A comparison of the oxidative stress response in single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair

Meta‑analysis of single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair

Whether single-incision laparoscopic totally extraperitoneal (SIL-TEP) inguinal hernia repair is similar or superior to multi-trocar laparoscopic totally extraperitoneal (MTL-TEP) inguinal hernia repair is controversial. We conducted this meta-analysis to compare the safety, efficacy and cosmetic effect of the two surgical methods. We systematically searched the Cochrane Library, Embase database and PubMed database for published studies on SIL-TEP and MTL-TEP inguinal hernia repair. The studies were screened and evaluated for quality according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for meta-analysis. Twenty studies were included, including 7 randomized controlled studies and 13 nonrandomized controlled studies. Meta-analysis revealed no significant difference between SIL-TEP and MTL-TEP inguinal hernia repair in terms of unilateral operation time (P = 0.12), bilateral operation time (P = 0.72), pain score on the first day after operation (P = 0.61], chronic pain rate (P = 0.61), total complication rate (P = 0.26), hospital stay (P = 0.72), and recurrence rate (P = 0.83), but the cosmetic effect score (P = 0.002) was higher in the former. These findings demonstrate that SIL-TEP inguinal hernia repair is safe, reliable and feasible. In addition, it can result in a better cosmetic effect of the incision than MTL-TEP inguinal hernia repair. SIL-TEP inguinal hernia repair should be considered for patients with stricter cosmetic requirements.Clinical trial registration: INPLASY2022110085.

Application of Quantitative Assessment Strategy-Based Nursing Combined with Empathic Nursing in Patients Undergoing Tension-Free Inguinal Herniorrhaphy

Objective

This study aimed to explore the application of quantitative assessment strategy-based nursing combined with empathic nursing in patients undergoing tension-free inguinal herniorrhaphy.

Methods

82 patients who underwent tension-free inguinal herniorrhaphy in our hospital from May 2020 to December 2021 were enrolled. According to the random number table method, they were divided into three groups (A, B, and C). Patients in group A received quantitative assessment strategy-based nursing combined with empathic nursing, and group B received quantitative assessment strategy-based nursing. Group C received a routine intervention. The early recovery of the three groups was observed. Heart rate (HR), oxygen saturation (SpO2), and blood pressure (BP) were recorded before entering the operating room and at the beginning of anesthesia. Mental Health Continuum-Short Form (MHC-SF, adult version) was used to assess the psychological status. The Modified Barthel Index (MBI) score of three groups at different time points was recorded. The complications of the three groups were observed.

Results

Compared with group C, wound healing time, ambulation time, hospital stay time, and time to resume daily activities in groups A and B were significantly shorter (all P < 0.05). At the beginning of anesthesia, HR and BP levels in the three groups were all decreased, with HR and BP levels in group A lower than those in group C and HR levels in group B lower than those in group C (all P < 0.05). After the intervention, the scores of emotional well-being, psychological well-being, and social well-being in groups A and B were higher than those in group C and the scores of psychological well-being and social well-being in group A were higher than those in group B (all P < 0.05). The daily living ability score of group A was higher than that of groups B and group C at discharge, one month after discharge, and three months after discharge, and the daily living ability score of group B was higher than that of group C at these three time points (all P < 0.05). No significant differences were observed in the incidence of complication rate among the three groups (10.71%, 14.81%, and 29.63%) (χ 2 = 3.616, all P > 0.05).

Conclusion

Quantitative evaluation strategy-based nursing combined with empathic nursing can effectively improve the early recovery of patients undergoing tension-free inguinal herniorrhaphy, reduce their stress response, and improve their mental health and daily living ability.

The Effect of Internal Mesh Fixation and External Fixation (Inguinal Hernia Truss) on Postoperative Complications in Patients with Inguinal Hernia Undergoing Totally Extraperitoneal Laparoscopic Hernioplasty

Background

The present study evaluated the effect of internal mesh fixation and external fixation (inguinal hernia truss) on postoperative complications in patients with inguinal hernia.

Materials and Methods

This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the external fixation for 6 weeks immediately after the surgery.

Results

The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6.4%, 19.4%, and 3.2% in Group A and 3.3%, 13.3%, and 3.3% in Group B (P > 0.05). Moreover, patients' pain scores 1 week and 1 month after the surgery in Group B were significantly lower than those of Group A (P < 0.05). However, the mean pain score of patients was not different between the two groups 3 and 6 months after the surgery (P > 0.05). Furthermore, the duration of return to work in Group B with an average of 8.07 ± 3.09 days was less than that of Group A with the average of 9.65 ± 5.34 days (P > 0.05).

Conclusion

The mentioned findings can trigger the use of external fixation and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true.

Totally extraperitoneal inguinal hernia repair in patients with hemophilia and von Willebrand disease. Prospective controlled study

Introduction

Laparoscopic surgery is associated with several advantages. Surgical procedures in hemophilia or von Willebrand patients without replacement therapy (RT) to correct clotting factor deficiency may result in serious, life-threatening hemorrhagic episodes. Clotting factor concentrates improve hemostatic control but bleeding risk in major invasive procedures remains high.

Aim

Evaluation of totally extraperitoneal inguinal hernia repair (TEP-IHR) in patients with congenital hemorrhagic disorders (H) and comparison with results for non-hemophiliacs (NH) with regard to bleeding, postoperative pain, hernia recurrence, surgery time, demand for painkillers, hospital stay and recovery time.

Material and methods

The prospective controlled trial included 67 consecutive male patients scheduled for TEP-IHR between January 2010 and December 2018. Surgery was performed in groups H (n = 22) and NH (n = 45). Full study inclusion criteria were met by 65 patients (22 and 43 in H and NH groups respectively). Follow-up was carried out on the 1^st, 2^nd, and 7^th day and in the 1st and 3rd month postoperatively.

Results

TEP-IHR was successful for all patients. No life-threatening bleeding occurred and no patient required red blood cell transfusions or reoperation. No hernia recurrence was reported. No statistically significant differences were observed between the groups with regard to surgery duration, postoperative hematoma frequency and demand for painkillers. In the H group, pain intensity was significantly higher during the first postoperative month and hospitalization and recovery were significantly longer.

Conclusions

TEP-IHR in hemophiliacs with RT is feasible and as effective for preventing hernia recurrence as in NH-patients. In hemophiliacs risk of bleeding complications and demand for painkillers are comparable to non-hemophiliacs although pain is more intense.

Effects of different anesthetic methods on immune function and oxidative stress in patients undergoing laparoscopic herniorrhaphy

Introduction

The influence of anesthetic method on the immune function and oxidative stress in patients receiving laparoscopic herniorrhaphy remains largely unknown.

Aim

To assess the effects of different anesthetic methods on the immune function and oxidative stress in patients undergoing laparoscopic herniorrhaphy.

Material and methods

A total of 280 eligible patients were randomly divided into two groups to receive total intravenous anesthesia (TIVA group) and inhalation anesthesia (IA group). T lymphocyte subsets, oxidative stress response indices and inflammatory factor levels were measured before anesthesia, at the end of the operation, and 1 and 3 days after the operation. The incidence rates of adverse reactions were compared.

Results

At the end of and 1 day after the operation, CD3⁺ and CD4⁺ T cells and CD4⁺/CD8⁺ decreased in both groups compared with those before anesthesia (p < 0.05). Three days after the operation, CD3⁺ and CD4⁺ T cells decreased in both groups compared with those before anesthesia, which were higher in the TIVA group (p < 0.05). Interleukin-6 and C-reactive protein levels were significantly lower in the TIVA group (p < 0.05). At the end of and 1 and 3 days after the operation, oxidative stress response indices superoxide dismutase, catalase and glutathione peroxidase declined in both groups compared with those before anesthesia, which were higher in the IA group (p < 0.05). The incidence rate of adverse reactions was significantly higher in the IA group (p = 0.002).

Conclusions

Compared with IA, TIVA has less effect on the immune function and oxidative stress of patients undergoing laparoscopic herniorrhaphy, and controls the inflammatory response more effectively, accompanied by a lower incidence rate of adverse reactions.