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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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Li J, Shao X, Cheng T. Comparison of Different Weight Meshes in Ventral/Incisional Hernia Repair, the Outcomes of Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:402-410. [PMID: 37311039 DOI: 10.1097/sle.0000000000001191] [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: 12/23/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The use of mesh is not without complications. Decreasing the mesh weight with the light-weight (LW) mesh may improve tissue growth and diminish mesh-related complications, yet, clinically, there are conflicting results regarding the influence of different weight meshes in ventral/incisional hernia repair. The aim of the present study is to compare the outcomes of different weight meshes for ventral/incisional hernia repair. METHODS The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies were published through January 1, 2022, using the keywords "heavy weight" "light weight" "mesh" "ventral hernia" "incisional hernia". All relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS Eight trials (4 randomized controlled trials, 3 prospective studies, and 1 retrospective study) containing 1844 patients were included in the present meta-analysis. The pooled results showed that there was a significantly more rate of foreign body perception in the heavy-weight mesh group compared with the LW mesh group (odds ratio = 5.02, 95% CI: 1.05, 24.06). There was no significant difference concerning hernia recurrence, seroma, hematoma, surgical site infection, reoperation rate, chronic pain, quality of life, and hospital stay among different weight mesh groups. CONCLUSION Different weight meshes showed similar clinical results in ventral/incisional hernia repair, except that, perception of foreign body was reported more frequently in the heavy-weight mesh group as compared with the LW mesh group. However, the long-term hernia recurrence with different weights of meshes needs to be reevaluated considering the relative short-term follow-up in these studies.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
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Sinha MK, Barman A, Tripathy PR, Shettar A. Nerve identification in open inguinal hernioplasty: A meta-analysis. Turk J Surg 2022; 38:315-326. [PMID: 36875277 PMCID: PMC9979557 DOI: 10.47717/turkjsurg.2022.5882] [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: 08/25/2022] [Accepted: 11/26/2022] [Indexed: 01/11/2023]
Abstract
Objectives In open inguinal hernioplasty, three inguinal nerves are encountered in the surgical field. It is advisable to identify these nerves as careful dissection reduces the chances of debilitating post-operative inguinodynia. Recognizing nerves during surgery can be challenging. Limited surgical studies have reported on the identification rates of all nerves. This study aimed to calculate the pooled prevalence of each nerve from these studies. Material and Methods We searched PubMed, CENTRAL, CINAHL, ClinicalTrials.gov and Research Square. We selected articles that reported on the prevalence of all three nerves during surgery. A meta-analysis was performed on the data from eight studies. IVhet model from the software MetaXL was used for preparing the forest plot. Subgroup analysis was performed to understand the cause of heterogeneity. Results The pooled prevalence rates for Ilioinguinal nerve (IIN), Iliohypogastric nerve (IHN), and genital branch of genitofemoral nerve (GB) were 84% (95% CI 67-97%), 71% (95% CI 51-89%) and 53% (95% CI 31-74%), respectively. On subgroup analysis, the identification rates were higher in single centre studies and studies with a single primary objective as nerve identification. The heterogeneity was significant in all pooled values, excluding the subgroup analysis of IHN identification rates in single-centre studies. Conclusion The pooled values indicate low identification rates for IHN and GB. Significant heterogeneity and large confidence intervals reduce the importance of these values as quality standards. Better results are observed in single-centre studies and studies which are focused on nerve identification.
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Affiliation(s)
- Mithilesh Kumar Sinha
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Ankit Shettar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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Liu J, Bittner R, Shen Y, Chen J. Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case. Surg Endosc 2022; 37:2712-2718. [PMID: 36451041 DOI: 10.1007/s00464-022-09759-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. METHODS Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. RESULTS A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0 days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0 days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). CONCLUSIONS Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Reinhard Bittner
- Director of the Surgical Clinic, Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China.
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Li B, Shi S, Qin C, Yu J, Gong D, Nie X, Miao J, Lai Z, Cui W, Li G. Internal Ring Defect Closure Technique in Laparoscopic Mesh Hernioplasty for Indirect Inguinal Hernia. Front Surg 2022; 9:794420. [PMID: 35198596 PMCID: PMC8858848 DOI: 10.3389/fsurg.2022.794420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The best way to reduce seroma formation after laparoscopic indirect hernia repair is debated. We noticed that internal ring defect closure in laparoscopic mesh hernioplasty could provide promising outcomes with an effect on diminishing seroma formation. We introduce our closure technique and report our experience. Methods This prospective study was conducted from May 2019 to May 2021. Patients with European Hernia Society classification L3 indirect or scrotal hernia were recruited and underwent laparoscopic transabdominal patch plasty (TAPP). Hernia defect closure was performed before mesh deployment. The primary outcomes were seroma formation, postoperative pain, and hernia recurrence. Perioperative data and postoperative complications were also recorded. Results Consecutive 77 patients with 89 indirect hernias (including 51 scrotal hernias) were recruited in two regional tertiary hospitals. All operations were successful without open conversion. The mean size of the hernia defect was 3.7 ± 0.5 cm (range, 2.5–5.0 cm). The mean operative time for each hernia repair (peritoneum to peritoneum) was 48.3 ± 10.8 min (range, 33–72 min), and the mean time required for internal ring closure was 6.7 ± 2.2 min (range, 4–10 min). Intraoperative bleeding was minimal. The mean visual analog scale pain score at rest on the first postoperative day was 2.2 (range, 1–4). The average postoperative length of hospital stay was 18 h (range, 14–46 h). During a mean follow-up period of 9.4 months (range, 3–23 months), no hernia recurrence or chronic pain were noted. Seroma formation was detected on six sides of unilateral hernias (6.7%) on postoperative day 7, with a mean volume of 45.8 ml (range, 24–80 ml). All seromas were mild and resolved spontaneously within 3 months, with no need for evacuation or other treatment and without major impact on the final outcome. Conclusions Defect closure in laparoscopic mesh hernioplasty for large indirect hernias is safe and feasible and can significantly reduce postoperative seroma formation and relative complications. This approach is recommended in large indirect or scrotal hernia repair.
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Affiliation(s)
- Binggen Li
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shange Shi
- Department of General Surgery, Pengpai Memorial Hospital, Shanwei, China
| | - Changfu Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiwei Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Duhui Gong
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Xiangyang Nie
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Jinchao Miao
- Department of General Surgery, Pengpai Memorial Hospital, Shanwei, China
| | - Zeru Lai
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Wenbo Cui
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Guoxin Li
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Zhou Z, Yan L, Li Y, Zhou J, Ma Y, Tong C. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance. Surg Radiol Anat 2022; 44:1531-1543. [PMID: 36404360 PMCID: PMC9734211 DOI: 10.1007/s00276-022-03046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. METHODS Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. RESULTS Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. CONCLUSIONS We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.
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Affiliation(s)
- Zheqi Zhou
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China ,grid.440747.40000 0001 0473 0092Yan’an University, Yan’an, China
| | - Likun Yan
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Yi Li
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Jinsong Zhou
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Yanbing Ma
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Cong Tong
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
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Li J, Xu Y, Shao X, Ji Z. Femoral nerve injury following transabdominal preperitoneal inguinal hernia repair: A case report. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2022. [DOI: 10.4103/ijawhs.ijawhs_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Alius C, Balalau C, Dumitrescu D, Gradinaru S. Essentials of surgical anatomy and technique in TAPP repair of inguinal hernia. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/3.2/66.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic hernia repair has opened a new era in hernia surgery shifting paradigms from anterior to posterior approaches. This has exposed surgeons to new anatomical perspectives, technical challenges and clinical implications all of which preventing the technique from becoming ubiquitous despite numerous advantages, limited contraindications and low recurrence rates. In order to address the difficult learning curve of the laparoscopic transabdominal preperitoneal hernia repair this paper presents the experience and points of view from a tertiary surgical department on the systematization of anatomical concepts pertinent to the TAPP repair technique, a decalogue of suggestions related to the surgical technique and a short reminder of the most common complications and how to avoid them. Revising the anatomy essentials and proposing a decalogue of the surgical technique and a memento on the most common complications will provide young surgeons with a scaffold of basic knowledge on TAPP hernia repair.
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