienda Ospedaliera Santa Maria Terni, Via Tristano Di Joannuccio, 05100, Terni, Italy
| | - Vito D'Andrea
- Inguinal NerveWorking Group, Terni, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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9
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Beard JH, Ohene-Yeboah M, Tabiri S, Amoako JKA, Abantanga FA, Sims CA, Nordin P, Wladis A, Harris HW, Löfgren J. Outcomes After Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana. JAMA Surg 2020; 154:853-859. [PMID: 31241736 DOI: 10.1001/jamasurg.2019.1744] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Inguinal hernia is the most common general surgical condition in the world. Although task sharing of surgical care with nonsurgeons represents one method to increase access to essential surgery, the safety and outcomes of this strategy are not well described for hernia repair. Objective To compare outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Design, Setting, and Participants This prospective cohort study was conducted from February 15, 2017, to September 17, 2018, at the Volta Regional Hospital in Ho, Ghana. Following successful completion of a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repair with mesh according to the Lichtenstein technique on 242 men with primary, reducible inguinal hernia. Main Outcomes and Measures The primary end point was hernia recurrence at 1 year. The noninferiority limit was set at 5 percentage points. Secondary end points included postoperative complications at 2 weeks and patient satisfaction, pain, and self-assessed health status at 1 year. Results Two-hundred forty-two patients were included; 119 men underwent operations performed by medical doctors and 123 men underwent operations performed by surgeons. Preoperative patient characteristics were similar in both groups. Two-hundred thirty-seven patients (97.9%) were seen at follow-up at 2 weeks, and 223 patients (92.1%) were seen at follow-up at 1 year. The absolute difference in recurrence rate between the medical doctor group (1 [0.9%]) and the surgeon group (3 [2.8%]) was -1.9 (1-tailed 95% CI, -4.8; P < .001), demonstrating noninferiority of the medical doctors. There were no statistically significant differences in postoperative complications (34 [29.1%] vs 29 [24.2%]), patient satisfaction (112 [98.2%] vs 108 [99.1%]), severe chronic pain (1 [0.9%] vs 4 [3.7%]), or self-assessed health (85.9 vs 83.7 of 100) for medical doctors and surgeons. Conclusions and Relevance This study shows that medical doctors can be trained to perform elective inguinal hernia repair with mesh in men with good results and high patient satisfaction in a low-resource setting. This finding supports surgical task sharing to combat the global burden of hernia disease.
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Affiliation(s)
- Jessica H Beard
- Lewis Katz School of Medicine, Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Temple University, Philadelphia, Pennsylvania
| | - Michael Ohene-Yeboah
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra
| | - Stephen Tabiri
- Department of Surgery, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Joachim K A Amoako
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra
| | - Francis A Abantanga
- Department of Surgery, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Carrie A Sims
- Trauma Center at Penn, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Pär Nordin
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andreas Wladis
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Hobart W Harris
- Department of Surgery, University of California, San Francisco
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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10
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Lin M, Long G, Chen M, Chen W, Mo J, Chen N. Giant recurrent left inguinal hernia with femoral nerve injury: a report of a rare case. BMC Surg 2020; 20:123. [PMID: 32517752 PMCID: PMC7280683 DOI: 10.1186/s12893-020-00786-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background Giant inguinal hernia(GIH), a rare disease, has brought great challenges to surgeons. GIH is defined as an inguinal hernia that extends below the midpoint of the inner thigh in standing position. However, a giant recurrent inguinal hernia resulting from previous operations that destroy the anatomical structure of the inguinal region is extremely rare. Nerve injury, a complication following inguinal hernia repair, is mostly found in ilioinguinal nerve and iliohypogastric nerve, which often presents as numbness and acute or chronic pain, while postoperative muscular dysfunction results from femoral nerve injury is rare. Case presentation A 77-years-old woman presented with a complaint of a reducible mass in the left inguinal of duration 1 year. The patient had three previous inguinal hernia repairs. Physical examination and auxiliary examination indicated a giant inguinal hernia with femoral nerve injury. After preoperative evaluation and preparation, a transabdominal partial extraperitoneal(TAPE) repair have performed. Finally, the patient recovered and was discharged. Conclusions In conclusion, we reported a rare case of a giant recurrent inguinal hernia with femoral nerve injury and made a successful treatment for the patient via transabdominal partial extraperitoneal(TAPE) repair.
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Affiliation(s)
- Manzhou Lin
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Guojie Long
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Ming Chen
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.
| | - Weice Chen
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Jian Mo
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Nianping Chen
- Department of Hernia and Abdominal Wall Surgery, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
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11
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Castro Ruiz C, Pavesi E, Ugoletti L, Zizzo M, Annessi V. Re: Chronic pain and risk for reoperation for recurrence after inguinal hernia repair using self-gripping mesh. Surgery 2020; 169:1257. [PMID: 32456784 DOI: 10.1016/j.surg.2020.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Carolina Castro Ruiz
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy; Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Italy.
| | - Erica Pavesi
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Lara Ugoletti
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Maurizio Zizzo
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Italy; Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Valerio Annessi
- Surgical Oncology Unit. Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
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12
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Ran K, Wang X, Zhao Y. Open tensionless repair techniques for inguinal hernia: a meta-analysis of randomized controlled trials. Hernia 2019; 24:733-745. [DOI: 10.1007/s10029-019-02106-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
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13
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Konschake M, Zwierzina M, Moriggl B, Függer R, Mayer F, Brunner W, Schmid T, Chen DC, Fortelny R. The inguinal region revisited: the surgical point of view : An anatomical-surgical mapping and sonographic approach regarding postoperative chronic groin pain following open hernia repair. Hernia 2019; 24:883-894. [PMID: 31776877 PMCID: PMC7395915 DOI: 10.1007/s10029-019-02070-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Inguinodynia or chronic post-herniorrhaphy pain, defined as pain lasting longer than 3 months after open inguinal hernia repair, has become the most important complication after inguinal surgery and therefore compromises the patient´s quality of life. A major reason for inguinodynia might be the lack of neuroanatomical knowledge and suboptimal "management" of the nerves during surgery. METHODS We present a detailed neuroanatomic mapping of the inguinal region by dissection including the most important surgical landmarks with all nerves confirmed by immunohistochemistry, ultrasound guided visualization of the iliohypogastric, ilio-inguinal, and genital branch of the genitofemoral nerve, and a practical (preoperative) algorithm for clinical management. RESULTS Surgically and ultrasonographically relevant structures ("landmarks") in open hernia repair are the anterior-superior iliac spine, pubic tubercle, Camper´s fascia (superficial layer of the superficial abdominal fascia), External oblique aponeurosis, Internal oblique muscle, Transversus abdominis muscle, superficial inguinal ring, external spermatic fascia, cremasteric fascia with cremaster muscle fibers, internal spermatic fascia, cremasteric vein (=external spermatic vein = "blue line"), ductus deferens, pampiniform plexus, inguinal ligament and the inferior epigastric vessels. CONCLUSION A detailed understanding of inguinal anatomy is an indispensable basic requirement for all surgeons to perform inguinal ultrasonography as well as open inguinal hernia repair, avoiding complications, especially postoperative inguinodynia.
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Affiliation(s)
- M Konschake
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria.
| | - M Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - B Moriggl
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria
| | - R Függer
- Department of Surgery, Elisabethinen Hospital, Linz, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - W Brunner
- Department of Surgery, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - T Schmid
- Department for Visceral-, Transplantation- and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - D C Chen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Lichtenstein Amid Hernia Clinic, Santa Monica, CA, USA
| | - R Fortelny
- Department of General-, Visceral- and Oncological Surgery, Wilhelminenspital, Vienna, Austria
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Grebić D, Naglič N, Mijolović Ž. Postoperative groin pain in patients operated with different surgical techniques for inguinal hernia repair. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04858-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Patterson TJ, Beck J, Currie PJ, Spence RAJ, Spence G. Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair. Br J Surg 2019; 106:824-836. [PMID: 30990238 DOI: 10.1002/bjs.11139] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/07/2018] [Accepted: 01/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Inguinal hernia repair is a common low-risk intervention. Patient-reported outcomes (PROs) are being used increasingly as primary outcomes in clinical trials. The aim of this study was to review and meta-analyse the PROs in RCTs comparing laparoscopic versus open inguinal hernia repair techniques in adult patients. METHODS A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only RCTs in peer-reviewed journals were considered. PubMed, Ovid Embase, Scopus and the Cochrane Library were searched. In addition, four trial registries were searched. The search interval was between 1 January 1998 and 1 May 2018. Identified publications were reviewed independently by two authors. The review was registered in the PROSPERO database (CRD42018099552). Bias was assessed using the Cochrane Collaboration risk-of-bias tool. RESULTS Some 7192 records were identified, from which 58 unique RCTs were selected. Laparoscopic hernia repair was associated with significantly less postoperative pain in three intervals: from 2 weeks to within 6 months after surgery (risk ratio (RR) 0·74, 95 per cent c.i. 0·62 to 0·88), 6 months to 1 year (RR 0·74, 0·59 to 0·93) and 1 year onwards (RR 0·62, 0·47 to 0·82). Paraesthesia (RR 0·27, 0·18 to 0·40) and patient-reported satisfaction (RR 0·91, 0·85 to 0·98) were also significantly better in the laparoscopic repair group. CONCLUSION The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to counsel patients. It was constrained by heterogeneity of reporting for several outcomes.
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Affiliation(s)
- T J Patterson
- Department of General Surgery, Ulster Hospital, Dundonald, BT16 1RH, UK
| | - J Beck
- Department of General Surgery, Ulster Hospital, Dundonald, BT16 1RH, UK
| | - P J Currie
- Department of General Surgery, Ulster Hospital, Dundonald, BT16 1RH, UK
| | - R A J Spence
- Department of General Surgery, Ulster Hospital, Dundonald, BT16 1RH, UK
| | - G Spence
- Department of General Surgery, Ulster Hospital, Dundonald, BT16 1RH, UK
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16
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Decker E, Currie A, Baig MK. Prolene hernia system versus Lichtenstein repair for inguinal hernia: a meta-analysis. Hernia 2019; 23:541-546. [PMID: 30771031 DOI: 10.1007/s10029-019-01897-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/20/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lichtenstein repair is standard practice for inguinal herniorrhaphy, but there is increasing public concern in the use of mesh and postoperative chronic pain. New mesh technology, such as the prolene hernia system, has a preperitoneal component to reinforce the myopectineal orifice aim to reduce the risk of recurrence and chronic pain. This meta-analysis compares outcomes using prolene hernia system versus lichenstein repair for inguinal hernias. METHODS Randomized-controlled trials comparing prolene hernia system and Lichtenstein repair were identified using Embase, Medline, and published conference abstracts. Primary outcomes were recurrence and chronic pain. Secondary outcomes were mean operating time, composite complications, surgical reintervention, and time to normal activities. Odds ration and standardized mean differences were calculated. RESULTS 1377 hernia repairs were identified from a total of 7 trials. Mean follow-up was 12-91 months. There was no difference between the techniques for recurrence [pooled analysis odds ratio: 0.86 (95% CI 0.32-2.28); p = 0.76] and chronic pain [pooled analysis odds ratio: 1.00 (95% CIs 0.65-1.55); p = 1]. Prolene hernia system demonstrated a shorter time to return to normal activities [pooled weighted mean difference - 0.54 (95% CI - 1.07 to - 0.01); p = 0.04]. Other outcomes were similar in mean operating time, composite complications, and surgical reintervention. CONCLUSION Both prolene hernia system and Lichenstein repair appear comparable acceptable techniques for inguinal herniorrhaphy. Further longer-term studies of new mesh technologies will improve information available to surgeons and their patients.
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Affiliation(s)
- E Decker
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, BN11 2DH, UK.
| | - A Currie
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, BN11 2DH, UK
| | - M K Baig
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, BN11 2DH, UK
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Percalli L, Pricolo R, Passalia L, Riccò M. Comparison between self-gripping, semi re-absorbable meshes with polyethylene meshes in Lichtenstein, tension-free hernia repair: preliminary results from a single center. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:72-78. [PMID: 29633746 PMCID: PMC6357604 DOI: 10.23750/abm.v89i1.6594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/31/2017] [Indexed: 01/06/2023]
Abstract
Even tough inguinal hernia repair is among the commonest operations in general surgery, the choice for an optimal approach continues to be a controversial topic. Because of the low recurrence rates and low prevalence of complications, tension-free mesh augmented operation has become the standard technique in inguinal hernia surgery, significantly reducing hernia recurrence rates. On the contrary, prevalence of chronic postoperative groin pain (CPGI) i.e. pain beyond a three month-postoperative period still remains significant: as rates of CPGI may range between 15% and 53%, surgical approaches aimed to avoid chronic post-hernioplasty pain have been extensively debated, and the avoidance of CPGI has become one of the primary endpoints of surgical research on inguinal hernia repair). Recently, a sound base of evidence suggested that the entrapment of peripheral nervous fibers innervating part of the structures in the inguinal canal and stemming from ilioinguinal (Th12), iliohypogastric (L1) nerves as well as from the genital branch of the genito-femoral nerve (L1, L2), may eventually elicit CPGI (1-10). Consequently, innovative fixation modalities (e.g. self-gripping meshes, glue fixation, absorbable sutures), and new material types (e.g. large-pored meshes) with self-adhesive sticking or mechanical characteristics, have been developed in order to avoid penetrating fixings such as sutures, clips and tacks. However, some uncertainties still remain about the pros and cons of such meshes in terms of chronic pain, as new, innovative mesh apparently does not significantly reduce the rate of CPGI. Parietex ProGrip® (MedtronicsTM) is a bicomponent mesh comprising of monofilament polyester and a semi re-absorbable polylactic acid gripping system that allows sutureless fixation of prosthetic mesh to the posterior inguinal wall. As ProGrip® does not requires additional fixation, inguinal canal may be closed within minutes after adequate groin dissection, ultimately shortening operating time. In other words, ProGrip® has the potential for significant savings, in terms of surgical and post-operating costs as well (10). The aim of our study is therefore to compare the results of the same technique with two different mesh materials (ProGrip® mesh vs. polyethylene mesh), in terms of operative time, post-operative pain, complications, and recurrence rates. (www.actabiomedica.it)
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Affiliation(s)
- Luigi Percalli
- UO General Surgery - Departement of Surgery AUSL Piacenza.
| | - Renato Pricolo
- UO Surgery - Surgical Departement of ASSP Lodi - Codogno Hospital via G. Marconi 1, 26845 Codogno (LO).
| | | | - Matteo Riccò
- Local Health Unit of Reggio Emilia - Department of Public Health - Occupational Health and Safety Unit. V.le Amendola n.2 - 42022 Reggio Emilia (RE).
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Chandrasekar S, Jeyakumar S, Ganapathy T. WITHDRAWN: Glue versus suture for mesh fixation in inguinal hernia repair. Int J Surg 2018:S1743-9191(18)30636-8. [PMID: 29578093 DOI: 10.1016/j.ijsu.2018.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/14/2018] [Indexed: 11/15/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
| | - S Jeyakumar
- Department of General Surgery, SRM Medical College, Hospital and Research Centre, India
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19
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Is It the Mesh? Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00058.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It is well known that after inguinal herniorrhaphy, some patients develop inguinodynia. Pain has often been blamed on injury or entrapment of the ilioinguinal nerve. Since the advent of mesh, we have noticed a number of patients with persistent pain even after the ilioinguinal nerve has been transected or blocked. For that reason, a retrospective review was done to analyze whether the mesh could be a culprit for this chronic pain syndrome. A total of 12 cases were reviewed. All patients underwent exploration of the inguinal area, along with removal of the previous mesh and herniorraphy with a McVay technique. After exploration and removal of the mesh, the inguinal pain was greatly improved within 2 months of the time of surgery in all 12 patients. Despite changes in mesh manufacturing and hernia repair technique, we believe that there is a possible correlation between the mesh and inguinodynia in a certain subset of patients that seems to be unrelated to nerve pathology. This correlation may prompt revision in training surgical residents in primary tissue repair and may lead to further investigations regarding patient response to inguinal mesh placement.
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What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20,004 patients from the Herniamed Registry. Surg Endosc 2017; 32:1971-1983. [PMID: 29075969 PMCID: PMC5845068 DOI: 10.1007/s00464-017-5893-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/13/2017] [Indexed: 10/26/2022]
Abstract
BACKGROUND In inguinal hernia repair, chronic pain must be expected in 10-12% of cases. Around one-quarter of patients (2-4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perioperative complications, and penetrating mesh fixation. This present analysis of data from the Herniamed Hernia Registry now investigates the influencing factors for chronic pain in male patients after primary, unilateral inguinal hernia repair in TAPP technique. METHODS In total, 20,004 patients from the Herniamed Hernia Registry were included in uni- and multivariable analyses. For all patients, 1-year follow-up data were available. RESULTS Multivariable analysis revealed that onset of pain at rest, on exertion, and requiring treatment was highly significantly influenced, in each case, by younger age (p < 0.001), preoperative pain (p < 0.001), smaller hernia defect (p < 0.001), and higher BMI (p < 0.001). Other influencing factors were postoperative complications (pain at rest p = 0.004 and pain on exertion p = 0.023) and penetrating compared with glue mesh fixation techniques (pain on exertion p = 0.037). CONCLUSIONS The indication for inguinal hernia surgery should be very carefully considered in a young patient with a small hernia and preoperative pain.
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21
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Acceptance of Fibrin Glue Fixation in Lichtenstein Hernia Repair: a Faraway Dream. Indian J Surg 2017; 79:178-179. [PMID: 28442851 DOI: 10.1007/s12262-016-1583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022] Open
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Unilateral paravertebral block compared with subarachnoid anesthesia for the management of postoperative pain syndrome after inguinal herniorrhaphy: a randomized controlled clinical trial. Pain 2017; 157:1105-1113. [PMID: 26761379 DOI: 10.1097/j.pain.0000000000000487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inguinal herniorrhaphy is a common surgical procedure. The aim of this investigation was to determine whether unilateral paravertebral block could provide better control of postoperative pain syndrome compared with unilateral subarachnoid block (SAB). A randomized controlled study was conducted using 50 patients with unilateral inguinal hernias. The patients were randomized to receive either paravertebral block (S group) or SAB (C group). Paravertebral block was performed by injecting a total of 20 mL of 0.5% levobupivacaine from T9 to T12 under ultrasound guidance, whereas SAB was performed by injecting 13 mg of 0.5% levobupivacaine at the L3 to L4 level. Data regarding anesthesia, hemodynamic changes, side effects, time spent in the postanesthesia care unit, the Karnofsky Performance Status, acute pain and neuropathic disturbances were recorded. Paravertebral block provided good anesthesia of the inguinal region without patient or surgeon discomfort, with better hemodynamic stability and safety and with a reduced time to discharge from the postanesthesia care unit compared with SAB. During the postsurgical and posthospital discharge follow-ups, rest and incident pain and neuropathic positive phenomena were better controlled in the S group than in the C group. The consumption of painkillers was higher in the C group than in the S group throughout the follow-up period. Paravertebral block can be considered a viable alternative to common anesthetic procedures performed for inguinal hernia repair surgery. Paravertebral block provided good management of acute postoperative pain and limited neuropathic postoperative disturbances.
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Dor crônica persistente pós‐operatória: o que sabemos sobre prevenção, fatores de risco e tratamento? Braz J Anesthesiol 2016; 66:505-12. [DOI: 10.1016/j.bjan.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
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Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment. Braz J Anesthesiol 2016; 66:505-12. [PMID: 27591465 DOI: 10.1016/j.bjane.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. CONTENT This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. CONCLUSION Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.
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Karakose O, Eken H. Shouldice herniorrhaphy – still an effective technique: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Antoniou SA, Köhler G, Antoniou GA, Muysoms FE, Pointner R, Granderath FA. Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 2015; 211:239-249.e2. [PMID: 26316363 DOI: 10.1016/j.amjsurg.2015.06.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/11/2015] [Accepted: 06/29/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence for open groin hernia repair demonstrates less pain with bioglue mesh fixation compared with invasive methods. This study aimed to assess the short- and long-term effects of laparoscopic groin hernia repair with noninvasive and invasive mesh fixation. DATA SOURCES A systematic review of MEDLINE, CENTRAL, and OpenGrey was undertaken. Randomized trials assessing the outcome of laparoscopic groin hernia repair with invasive and noninvasive fixation methods were considered for data synthesis. Nine trials encompassing 1,454 patients subjected to laparoscopic hernia repair with mesh fixation using biologic or biosynthetic glue were identified. Short-term data were inadequate for data synthesis. Chronic pain was less frequently reported by patients subjected to repair with biologic glue fixation than with penetrating methods (odds ratio .46, 95% confidence interval .22 to .93). Duration of surgery, incidence of seroma/hematoma, morbidity, and recurrence were similar. CONCLUSIONS Laparoscopic groin hernia repair with bioglue mesh fixation was associated with a reduced incidence of chronic pain compared with mechanical fixation, without increasing morbidity or recurrence. Longer term data on recurrence are necessary.
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Affiliation(s)
- Stavros A Antoniou
- Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany; Department of General Surgery, University Hospital of Heraklion, Crete, Greece.
| | - Gernot Köhler
- Department of General Surgery, Sisters of Charity Hospital, Linz, Austria
| | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Rudolph Pointner
- Department of General Surgery, Hospital Zell am See, Zell am See, Austria
| | - Frank-Alexander Granderath
- Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany
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Tanrikulu Y, Cagsar M, Yalcin B, Kokturk F, Yilmaz G, Temi V. Effect of peritoneal incision on immediate pain after inguinal hernia repair: A Prospective Cohort Study. Int Surg 2015; 104:556-562. [PMID: 26205637 DOI: 10.9738/intsurg-d-15-00182.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Hernia repair is a common surgical procedure, and postoperative pain is an inevitable result of hernia surgery. The prevention of postoperative pain is of considerable importance in terms of patient comfort and early discharge. In this study, we evaluated the effects of a peritoneal incision on pain in the early postoperative period. SUMMARY OF BACKGROUND DATA This was a prospective clinical study with 75 patients undergoing inguinal hernia repair. METHODS Patients were divided into five groups: group 1: indirect hernia, Lichtenstein repair with peritoneal incision, group 2: indirect hernia, Lichtenstein repair without peritoneal incision, group 3: all hernias, trans-abdominal preperitoneal(TAPP) repair, group 4: all hernias, total extraperitoneal (TEP) repair, and group 5: direct hernia, Lichtenstein repair with no peritoneal incision. Groups were compared in terms of postoperative pain scores at three different times and complications. RESULTS There were 62 males and 13 females; their average age was 51.25 years. The visual analog scale (VAS) scores were lower in groups 2, 4, and 5, and there were differences among groups and within each group according to VAS changes assessed at all time points (p < 0.05). There was no difference, according to VAS analysis, between open and laparoscopic surgery groups. There was a difference according to VAS changes in each group between hernia sides (p < 0.001). CONCLUSION Peritoneal incision is a significant risk factor for postoperative pain after inguinal hernia repair. But, surgical procedure was not a risk factor although VAS scores were higher in open than laparoscopic surgery.
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Affiliation(s)
- Yusuf Tanrikulu
- a Zonguldak Ataturk State Hospital, Zonguldak, 67100, Turkey
| | - Mithat Cagsar
- b Zonguldak Atatürk State HospitalDepartment of General Surgery
| | - Boran Yalcin
- c Zonguldak Atatürk State HospitalDepartment of General Surgery
| | - Furuzan Kokturk
- d Bulent Ecevit University, Faculty of Medicine, Department of Emergency Medicine
| | - Gokhan Yilmaz
- e Zonguldak Atatürk State HospitalDepartment of General Surgery
| | - Volkan Temi
- f Zonguldak Atatürk State HospitalDepartment of General Surgery
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Gao PZ, Li M, Yu YJ, Hao XD, Li WZ, Rong YJ, Zheng ZG, Meng N. Clinical Implantation with the novel D-13 prosthesis for inguinal hernioplasty: A retrospective cohort study. Int J Surg 2015; 17:24-7. [PMID: 25782342 DOI: 10.1016/j.ijsu.2015.02.028] [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: 10/10/2014] [Revised: 02/11/2015] [Accepted: 02/26/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Using a mesh to repair inguinal hernias is now a standard procedure that is widely accepted as superior to primary suture repair. Although a variety of meshes are available, individual meshes may have their own unattractive features. This retrospective study examines the efficacy of our originally designed D-13 prosthesis, which is used in patients with inguinal hernias. METHODS A total of 305 patients who underwent a herniorrhaphy between January 2009 and March 2011 were included in this study. The recurrent rate, chronic pain and feeling of a foreign body were examined at a 3-year follow-up. The D-13 prosthesis, made from clear polypropylene monofilament mesh, was originally designed by the first author of this study and constructed with the upper and lower pieces of polypropylene mesh having different shapes and sizes. Both pieces are linked together by a connector. RESULTS The mesh is well tolerated. At a 3-year follow-up, only two patients had a foreign body sensation at the operative site, and three patients had recurrent hernias. CONCLUSION The unique design of the D-13 prosthesis with two pieces of mesh provided encouraging long-term outcome for hernia recurrence, chronic pain and the feeling of a foreign body.
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Affiliation(s)
- Peng-Zhi Gao
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Ming Li
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China.
| | - Ying-Jian Yu
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Xiang-Dong Hao
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Wu-Zi Li
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Ya-Jun Rong
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Zhi-Gang Zheng
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
| | - Ning Meng
- Department of Surgery, Shijiazhuang First Hospital, Hebei, China
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Team Training (Training at Own Facility) versus Individual Surgeon's Training (Training at Trainer's Facility) When Implementing a New Surgical Technique: Example from the ONSTEP Inguinal Hernia Repair. Surg Res Pract 2014; 2014:762761. [PMID: 25506078 PMCID: PMC4258376 DOI: 10.1155/2014/762761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/10/2014] [Indexed: 01/29/2023] Open
Abstract
Background. When implementing a new surgical technique, the best method for didactic learning has not been settled. There are basically two scenarios: the trainee goes to the teacher's clinic and learns the new technique hands-on, or the teacher goes to the trainee's clinic and performs the teaching there. Methods. An informal literature review was conducted to provide a basis for discussing pros and cons. We also wanted to discuss how many surgeons can be trained in a day and the importance of the demand for a new surgical procedure to ensure a high adoption rate and finally to apply these issues on a discussion of barriers for adoption of the new ONSTEP technique for inguinal hernia repair after initial training. Results and Conclusions. The optimal training method would include moving the teacher to the trainee's department to obtain team-training effects simultaneous with surgical technical training of the trainee surgeon. The training should also include a theoretical presentation and discussion along with the practical training. Importantly, the training visit should probably be followed by a scheduled visit to clear misunderstandings and fine-tune the technique after an initial self-learning period.
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Arslan K, Erenoglu B, Turan E, Koksal H, Dogru O. Minimally invasive preperitoneal single-layer mesh repair versus standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial. Hernia 2014; 19:373-81. [DOI: 10.1007/s10029-014-1306-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Lichtenstein technique for inguinal hernia repair using polypropylene mesh fixed with sutures vs. self-fixating polypropylene mesh: a prospective randomized comparative study. Hernia 2014; 18:193-8. [PMID: 24430578 DOI: 10.1007/s10029-013-1211-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Chronic postoperative pain is probably the most significant complication of tension-free inguinal hernia repair as its presence can considerably affect the life quality of the patient. Different mesh materials and different surgical techniques for mesh fixation have been applied to reduce chronic postoperative pain, with controversial, nevertheless, results. The aim of this prospective randomized study was to evaluate the effect of a relatively new mesh with self-fixating properties, used to repair inguinal hernia with the Lichtenstein technique, on early and chronic postoperative pain. METHODS Between June 2009 and June 2010, 50 patients with primary unilateral inguinal hernia were treated using the Lichtenstein technique. Patients were randomly assigned to receive either a polypropylene mesh, fixed with polypropylene sutures (n = 25; group A), or a self-fixating polypropylene mesh with resorbable polylactic acid microgrips (n = 25; group B). Demographic data were recorded. Early and chronic postoperative pain was evaluated using the visual analog scale (VAS). Duration of surgery, complications, length of hospitalization and recurrence were also recorded. RESULTS No statistical difference was found between the two groups in association to demographic data. Operating time was 53.4 ± 12.5 and 44.4 ± 7.2 min in groups A and B, respectively, and the difference was statistically significant (p < 0.001). No difference was observed between the groups regarding the postoperative complications. The VAS of early postoperative pain was 1.7 ± 1.9 in group A and 1.3 ± 1.6 in group B, with the difference being not statistically significant (p = 0.21). Concerning chronic pain, no remarkable statistically significant difference was observed between the two groups at 3-month, 1- and 2-year follow-up period. At the end of the study, no recurrence was reported in either group. CONCLUSIONS Self-fixating mesh can be safely and effectively used in inguinal hernia repair with the additional advantage of reducing the operative time compared to the classic Lichtenstein technique. However, its use is not accompanied by reduced rates in early or chronic postoperative pain.
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Fang Z, Zhou J, Ren F, Liu D. Self-gripping mesh versus sutured mesh in open inguinal hernia repair: system review and meta-analysis. Am J Surg 2014; 207:773-81. [PMID: 24495321 DOI: 10.1016/j.amjsurg.2013.08.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this article was to compare the outcomes of self-gripping mesh (GM) with sutured mesh (SM) in open inguinal hernia repair. METHODS A systematic review and meta-analysis were taken to compare the outcomes of GM and SM in open inguinal hernia repair. RESULTS A total of 1,353 patients in 6 randomized controlled trials and 2 observational studies were reviewed (666 patients in GM group; 687 patients in SM group). The 2 groups did not significantly differ in chronic groin pain (P = .23) or recurrence (P = .59). The operating time was significantly shorter in GM group (P < .00001). There was no significant difference in infection (P = .18), seromas (P = .35), hematomas (P = .87), or discomfort (P = .58) between the 2 groups. CONCLUSIONS The data showed that GM was equivalent to SM in open inguinal hernia repair. However, this new mesh still needs to be confirmed in large, multi-center, well-designed randomized controlled trials.
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Affiliation(s)
- Zhixue Fang
- Department of Geriatrics Surgery, the Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Jianping Zhou
- Department of Geriatrics Surgery, the Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Feng Ren
- Department of Geriatrics Surgery, the Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, Hunan 410011, P.R. China.
| | - Dongcai Liu
- Department of Geriatrics Surgery, the Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, Hunan 410011, P.R. China
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Sanders DL, Waydia S. A systematic review of randomised control trials assessing mesh fixation in open inguinal hernia repair. Hernia 2013; 18:165-76. [PMID: 23649403 DOI: 10.1007/s10029-013-1093-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 04/26/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE The technique for fixation of mesh has been attributed to adverse patient and surgical outcomes. Although this has been the subject of vigorous debate in laparoscopic hernia repair, the several methods of fixation in open, anterior inguinal hernia repair have seldom been reviewed. The aim of this systematic review was to determine whether there is any difference in patient-based (recurrence, post-operative pain, SSI, quality of life) or surgical outcomes (operative time, length of operative stay) with different fixation methods in open anterior inguinal hernioplasty. METHODS A literature search was performed in PubMed, EMBASE and the Cochrane Library databases. Randomised clinical trials assessing more than one method of mesh fixation (or fixation versus no fixation) of mesh in adults (>18 years) in open, anterior inguinal hernia repair, with a minimum of 6-month follow-up and including at least one of the primary outcome measures (recurrence, chronic pain, surgical site infection) were included in the review. Secondary outcomes analysed included post-operative pain (within the first week), quality of life, operative time and length of hospital stay. RESULTS Twelve randomised clinical trials, which included 1,992 primary inguinal hernia repairs, were eligible for inclusion. Four studies compared n-butyl-2 cyanoacrylate (NB2C) glues to sutures, two compared self-fixing meshes to sutures, four compared fibrin sealant to sutures, one compared tacks to sutures, and one compared absorbable sutures to non-absorbable sutures. The majority of the trials were rated as low or very low-quality studies. There was no significant difference in recurrence or surgical site infection rates between fixation methods. There was significant heterogeneity in the measurement of chronic pain. Three trials reported significantly lower rates of chronic pain with fibrin sealant or glue fixation compared to sutures. A further three studies reported lower pain rates within the first week with non-suture fixation techniques compared to suture fixation. A significant reduction in operative time, ranging form 6 to 17.9 min with non-suture fixation, was reported in five of the studies. Although infrequently measured, there were no significant differences in length of hospital stay or quality of life between fixation methods. CONCLUSIONS There is insufficient evidence to promote fibrin sealant, self-fixing meshes or NB2C glues ahead of suture fixation. However, these products have been shown to be at least substantially equivalent, and moderate-quality RCTs have suggested that both fibrin sealant and NB2C glues may have a beneficial effect on reducing immediate post-operative pain and chronic pain in at-risk populations, such as younger active patients. It will ultimately be up to surgeons and health-care policy makers to decide whether based on the limited evidence these products represent a worthwhile cost for their patients.
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Affiliation(s)
- D L Sanders
- Department of Upper GI Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, UK,
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Sajid MS, Kalra L, Parampalli U, Sains PS, Baig MK. A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in influencing the incidence of chronic groin pain following laparoscopic inguinal hernia repair. Am J Surg 2013; 205:726-36. [PMID: 23561639 DOI: 10.1016/j.amjsurg.2012.07.046] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/19/2012] [Accepted: 07/24/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND A systematic analysis was conducted of randomized controlled trials (RCTs) comparing lightweight mesh (LWM) with heavyweight mesh in laparoscopic inguinal hernia repair. METHODS Data extracted from the included RCTs were analyzed according to the principles of meta-analysis. RESULTS Eleven RCTs encompassing 2,189 patients were analyzed. In a fixed-effects model, operating time, postoperative pain, and recurrence rate were statistically similar between LWM and heavyweight mesh. LWM was associated with fewer perioperative complications and a reduced risk for developing chronic groin pain. There was also a reduced risk for developing other groin symptoms, such as foreign body sensations, but it was not statistically significant. CONCLUSIONS The use of LWM for laparoscopic inguinal hernia repair is not associated with an increased risk for hernia recurrence. LWM reduces the incidence of chronic groin pain, groin stiffness, and foreign body sensations. Therefore, LWM may routinely be used in laparoscopic inguinal hernia repair. However, high-quality RCTs with longer follow-up periods are required to validate these findings.
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Affiliation(s)
- Muhammad S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, UK.
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Paajanen H, Rönkä K, Laurema A. A single-surgeon randomized trial comparing three meshes in lichtenstein hernia repair: 2- and 5-year outcome of recurrences and chronic pain. Int J Surg 2012; 11:81-4. [PMID: 23246868 DOI: 10.1016/j.ijsu.2012.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic pain may be a major long-term problem related to mesh material and operative trauma in inguinal hernioplasty. STUDY DESIGN Lichtenstein hernioplasty was performed under local anaesthesia in 312 patients by the same surgeon and technique between 2003 and 2005. The patients were randomized to receive a partly absorbable polypropylene-polyglactin mesh (Vypro II(®) 50 g/m(2), 104 hernias), a lightweight polypropylene mesh (Premilene Mesh LP(®) 55 g/m(2), 107 hernias) or a conventional densely woven polypropylene mesh (Premilene(®) 82 g/m(2), 101 hernias). The 2- and 5-year recurrences and pain scores were analysed. RESULTS Patient's characteristics and the mean duration of operation (30-32 min) were similar between the three groups. After two years, there were 6 recurrences (2 in each group) of which 3 patients were re-operated. A feeling of a foreign body and sensation of pain were comparable with all meshes. After five years, overall recurrence rate was 10/312 (3.2%) with only 4 re-operations. A feeling of a foreign body (6.5-8.1%), chronic pain (13-23%) as well as use of analgesics (0-2.9%) were similar in all groups. CONCLUSION There were no statistical differences between the three meshes in pain, a feeling of a foreign body or use of analgesics after 5 years of Lichtenstein hernioplasty, when the same surgeon operated all patients with exactly the same surgical technique. CLINICAL TRIAL REGISTER: NCT01295437.
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Affiliation(s)
- Hannu Paajanen
- Kuopio University Hospital, PL 1777, 70211 Kuopio, Finland.
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Obturator nerve injury in laparoscopic inguinal hernia mesh repair. Hernia 2012; 17:801-4. [DOI: 10.1007/s10029-012-0972-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Currie A, Andrew H, Tonsi A, Hurley PR, Taribagil S. Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis. Surg Endosc 2012; 26:2126-33. [PMID: 22311304 DOI: 10.1007/s00464-012-2179-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/17/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Reinforcement of inguinal hernia repair with prosthetic mesh is standard practice but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in lighter-weight mesh. Minimally invasive approaches have also significantly reduced postoperative recovery from inguinal hernia repair. The aim of this systematic review was to compare the outcomes after laparoscopic inguinal repair using new lightweight or traditional heavyweight mesh in published randomised controlled trials. METHODS Medline, Embase, trial registries, conference proceedings, and reference lists were searched for controlled trials of heavyweight versus lightweight mesh for laparoscopic repair of inguinal hernias. The primary outcomes were recurrence and chronic pain. Secondary outcomes were visual analogue pain score at 7 days postoperatively, seroma formation, and time to return to work. Risk differences were calculated for categorical outcomes and standardised mean differences for continuous outcomes. RESULTS Eight trials were included in the analysis of 1,667 hernias in 1,592 patients. Mean study follow-up was between 2 and 60 months. There was no effect on recurrence [pooled analysis risk difference 0.00 (95% CI -0.01 to 0.01), p = 0.86] or chronic pain [pooled analysis risk difference -0.02 (95% CI -0.04 to 0.00); p = 0.1]. Lightweight and heavyweight mesh repair had similar outcomes with regard to postoperative pain, seroma development, and time to return to work. CONCLUSION Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.
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Affiliation(s)
- Andrew Currie
- Department of General Surgery, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
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Sajid MS, Leaver C, Baig MK, Sains P. Lightweight versus Heavyweight mesh for open repair of inguinal hernia. Cochrane Database Syst Rev 2011. [DOI: 10.1002/14651858.cd009495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Muhammad S Sajid
- Worthing Hospital; Department of Colorectal Surgery; Western Sussex Hospitals NHS Trust Worthing West Sussex UK BN11 2DH
| | - Catherine Leaver
- Worthing Hospital, Worthing & Southlands Hospitals NHS Trust; Department of Colorectal Surgery; Lyndhurst Road Worthing West Sussex UK BN11 2DH
| | - Mirza K Baig
- Worthing Hospital, Western Sussex Hospitals NHS Trust; Department of Colorectal Surgery; Lyndhurst Road Worthing West Sussex UK BN11 2DH
| | - Parv Sains
- Worthing Hospital, Western Sussex Hospitals NHS Trust; Department of Colorectal Surgery; Lyndhurst Road Worthing West Sussex UK BN11 2DH
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