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Chue KM, Kabir T, Wong WK, Kam JH, Tan JTH, Tan CC, Ong LWL, Chua H, Tan AYH, Leong FQH, Koh FHX, Foo FJ, Ngaserin S, Yeung BPM. Impact of slit compared with nonslit mesh in laparoscopic groin hernia repairs-A comprehensive propensity score analysis of a cohort of 611 hernias. Surgery 2024; 176:1424-1432. [PMID: 39191601 DOI: 10.1016/j.surg.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND The slit-mesh technique for laparoscopic groin hernia repair remains controversial. We present the largest cohort of patients to date that have undergone laparoscopic hernia repair with this technique and aim to evaluate the impact of both techniques on postoperative recurrence and other secondary outcomes. METHODS A retrospective, single-institution cohort study of patients who underwent a laparoscopic groin hernia repair over a 5.5-year period was performed. Univariate and multivariate analyses were performed to identify factors associated with recurrence, chronic pain, complications, length of stay, and operative time. A propensity score analysis also was performed. Time to recurrence was then subsequently plotted on a Kaplan-Meier survival analysis. RESULTS In total, 611 laparoscopic groin hernia repairs (nonslit: n = 353; slit: n = 258) were reviewed. Mean follow-up duration was 6.6 months. On the multivariate analysis, body mass index was inversely correlated with recurrence (odds ratio, 0.792; 95% confidence interval, 0.656-0.956), whereas a slit mesh had lower recurrence (odds ratio, 0.228; 95% confidence interval, 0.064-0.809). In the propensity score-adjusted analysis, slit mesh remained significantly associated with reduced recurrence (adjusted odds ratio, 0.251; 95% confidence interval, 0.070-0.900), with no differences in chronic pain (adjusted odds ratio, 1.297; 95% confidence interval, 0.275-6.128) or postoperative complications (adjusted odds ratio, 1.808; 95% confidence interval, 0.429-7.620). Operative time also was reduced in the slit-mesh group (P = .009). CONCLUSIONS The slit-mesh technique was associated with a reduced likelihood of postoperative recurrence and shorter operative time, with no impact on postoperative chronic pain or complications. A lower body mass index was also correlated with increased likelihood of postoperative recurrence.
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Affiliation(s)
- Koy Min Chue
- Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore.
| | - Tousif Kabir
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Hepatobiliary and Pancreatic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Wai Keong Wong
- Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore; Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Juinn Huar Kam
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Hepatobiliary and Pancreatic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jeremy Tian Hui Tan
- Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore; Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Choon Chieh Tan
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Head and Neck Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Lester Wei Lin Ong
- Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore
| | - Huiwen Chua
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Breast Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Alvin Yong Hui Tan
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Hepatobiliary and Pancreatic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Faith Qi Hui Leong
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Breast Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Frederick Hong Xiang Koh
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Colorectal Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Fung Joon Foo
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Colorectal Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Sabrina Ngaserin
- Singhealth Duke-NUS Academic Medical Centre, Singapore; Breast Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Baldwin Po Man Yeung
- Upper Gastrointestinal and Bariatric Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore; Singhealth Duke-NUS Academic Medical Centre, Singapore
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Dong H, Li L, Feng HH, Wang DC. Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci 2023; 16:138-147. [PMID: 37964861 PMCID: PMC10641249 DOI: 10.1016/j.sopen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023] Open
Abstract
Background Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.
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Affiliation(s)
- Hui Dong
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Li Li
- Department of Pediatric Surgery, Zigong First People's Hospital, Zigong 643000, Sichuan, China
| | - Hui-He Feng
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan, China
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Szasz P, Mainprize M, Spencer Netto FAC. Muscular groin hernias: an anatomical variation as a cause of recurrence. Hernia 2023; 27:1483-1489. [PMID: 37480501 DOI: 10.1007/s10029-023-02840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/09/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The objective of this study was to understand our center's experience with the rare entity of muscular groin hernias. Specifically, to determine this hernia's incidence and characteristics and provide valuable information to surgeons that can be utilized at the time of a hernia repair regardless of modality used. METHODS This was a retrospective chart review between 2005 and 2019. Patients who had a primary or recurrent groin hernia operation for an atypically located hernia (other than direct, indirect, or femoral) were included. Descriptive statistics were utilized to present the hernia and patient data as median (interquartile range, range). RESULTS There were 152 patients with 155 muscular hernias identified in primary operations and 41 patients with 41 muscular hernias identified in recurrent operations. In both primary and recurrent groups there were more males, and the males were on average younger with a higher body mass index (BMI) than females. Most muscular hernias were located lateral (76) or lateral/superior (33) to the internal ring with a median distance between 2 and 3 cm (1, 0.3-5; 2.8,2-5) from the internal ring. A concurrent ipsilateral inguinal hernia was found and repaired in 42.3% of left and 46.8% of right sided primary muscular hernia operations. A concurrent ipsilateral inguinal hernia was noted in 5% of left and 14.3% of right sided recurrent muscular operations. In left sided recurrent operations for a muscular hernia, 68.9% had a previous ipsilateral inguinal hernia repair and in right sided recurrent operations, 67.7% had a previous ipsilateral inguinal hernia repair. CONCLUSION This study describes a previously unidentified groin muscular hernia in both primary and recurrent hernia operations as a potential cause of hernia recurrence and identifies muscular hernia locations. This information can be utilized at the time of surgery to identify and subsequently repair these defects, leading to improved patient and hernia outcomes.
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Affiliation(s)
- Peter Szasz
- Department of Surgery, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
| | - Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 7N2, Canada.
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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Dumitrescu V, Tribus LC, Trotea T, Costea DO, Dumitrescu D. Anatomical peculiarities of dissection in the transabdominal preperitoneal procedure for inguinal hernias. J Med Life 2023; 16:948-952. [PMID: 37675161 PMCID: PMC10478660 DOI: 10.25122/jml-2023-0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 09/08/2023] Open
Abstract
Inguinal hernia, a common surgical pathology, has substantial medical, social, and economic implications. Over time, various repair techniques have been explored to optimize outcomes, considering multiple postoperative factors beyond recurrence risk. This article aims to define anatomical and technical aspects impacting the immediate and late postoperative evolution of patients with inguinal hernia. Precise knowledge of anatomical structures and standardized surgical gestures result in the reduction of intraoperative and postoperative complications. Throughout history, the alloplastic procedure has demonstrated superiority over the anatomical approach, reinforcing the potential for ongoing advancements. Correct performance according to well-defined principles improves patients' quality of life after inguinal hernia surgery. These principles encompass the exact knowledge of anatomy, dissection steps, dissection limits, the sequence of dissection, and the prosthetic materials used. We describe our approach, with the laparoscopic method representing over 90% of cases at our clinic, indicating the shift towards minimally invasive techniques and emphasizing adherence to rigorous principles to achieve low perioperative complications.
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Affiliation(s)
- Victor Dumitrescu
- 4 Surgery Department, University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Laura Carina Tribus
- 2 Internal Medicine and Gastroenterology Department, Ilfov County Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tiberiu Trotea
- 4 Surgery Department, University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Dan Dumitrescu
- 4 Surgery Department, University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Tai TE, Bai GH, Shiau CH, Wu JC, Hou WH. Fascia defect closure versus non-closure in minimal invasive direct inguinal hernia mesh repair: a systematic review and meta-analysis of real-world evidence. Hernia 2023; 27:459-469. [PMID: 36576667 DOI: 10.1007/s10029-022-02732-5] [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: 10/09/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Laparoscopic and robotic inguinal hernia mesh repair are both common surgical procedures worldwide. Postoperative hernia recurrence and seroma formation are important concerns. In ventral hernia, primary defect closure in laparoscopic surgery reduces the recurrence rate. However, there is no synthetic evidence of direct inguinal hernia defect closure versus non-closure in minimal invasive surgery. Therefore, this study investigated the efficacy of defect closure in patients undergoing minimal invasive direct inguinal hernia mesh repair. METHODS Eligible studies were identified through a search of PubMed, Embase, Cochrane Library, and CINAHL from their inception until March 2022. Studies examining defect closure in laparoscopic direct inguinal hernia repair were included, and a meta-analysis was performed using the random-effect model. Sensitivity analyses were performed by removing one study at a time. The primary outcomes were hernia recurrence and seroma formation. Acute and chronic postoperative pain, operation time, and length of hospital stay were the secondary outcomes. RESULTS Five nonrandomized studies and one randomized controlled trial were included. Pooled analysis revealed defect closure might reduce the hernia recurrence rate (risk difference, - 0.02; 95% confidence interval [CI] - 0.04 to - 0.00; p = 0.02). The result of seroma formation (odds ratio, 0.49; 95% CI 0.17-1.46; p = 0.20) showed no significant difference. Moreover, no significant differences were observed in acute postoperative pain, chronic pain, length of hospital stay, and operation time. CONCLUSIONS Our study indicated defect closure seems to be an option to reduce the direct inguinal hernia recurrence rate. No significant benefits were shown in seroma formation and other secondary outcomes. Our study was mostly based on nonrandomized studies and underestimated the effect of defect closure; thus, further high-quality studies are required to draw definitive conclusions.
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Affiliation(s)
- Ting-En Tai
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Geng-Hao Bai
- Department of General Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chu-Hsuan Shiau
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan.
- College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Geriatrics and Gerontology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Three-point mesh fixation in robot-assisted transabdominal preperitoneal (R-TAPP) repair of 208 inguinal hernias: preliminary results of a single-center consecutive series. Langenbecks Arch Surg 2022; 407:2555-2561. [PMID: 35581394 DOI: 10.1007/s00423-022-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. METHODS Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3-0 suture. Patients were followed up at 10 and 30 days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. RESULTS Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1 week. Chronic pain (> 3 months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7 months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. CONCLUSIONS The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates.
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Bunkar SK, Verma K, Jhunjhunwala A, Singh A. A Randomized Controlled Clinical Trial of N-Butyl Cyanoacrylate Glue Fixation Versus Tacker Fixation of Mesh in Endoscopic Totally Extraperitoneal Hernia Repair. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03118-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Peitsch WKJ. Modified TAPP is the standard procedure for complex inguinal and femoral hernias: late results and patient satisfaction. Eur Surg 2020. [DOI: 10.1007/s10353-019-00624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc 2020; 34:1458-1464. [PMID: 32076858 DOI: 10.1007/s00464-020-07449-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although laparoscopic inguinal hernia repair was described about 30 years ago and advantages of the technique have been demonstrated, the utilization of this approach has not been what we would expect. Some reasons may be the need for surgeons to understand the posterior anatomy of the groin from a new vantage point, as well as to acquire advanced laparoscopic skills. Recently, however, the introduction of a robotic approach has dramatically increased the adoption of minimally invasive techniques for inguinal hernia repair. METHODS Important recent contributions to this evolution have been the establishment of a new concept known as the critical view of the Myopectineal Orifice (MPO) and the description of a new way of understanding the posterior view of the antomy of the groin (inverted Y and the five triangles). In this paper, we describe 10 rules for a safe MIS inguinal hernia repair (TAPP, TEP, ETEP, RTAPP) that combines these two new concepts in a unique way. CONCLUSIONS As the critical view of safety has made laparoscopic cholecystectomy safer, we feel that following our ten rules based on understanding the anatomy of the posterior groin as defined by zones and essential triangles and the technical steps to achieve the critical view of the MPO will foster the goal of safe MIS hernia repair, no matter which minimally invasive technique is employed.
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Affiliation(s)
- Christiano Claus
- Minimally Invasive Surgery Department, Jacques Perissat Institute, Positivo University, Jeremias Maciel Perretto St, 300, Curitiba, 81210-310, Brazil.
| | | | - Flavio Malcher
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA
| | | | - Edward Felix
- Department of Surgery, Marian Regional Medical Center, Santa Maria, CA, USA
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Sato M, Nozawa M, Watanabe T, Onoda T, Matsuyama A, Shiiya N, Wada H. Insufficiency of prosthetic posterolateral overlap related to recurrence after laparoscopic transabdominal preperitoneal inguinal hernioplasty, as assessed by video review. BMC Surg 2020; 20:27. [PMID: 32041581 PMCID: PMC7011534 DOI: 10.1186/s12893-020-0690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear. METHODS Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored. RESULTS The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period (p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period (p = 0.006). CONCLUSIONS Fully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia.
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Affiliation(s)
- Masanori Sato
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Masashi Nozawa
- Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
| | - Takahiro Watanabe
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.,Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
| | - Takanobu Onoda
- Department of Surgery, Yaizu City Hospital, 1000 Dobara, Yaizu, Shizuoka, Japan
| | - Atsuko Matsuyama
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hidetoshi Wada
- Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
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A 19 year population-based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs. Hernia 2019; 24:793-800. [PMID: 31786699 PMCID: PMC7395908 DOI: 10.1007/s10029-019-02073-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/19/2019] [Indexed: 11/17/2022]
Abstract
Introduction Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Methods This is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure. Results Of 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61–2.08, p < 0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007–1.013, p < 0.001), being more affluent (HR 1.18, 95% CI 1.01–1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22–2.88, p < 0.001). Conclusions LHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.
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Mikhin IV, Polyakov AA, Kosivtsov OA, Ryaskov LA. [Endoscopic surgery and laparoscopy are new insights of evolution of inguinal hernia repair (in Russian only)]. Khirurgiia (Mosk) 2019:121-128. [PMID: 30938367 DOI: 10.17116/hirurgia2019031121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is devoted to general and particular problems of inguinal hernia repair through the analysis of statistical data and comparison of advantages and disadvantages of various methods of inguinal hernia repair. Particular attention is paid to the analysis of current options of mesh implant fixing during endoscopic hernia repair: TAPP, TER, e-TER. Long-term outcomes are essential to determine surgical technique. The authors consider that careful adherence to the basic principles of minimally invasive surgery can reduce the incidence of complications, recurrences and chronic pain syndrome after inguinal hernia repair. The main advantages of current surgical technologies are accelerated rehabilitation, earlier restoration of social activity, improvement of the quality of life.
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Affiliation(s)
- I V Mikhin
- Chair of Surgical Diseases of Pediatric and Dental Faculties, Volgograd State Medical University of Ministry of Health of the Russian Federation, Volgograd, Russia
| | - A A Polyakov
- Chair of Surgical Diseases of Pediatric and Dental Faculties, Volgograd State Medical University of Ministry of Health of the Russian Federation, Volgograd, Russia
| | - O A Kosivtsov
- Chair of Surgical Diseases of Pediatric and Dental Faculties, Volgograd State Medical University of Ministry of Health of the Russian Federation, Volgograd, Russia
| | - L A Ryaskov
- Chair of Surgical Diseases of Pediatric and Dental Faculties, Volgograd State Medical University of Ministry of Health of the Russian Federation, Volgograd, Russia
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Roos MM, van Hessen CV, Verleisdonk EJMM, Clevers GJ, Davids PHP, Voorbrood CEH, Simmermacher RKJ, Burgmans JPJ. An 11-year analysis of reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high volume hernia center. Hernia 2018; 23:655-662. [PMID: 30244345 DOI: 10.1007/s10029-018-1827-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Developments in inguinal hernia surgery have substantially lowered recurrence rates, yet recurrences remain an important outcome parameter of inguinal hernia repair. The aim of this study was to analyze the characteristics of all reoperated groins after endoscopic totally extraperitoneal (TEP) inguinal hernia repair in a high-volume hernia clinic in the Netherlands. METHODS All groins with recurrence-like symptoms reoperated after previous TEP inguinal hernia repair between January 2006 and December 2016 were analyzed. Patient characteristics, imaging findings, primary hernia type, time to recurrence and recurrence type were assessed. RESULTS A total of 137 groins were reoperated in 130 patients. The median age at the TEP procedure was 55 years [interquartile range (IQR) 45-64 years]. Fifty-seven groins were initially part of a bilateral procedure (42%). Median time until recurrence was 9 months (IQR 4-26 months). Reoperation findings were a hernia recurrence in 76%, an isolated lipoma in 18%, and no recurrence or lipoma in 6%. The majority of hernias recurred at their initial site (70%), of which the greatest part involved direct hernias. Isolated lipomas were more frequently seen after indirect hernia repair. CONCLUSIONS Inguinal hernia recurrences were still observed in this high-volume hernia clinic. Recurrences were most frequently seen at their initial hernia site, the majority involving direct hernias. Isolated lipomas presenting as a pseudorecurrence were most frequently seen after correction of indirect hernias. In accordance with the current guidelines, reducing recurrence rates can be achieved by mesh fixation in bilateral, large and direct defects and by thoroughly reducing lipomas.
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Affiliation(s)
- M M Roos
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands.
| | - C V van Hessen
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - E J M M Verleisdonk
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - G J Clevers
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - P H P Davids
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - C E H Voorbrood
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
| | - R K J Simmermacher
- Department of Surgery, University Medial Center Utrecht, Utrecht, The Netherlands
| | - J P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis, Utrecht/Zeist, The Netherlands
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Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2018; 33:418-428. [PMID: 29987564 DOI: 10.1007/s00464-018-6314-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Compared with open herniorrhaphy, laparoscopic herniorrhaphy can yield more favorable clinical outcomes. However, previous studies failed to give definite answer for comparison between laparoscopic inguinal hernia repair approaches. This study aimed to systematically determine the differences in recurrence rate, duration of return to work, pain, surgery duration, and duration of hospital stay between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approach for inguinal hernia. METHODS PubMed, Embase, and Cochrane Library (including the Cochrane Central Register of Controlled Trials) abstracts up to September 2017 were searched for randomized controlled trials (RCTs) comparing TAPP or TEP hernia repairing. The hernia recurrence rate, time to return to work, analgesic consumption, surgery duration, hospital stay, and the pain score were recorded with subgroup analysis of the hernia type. RESULTS Sixteen RCTs that randomized 1519 patients with hernia into TEP and TAPP repair groups were analyzed in this study. The results revealed that TEP repair resulted in shorter hospital stay of primary cases (MD - 0.87, 95% CI - 1.67 to - 0.07) but was associated with a longer operative duration in recurrent hernia group (MD 3.35, 95% CI 0.16 - 6.54). CONCLUSIONS TEP and TAPP have their own advantages. TEP repair reduces short-term postoperative pain more effectively than TAPP repair and results in shorter hospital stay of primary cases. In contrast, TAPP repair is correlated with shorter surgery duration. These findings show that shared decision-making regarding both approaches of laparoscopic hernia repair may be needed.
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Affiliation(s)
- Li-Siou Chen
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chieh Chen
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Chih Wu
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Long-Wen Tsai
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Min-Zhe Liu
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.
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Affiliation(s)
- Jorge Daes
- *Department of Minimally Invasive Surgery, Clinica Portoazul, Barranquilla, Colombia †Department of Surgery, Marian Regional Medical Center, Santa Maria, CA
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Soeta N, Saito T, Ito F, Gotoh M. Preperitoneal Suction Technique to Secure the Proper Mesh Position During Laparoscopic Herniorrhaphy. Surg Laparosc Endosc Percutan Tech 2017; 26:e167-e170. [PMID: 27870783 PMCID: PMC5142360 DOI: 10.1097/sle.0000000000000338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: Dislocation of the mesh is 1 cause of recurrence after laparoscopic inguinal hernia repair (LIHR). Here, we propose a new procedure, the “preperitoneal cavity suction technique,” to confirm mesh position during LIHR under a transabdominal preperitoneal approach (TAPP). Patients and Methods: We developed the “preperitoneal cavity suction technique” during LIHR by TAPP, visualizing the mesh through the closed peritoneum by vacuuming up the carbon dioxide and effusion at the preperitoneal cavity using a suction tube inserted through the tunnel from a laterally placed trocar into the preperitoneal space. We applied this technique in adults with inguinal hernias who were scheduled to undergo elective surgery in our hospital between April 2013 and March 2015. Results: In total, 84 lesions were treated in 74 consecutive LIHRs by TAPP. The “preperitoneal cavity suction technique” was applied to 83 lesions. We confirmed appropriate positioning of the mesh for 82 of the 83 lesions (98.8%), with dislocation of the mesh detected in 1 case. In that case, we reopened the peritoneal flap and repositioned the mesh correctly during the operation. No patients complained of pain or a sense of discomfort, and no hematoma was identified around the dissected area or anterior superior iliac spine on the affected side. Mean duration of hospitalization was 2.5 days. No cases of hernia recurrence were observed during follow-up (range, 7 to 31 mo; median, 15 mo). Conclusions: The “preperitoneal suction technique” seems useful to detect mesh dislocation and has potential to reduce TAPP-related complications.
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Affiliation(s)
- Nobutoshi Soeta
- Departments of *Surgery, Aizu Medical Center ‡Surgery, Fukushima Medical University †Department of Surgery, Iwase General Hospital, Fukushima, Japan
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Niebuhr H, Köckerling F. Surgical risk factors for recurrence in inguinal hernia repair - a review of the literature. Innov Surg Sci 2017; 2:53-59. [PMID: 31579737 PMCID: PMC6754004 DOI: 10.1515/iss-2017-0013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023] Open
Abstract
Despite all the progress made in inguinal hernia surgery driven by the development of meshes and laparoendoscopic operative techniques, the proportion of recurrent inguinal hernias is still from 12% to 13%. Recurrences can present very soon after primary inguinal hernia repair generally because of technical failure. However, they can also develop much later after the primary operation probably due to patient-specific factors. Supported by evidence-based data, this review presents the surgical risk factors for recurrent inguinal hernia after the primary operation. The following factors are implicated here: choice of operative technique and mesh, mesh fixation technique, mesh size, management of medial and lateral hernia sac, sliding hernia, lipoma in the inguinal canal, operating time, type of anesthesia, participation in a register database, femoral hernia, postoperative complications, as well as the center and surgeon volume. If these surgical risk factors are taken into account when performing primary inguinal hernia repair, a good outcome can be expected for the patient. Therefore, they should definitely be observed.
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Affiliation(s)
- Henning Niebuhr
- Hanse-Hernia Center, Alte Holstenstrasse 16, D-21031 Hamburg, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, D-13585 Berlin, Germany
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Dehal A, Woodward B, Johna S, Yamanishi F. Bilateral laparoscopic totally extraperitoneal repair without mesh fixation. JSLS 2016; 18:JSLS-D-13-00297. [PMID: 25392633 PMCID: PMC4154423 DOI: 10.4293/jsls.2014.00297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for inguinal hernia from January 2005 to December 2011. Demographic, operative, and postoperative data were obtained for analysis. Results: A total of 343 patients underwent simultaneous bilateral laparoscopic totally extraperitoneal repair of 686 primary and recurrent inguinal hernias from January 2005 to December 2011. The mean operative time was 33 minutes. One patient was converted to an open approach (0.3%), and 1 patient had intraoperative bladder injury. Postoperative hematoma/seroma occurred in 5 patients (1.5%), wound infection in 1 (0.3%), hematuria in 2 (0.6%), and acute myocardial infarction in 1 (0.3%). Chronic pain developed postoperatively in 9 patients (2.6%); 3 of them underwent re-exploration. All patients were discharged home a few hours after surgery except for 3 patients. Among the 686 hernia repairs, there were a total of 20 recurrences (2.9%) in 18 patients (5.2%). Two patients had bilateral recurrences, whereas 16 had unilateral recurrences. Twelve of the recurrences occurred after 1 year (60%). Fourteen recurrences occurred among direct hernias (70%). Conclusion: Compared with the literature, our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but had a slight increase in recurrence rate.
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Affiliation(s)
- Ahmed Dehal
- Department of General Surgery, Kaiser Permanente, Fontana, California
| | - Brandon Woodward
- Department of General Surgery, Kaiser Permanente, Fontana, California
| | - Samir Johna
- Department of General Surgery, Kaiser Permanente, Fontana, California
| | - Frank Yamanishi
- Department of General Surgery, Kaiser Permanente, Fontana, California
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Physical Characteristics of Medical Textile Prostheses Designed for Hernia Repair: A Comprehensive Analysis of Select Commercial Devices. MATERIALS 2015; 8:8148-8168. [PMID: 28793704 PMCID: PMC5458830 DOI: 10.3390/ma8125453] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 01/25/2023]
Abstract
Inguinal hernia repairs are among the most frequent operations performed worldwide. This study aims to provide further understanding of structural characteristics of hernia prostheses, and better comprehensive evaluation. Weight, porosity, pore size and other physical characteristics were evaluated; warp knitting structures were thoroughly discussed. Two methods referring to ISO 7198:1998, i.e., weight method and area method, were employed to calculate porosity. Porosity ranged from 37.3% to 69.7% measured by the area method, and 81.1% to 89.6% by the weight method. Devices with two-guide bar structures displayed both higher porosity (57.7%–69.7%) and effective porosity (30.8%–60.1%) than single-guide bar structure (37.3%–62.4% and 0%–5.9%, respectively). Filament diameter, stitch density and loop structure combined determined the thickness, weight and characteristics of pores. They must be well designed to avoid zero effective porosity regarding a single-bar structure. The area method was more effective in characterizing flat sheet meshes while the weight method was perhaps more accurate in describing stereoscopic void space for 3D structure devices. This article will give instructive clues for engineers to improve mesh structures, and better understanding of warp knitting meshes for surgeons.
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Chandra P, Phalgune D, Shah S. Comparison of the Clinical Outcome and Complications in Laparoscopic Hernia Repair of Inguinal Hernia With Mesh Fixation Using Fibrin Glue vs Tacker. Indian J Surg 2015; 78:464-470. [PMID: 28100943 DOI: 10.1007/s12262-015-1410-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/12/2015] [Indexed: 02/04/2023] Open
Abstract
Although laparoscopic repair offers a quick and less morbid way of treating hernias, complications like hematoma, seroma, neuralgia, recurrence, mesh infection, hydrocele, etc. are known. The present study was undertaken to compare various clinical outcomes between mesh fixation using fibrin glue and mesh fixation with tacker in a 3-months follow-up. One hundred patients aged 18 to 60 years having inguinal hernia admitted in Poona Hospital and Research Centre, Pune, between October 2012 and November 2014 for laparoscopic hernia surgery and ready to participate in this study were included. All of them underwent laparoscopic repair of hernia by total extra peritoneal (TEP) method following sample surgical protocol in all of them except for method of mesh fixation. Mean time calculated from insertion of the first trocar to beginning of skin suturing was 54.9 min in tacker group and 50.3 min in fibrin glue group with no statistically significant difference between the two. The incidence of urinary retention was significantly higher in tacker (34 %) as compared to fibrin glue (12 %) group. Incidence of hematoma was significantly higher in tacker group in 15-day follow-up, but there was no significant difference in hematoma formation at hernial sites in both groups after 15 days of follow-up. The incidence of neuralgia was significantly higher in the tacker group (24 %) compared with the fibrin glue group (2 %). Significantly, more number of people in the fibrin glue group 68 and 90 %, respectively, returned to work during 15 and 30 days follow-up as compared to the tacker group 46 and 64 %. Fibrin glue can be considered as an alternative to tacker for mesh fixation.
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Gardiner A, Drummond R, Stevenson R, Wright E, McIlveen E, Couves A, Oliphant R. Re: Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surg 2015; 211:305-6. [PMID: 26362200 DOI: 10.1016/j.amjsurg.2015.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Amy Gardiner
- Royal Alexandra Hospital, Department of General Surgery, Paisley, Scotland, UK
| | - Robert Drummond
- Glasgow Royal Infirmary, Department of General Surgery, Glasgow, Scotland, UK
| | - Richard Stevenson
- Queen Elizabeth University Hospital, Department of Surgery, Glasgow, Scotland, UK
| | - Emma Wright
- Royal Alexandra Hospital, Department of General Surgery, Paisley, Scotland, UK
| | - Erin McIlveen
- West of Scotland Surgical Training Scheme, Glasgow, Scotland, UK
| | - Adam Couves
- West of Scotland Surgical Training Scheme, Glasgow, Scotland, UK
| | - Raymond Oliphant
- Glasgow Royal Infirmary, Department of General Surgery, Glasgow, Scotland, UK
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Lamoshi AY, Hobbs GR, Khan FJ. Factors affecting hernia recurrence after Strattice mesh repair: A retrospective study. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abdulraouf Y. Lamoshi
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
| | - Gerry R. Hobbs
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
| | - Fawad J. Khan
- Department of General Surgery; West Virginia University; Morgantown West Virginia USA
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Agresta F, Torchiaro M, Tordin C. Laparoscopic transabdominal inguinal hernia repair in community hospital settings: a general surgeon's last 10 years experience. Hernia 2014; 18:745-50. [PMID: 24760165 DOI: 10.1007/s10029-014-1251-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/06/2014] [Indexed: 12/01/2022]
Abstract
UNLABELLED Numerous studies have documented the laparoscopic TransAbdominal Pre-Peritoneal (TAPP) approach as an excellent choice for inguinal hernia repair, especially with an experienced surgeon. A cohort population of patients who underwent TAPP laparoscopic surgery for inguinal hernias over the last 10 years, with follow-up, were evaluated, focusing on the feasibility, safety and benefits of this procedure in a community hospital setting. MATERIALS AND METHODS A total of 533 patients underwent TAPP for inguinal hernias between January 2003 and March 2013 in two community hospitals in the Northeast of Italy-"Civil Hospital" in Vittorio Veneto (TV) and "Civil Hospital" in Adria (RO). RESULTS The total number of hernias treated was 1,000. The overall mean operative time was 43.50 min (±13.2). All but three of the procedures were done on a day surgery basis. There were no conversions to open repair or deaths in our series. We had two cases of small bowel obstruction and eight relapses (0.8 %) in our series. The mean follow-up was 59.4 months (±5.6; range 3-120). No patients reported severe pain at 10 days, 21 patients (3.9 %) reported mild pain at 3-month follow-up. Over 90 % of the patients had a return of physical work capacity within 2 weeks, the remaining within 30 days. All patients were completely satisfied (numerical rating scale 10/10) 3 months after the operation. CONCLUSIONS The analysis of the short- and long-term post-operative outcomes of our experience enabled us to conclude that in an appropriate setting, TAPP is feasible, effective, safe and beneficial for patients. It should be incorporated into general surgeons' expertise and selectively used for the management of patients with hernias, as long as adequate training is obtained and appropriate preparation performed.
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Affiliation(s)
- F Agresta
- Department of General Surgery, Ulss1 9 del Veneto, Ospedale Civile, Piazzale Etruschi 9, 45011, Adria (TV), Italy,
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Gopal SV, Warrier A. Recurrence after groin hernia repair-revisited. Int J Surg 2013; 11:374-7. [PMID: 23557981 DOI: 10.1016/j.ijsu.2013.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/20/2013] [Accepted: 03/23/2013] [Indexed: 10/27/2022]
Abstract
One of the commonly performed operations all over the world is hernia repair. Various open and laparoscopic procedures are available now for hernia repair. They are judged mainly by the recurrence rate following operation. The recognition of the causes of recurrence makes their prevention/elimination possible. Articles on hernia recurrence published in various journals over the past 40 years have been analysed. This review article mainly focuses on the causes of recurrence of hernia and their prevention. The causes of recurrence following open and laparoscopic hernia repair have been analysed. In open repair, early recurrences are due to faults in operative technique and postoperative infection. Late recurrences are due to patient factors like collagen defects, age and medical morbidities. In laparoscopic repair, technical aspects of surgery like dissection, mesh placement and fixation are the important factors which decide hernia recurrence.
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Affiliation(s)
- Sri Vengadesh Gopal
- Department of General Surgery, Coffs Harbour Hospital, Coffs Harbour, NSW 2450, Australia.
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