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Zhao F, Liu M, Chen J, Jin C, Chen F, Cao J, Liu Y. Clinical effects of prosthetic mesh in the treatment of incarcerated groin hernias. MINERVA CHIR 2018; 74:458-464. [PMID: 30334396 DOI: 10.23736/s0026-4733.18.07824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Incarcerated groin hernias are a common presentation as surgical emergencies. Other surgical treatment modalities are becoming more widely accepted including the use of prosthetic mesh and laparoscopy for assessment of hernia content viability and for repair. The aim of this study was to report our current experience with the use of prosthetic mesh in the treatment of incarcerated hernias and to compare the effects of different operative approaches. METHODS This retrospective study included 219 consecutive patients who underwent herniorrhaphy for incarcerated hernia between January 2013 and December 2017 in Beijing Chao-Yang Hospital. Twenty patients who were not used mesh were excluded. Patients who died in the postoperative period due to systemic complications, as well as those who were lost during the follow-up period, were excluded from the study. Demographics, surgical details, short term and long-term outcomes were collected. Mann-Whitney U-test and χ2 test were used for statistical analysis. RESULTS A total of 156 patients (78.4%) presented with inguinal hernias, 42 with femoral hernia (21.1%), and one with mixed hernia (0.5%), respectively. Mesh was placed in 199 patients (100%), including 15 patients with concomitant bowel resection. Four patients (2.0%) developed surgical site infections (SSI), four patients (2.0%) had foreign body sensation, one patient (0.5%) had hernia recurrence, two patients (1.0%) had chronic pain, 22 patients (11.1%) had seroma, and the mortality was 2.0%. No significant difference was noted concerning the development of surgical site infection, postoperative recurrence, chronic pain, foreign body sensation, and mortality rates between the transabdominal preperitoneal (TAPP) repair and open mesh repair. There was statistically significant difference in the postoperative incidence of seroma between two groups (12 of 49 [24.5%] vs. 10 of 150 [6.7%]; P=0.001). CONCLUSIONS Our experience demonstrates that acutely incarcerated or strangulated groin hernia in adults is a serious neglected problem. The use of mesh could become current practice even in case of bowel resection. There was no statistically significant difference in the postoperative complications between TAPP repair and open mesh repairs except seroma.
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Affiliation(s)
- Fenglin Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Min Liu
- The Third Clinical Medical School of Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China -
| | - Cuihong Jin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fuqiang Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Kosturakis AK, LaRusso KE, Carroll ND, Nicholl MB. First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital. J Robot Surg 2018; 12:699-704. [PMID: 29721702 DOI: 10.1007/s11701-018-0812-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
Abstract
The utilization of robotics in general surgery has increased significantly including usage in the Veterans Affairs (VA) system. We implemented a robotic inguinal hernia repair (RIHR) program in our VA hospital and report on initial experience with safety and outcomes. The first 100 consecutive RIHR at a VA hospital were reviewed and compared against the results of contemporaneous open inguinal hernia repair (OIHR). Data were collected for operative characteristics, surgical complications and pain related outcomes. Overall, operative times for OIHR were less than RIHR (83.7 vs. 109.7 min, p < 0.0001); however, there was no difference in operative time for bilateral repairs (121.5 vs. 121.9 min, p = ns). Complication rates were similar between the groups. RIHR patients had less pain at POD 1 than OIHR patients (p = 0.05). RIHR were less likely to have multiple post-op visits for pain than OIHR patients (p = 0.003). RIHR can be implemented in the VA system with acceptable surgical outcomes. RIHR may be associated with less post-operative pain in the early post-operative period.
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Affiliation(s)
| | | | - Nels D Carroll
- Department of Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Michael B Nicholl
- Department of Surgery, UT Health San Antonio, San Antonio, TX, USA. .,South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.
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Voorbrood CEH, Burgmans JPJ, Clevers GJ, Davids PHP, Verleisdonk EJMM, Schouten N, van Dalen T. One-stop endoscopic hernia surgery: efficient and satisfactory. Hernia 2013; 19:395-400. [PMID: 23949548 DOI: 10.1007/s10029-013-1151-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND One-stop surgery offers patients diagnostic work-up and subsequent surgical treatment on the same day. In the present study, patient satisfaction and efficiency from an institutional perspective were evaluated in patients who were referred for one-stop endoscopic inguinal hernia repair. METHOD In a high-volume inguinal hernia clinic, all consecutive patients referred for one-stop surgical treatment, were registered prospectively. An instructed secretary screened patients for eligibility for the one-stop option when the appointment was made. Totally extraperitoneal hernia repair under general anaesthesia was the preferred operative technique. Patient's satisfaction, successful day surgery and institutional efficiency were evaluated. RESULTS Between January 2010 and January 2012 a total of 349 patients (17 % of all patients in the hernia clinic) were referred for one-stop hernia repair. Mean age was 47.5 years and 96.3 % were males. Three hundred thirty-six patients underwent hernia surgery on the same day (96.3 %). In thirteen patients (3.7 %) no operative repair was done on the day of presentation due to an incorrect diagnosis (n = 7), a watchful waiting policy for asymptomatic hernia (n = 3), rescheduling due to a large scrotal hernia, and there were two "no shows". Following hernia repair 97 % of the patients were discharged on the same day, while ten patients required hospitalization. Based on the questionnaires the main satisfaction score among patients was 9.0 (8.89-9.17 95 % CI) on a scale ranging from 0 to 10. CONCLUSION One-stop hernia surgery is feasible and satisfactory from an institutional as well as from a patient's perspective.
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Affiliation(s)
- C E H Voorbrood
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands,
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Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc 2012; 27:789-94. [DOI: 10.1007/s00464-012-2512-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 07/05/2012] [Indexed: 10/27/2022]
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Choi YY, Kim Z, Hur KY. Swelling after laparoscopic total extraperitoneal repair of inguinal hernias: review of one surgeon's experience in 1,065 cases. World J Surg 2011; 35:43-6. [PMID: 21042911 DOI: 10.1007/s00268-010-0843-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND It is often difficult to assess the clinical significance of scrotal or operative site swelling after a laparoscopic total extraperitoneal (TEP) repair of an inguinal hernia. Specifically, surgeons are often faced with the dilemma of determining whether such a swelling is a recurrent hernia or just a swelling only. MATERIALS AND METHODS A total of 1,065 laparoscopic TEP inguinal hernia repairs were performed on 944 patients by a single surgeon between December 2000 and December 2008, and we reviewed these data. RESULTS The overall incidence of swelling formation was 6.5% (70 of 1,065 cases). Swellings were more frequent in males, and in association with the following diagnoses: indirect inguinal hernias, larger hernia defects, scrotal hernias, omental incarcerations, and the presence of residual distal sacs. Fifty-eight (83%) of 70 patients who had swelling after laparoscopic TEP did not need any intervention for swelling and the swelling resolved spontaneously. CONCLUSIONS Although postoperative swellings are a common complication after laparoscopic TEP repairs of inguinal hernias, swellings are minor complications, are not associated with hernia recurrence, and generally subside spontaneously.
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Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, 140-743, Korea
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Technical Tips Following More Than 2000 Transabdominal Preperitoneal (TAPP) Repair of the Groin Hernia. Surg Laparosc Endosc Percutan Tech 2010; 20:384-8. [DOI: 10.1097/sle.0b013e3182006845] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sigmoid colon fistula following totally extraperitoneal hernioplasty: an improper treatment for mesh infection or iatrogenic injury? Hernia 2010; 14:655-8. [PMID: 20617450 DOI: 10.1007/s10029-010-0700-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are only a few reports of severe mesh-related complications, and major bowel complications after totally extraperitoneal (TEP) hernioplasty are also rare. CASE REPORT A 75-year-old male patient, who had undergone TEP hernioplasty for a left inguinal hernia 2 months previously, presented with a left inguinal swelling that was found to be due to sigmoid colon-related mesh complications following TEP hernioplasty. CONCLUSIONS Infection is an accepted complication of hernia operation; however, it may be more serious following laparoscopic techniques. Successful TEP hernioplasty requires adequate dissection and complete exposure and coverage of all potential sites that cause inguinal hernia. If infection and suppuration are resistant to conservative methods or occur in the early postoperative period, aggressive imaging study and treatment provides definitive treatment and reduces the burden of complications.
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Ozmen M, Zulfikaroglu B, Ozalp N, Moran M, Soydinc P, Ziraman I. Femoral vessel blood flow dynamics following totally extraperitoneal vs Stoppa procedure in bilateral inguinal hernias. Am J Surg 2010; 199:741-5. [DOI: 10.1016/j.amjsurg.2009.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 03/18/2009] [Accepted: 03/18/2009] [Indexed: 11/26/2022]
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Preperitoneal herniation and bowel obstruction post laparoscopic inguinal hernia repair: case report and review of the literature. Hernia 2008; 12:535-7. [PMID: 18264661 DOI: 10.1007/s10029-008-0341-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 01/11/2008] [Indexed: 01/10/2023]
Abstract
Laparoscopic inguinal hernia repairs, both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP), are associated with peritoneal defects or tears. Nonclosure of the tears can lead to bowel obstruction. I present a case of an early (48 h) bowel obstruction related to a peritoneal defect post TAPP inguinal hernia repair. The literature on peritoneal closure and bowel obstruction related to laparoscopic inguinal hernia repair is reviewed as well as options for repairing defects.
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Massaron S, Bona S, Fumagalli U, Valente P, Rosati R. Long-term sequelae after 1,311 primary inguinal hernia repairs. Hernia 2007; 12:57-63. [PMID: 17851727 DOI: 10.1007/s10029-007-0277-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 08/02/2007] [Indexed: 01/18/2023]
Abstract
BACKGROUND Aim of this study was to analyze long-term sequelae, risk factors, and satisfaction after inguinal hernia primary repair. METHODS A postal questionnaire was mailed to all patients operated between January 1997 and December 2004 for inguinal hernia repair. Patients who had a lump in the groin and patients who experienced chronic problems were invited for a physical examination. Patients who reported having chronic pain were asked to fill out the short-form McGill Pain Questionnaire (SF-MPQ). RESULTS Chronic pain was present in 18.1% of cases. The strongest risk factors were presence of recurrence, use of heavyweight mesh, and age younger than 66 years. By means of the SF-MPQ, we found that the pain reported by most patients was sensory-discriminative in quality, with "tender" and "aching" being the most common descriptors used. About 71.3% of replies used descriptors typical of nociceptive pain, 8.9% of neuropathic pain, and 19.8% of nociceptive plus neuropathic. Chronic pain was severe in 2.1% of patients and interfered with normal activities, work, and exercise. The cumulative recurrence rate was 2.1%. There was a strong correlation between lump and recurrence. Patients declared themselves satisfied with the result of the operation in 93.1% of cases. Due to chronic pain, 6.5% of patients were unsatisfied. CONCLUSIONS This study demonstrates that the main problem after inguinal hernia repair remains chronic pain, which was the primary reason of dissatisfaction. The SF-MPQ is feasible and easy to administer to all patients and provides important information about qualitative features of the pain.
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Affiliation(s)
- S Massaron
- General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Via Manzoni, 56, Rozzano, Milan 20089, Italy.
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Kalliomäki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain 2007; 12:214-25. [PMID: 17606392 DOI: 10.1016/j.ejpain.2007.05.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/16/2007] [Accepted: 05/16/2007] [Indexed: 12/14/2022]
Abstract
In the Swedish Hernia Register 2834 inguinal hernia repairs in 2583 patients were registered in the county of Uppsala 1998-2004. In May 2005 the 2421 patients still alive were requested by mail to fill in a validated questionnaire concerning postherniorrhaphy pain. The final response rate became 72%. Altogether 519 patients (29%) stated that they had pain in the operated groin to some extent during past week. In 98 patients (6%) the pain interfered with daily activities. Factors associated with an increased risk of residual pain in a multivariate logistic regression analysis were age below median, operation for recurrence, open repair technique, history of preoperative pain, and less than three years from surgery. Factors not associated with occurrence of residual pain were gender, method of anaesthesia during surgery, hernia sac diameter, postoperative complications, hernia type, need for emergency operation, reducibility of the hernia sac and complete dissection of the hernia sac. Factors found to be associated with impairment of function due to pain in a multivariate logistic regression analysis were: age below median, female gender, medial hernia, open repair technique, postoperative complications, need for operation for recurrence, presence of preoperative pain and less than three years from surgery. The possibility of long-term pain as an outcome after hernia operations should be taken into consideration in the decision making prior to operation.
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Singhal T, Balakrishnan S, Grandy-Smith S, El-Hasani S. Consolidated five-year experience with laparoscopic inguinal hernia repair. Surgeon 2007; 5:137-40, 142. [PMID: 17575666 DOI: 10.1016/s1479-666x(07)80040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION After the introduction of laparoscopic hernia repair to the National Health Service (NHS), we studied the benefits and practicality of carrying out this specialised hernia repair technique in a District General NHS hospital. METHODS Patients with groin hernia were stratified into groups for day-surgery or inpatient care based on Trust guidelines. Patients underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair by a single consultant surgeon. Patients were followed-up in the clinic. All data were collected prospectively on a structured proforma. Postal questionnaire was sent to 100 randomly selected patients who had surgery more than two years ago and responses were evaluated. RESULTS A total of 830 hernias were operated upon in 572 patients, aged between 16 and 89 years. Three hundred and twelve patients had the operation as a day-case procedure, and the remaining 260 were treated as inpatients. Incidental hernias were discovered in 19.1% of patients, and were treated simultaneously. CONCLUSION The laparoscopic tension-free TAPP method of hernia repair, as done here, is cost-effective and efficacious. Most patients can be treated as day-cases. A low recurrence rate (0.36%) with low morbidity makes it an attractive method for routine treatment of groin hernias in the NHS.
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Affiliation(s)
- T Singhal
- General Surgery, Princess Royal University Hospital, Farnborough, Kent, BR6 8ND, UK.
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Abstract
The Lichtenstein repair is now the gold standard for open hernia repairs. This repair is easier to learn and easy to implement for the average general surgeon. Open mesh repairs are not the end-all in hernia operations, however, and surgeons must retain the knowledge for open tissue-based procedures. Laparoscopic inguinal hernia repair is a safe alternative to open repair for inguinal hernias but is much more operator dependent. Open mesh repair has a lower recurrence rate when compared with TEP or TAPP repairs for less experienced laparoscopists. Laparoscopic repair has a quicker return to work, is associated with less postoperative pain, and has a better cosmetic result. It is more difficult to learn, however, and hospital costs are higher. Surgeons need to look at their own numbers and experience to decide which approach is better given the clinical situation based on their proficiency with the various techniques.
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Affiliation(s)
- Brian Reuben
- Department of Surgery, Division of General Surgery, Salt Lake City VA Healthcare System and University of Utah School of Medicine, 30 North 1900 East, Room 3B110, SOM, Salt Lake City, UT 84132, USA
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Nzewi E, Elgilani F, Duignan J. Laparoscopic Inguinal Hernia Repair—An Unusual Complication. Surg Laparosc Endosc Percutan Tech 2006; 16:349-50. [PMID: 17057580 DOI: 10.1097/01.sle.0000213741.70030.4d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Laparoscopic inguinal hernia repair is associated with minimal postoperative pain, quicker return to normal activities, and very low recurrence rates. We describe an unusual complication after a laparoscopic total extraperitoneal repair.
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Affiliation(s)
- Emeka Nzewi
- Department of Surgery, St Michaels Hospital, Dun Laoghaire Co, Dublin, Ireland.
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Cihan A, Ozdemir H, Uçan BH, Acun Z, Comert M, Tascilar O, Cesur A, Cakmak GK, Gundogdu S. Fade or fate. Seroma in laparoscopic inguinal hernia repair. Surg Endosc 2005; 20:325-8. [PMID: 16333536 DOI: 10.1007/s00464-005-0052-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 05/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Postoperative fluid collection in the space left behind the dissected hernia sac in laparoscopic herniorraphy puts the surgeon in a dilemma as to whether it is a recurrence or a seroma, and it is not always easily judged only by physical examination (PE). Another important issue is what kind of seroma can be accepted as a complication of surgery. METHODS Thirty patients with unilateral inguinal hernia who had a hernia sac of >4 cm were operated on with transabdominal preperitoneal hernia repair (TAPP) technique and the collection at the hernia site was followed by PE and superficial ultrasonography (USG) postoperatively on the first day, first week, first month, and third month. RESULTS USG detected seroma in 20 patients, while 17 could be noticed by PE on the first postoperative day. At the end of the third month, seromas resolved by 90%, and could only be detected by USG in two patients. Pain or complication rates attributable to seroma in patients were not determined (p > 0.05) in the statistical analyses between the groups. CONCLUSIONS Superficial USG is a beneficial tool in differentiating early recurrence or seroma in patients. It should not be intervened with as a complication until the patient has complaints attributable to seroma.
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Affiliation(s)
- A Cihan
- Department of Surgery, Medical Faculty of the Zonguldak Karaelmas University, 67500, Turkey.
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Arregui ME, Young SB. Groin Hernia Repair by Laparoscopic Techniques: Current Status and Controversies. World J Surg 2005; 29:1052-7. [PMID: 15983713 DOI: 10.1007/s00268-005-7968-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Laparoscopic hernia repair remains controversial, and its position in current hernia surgery remains in flux. In this article we attempt to put the laparoscopic approach in perspective by describing the rationale for its development. We summarize studies comparing it with open repairs, including recent publications, meta-analyses, and systematic reviews; and we then contrast the data with recent findings of the United States Veterans Affairs Cooperative study 456. We discuss the current and future status of the laparoscopic approach to inguinal hernia repair and present an update of our own laparoscopic totally extraperitoneal technique without mesh fixation. From 1994 to 2004 we performed 314 hernia repairs on 224 patients with no intraoperative complications, no conversions to an open procedure, and no mortality. Thirty (14%) minor postoperative complications occurred. There were three herniated lipomas (preperitoneal fat) but no true peritoneal reherniations. We evaluate critical points of laparoscopic hernia repair including extensive preperitoneal dissection, mesh configuration, size and fixation, cost reduction, and the learning curve.
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Affiliation(s)
- Maurice E Arregui
- St. Vincent Hospital and Health Care Center, 2001 West 86th Street, Indianapolis, Indiana 46260, USA.
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Tamme C, Garde N, Klingler A, Hampe C, Wunder R, Köckerling F. Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results. Surg Endosc 2005; 19:1125-9. [PMID: 16021367 DOI: 10.1007/s00464-004-8219-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2004] [Accepted: 12/16/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND This prospective study of a new titanium-coated low-weight polypropylene (PP) mesh (16 g PP/m2) was designed to investigate the clinical efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP). METHODS In this study, 400 patients (average age, 53.5 years; range, 19-80 years) with a total of 588 inguinal hernias underwent surgery with the TEP technique between September 2002 and October 2003. Of these patients, 12.4% had experienced recurrent hernias after open suture herniotomy. In 92% of the cases (368 patients with 540 hernias), a lightweight (16 g PP/m2) titanium-coated polypropylene mesh was implanted without fixation, and in 8% (32 patients with 48 hernias) an identical medium-weight (35 g PP/m2) mesh was implanted. The first follow-up examination was scheduled for postoperative week 6. RESULTS In the lightweight mesh group, the mean group, operating time per patient was 61 min, corresponding to a calculated time per hernia of 41 min. Two intraoperative major complications occurred: an injury to the cecum and an injury to the bladder. In 12 cases (2%), bleeding from epigastric, testicular, or pubic bone vessels was observed. No injuries to pelvic vessels were seen. One patient was underwent an endoscopic revision to deal with an anticoagulation-related bleed. The mortality rate was 0%. In 12 patients, postoperative hematomas developed. One preperitoneal lipoma had to be extirpated. No infections of the mesh occurred. The median follow-up period for 371 patients (92.3%) was 7.2 weeks (range, 4-14 weeks). These 343 patients (with 504 hernias) had been provided with a lightweight titanium-coated polypropylene mesh (16 g PP/m2) (follow-up rate, 93.2%). Of these patients, 3.5% reported persistent ingunial pain, 1.7% described a sensation of rigidity in the region of the groin, and 3.2% reported dysesthesia. The early recurrence rate was 0.2%. CONCLUSIONS The TEP procedure can be performed safely and effectively with the appreciably material-reduced and titanium-coated polypropylene mesh without the need for fixation of the implant. The low early recurrence rate of 0.2% is evidence that the posterior wall of the inguinal canal is adequately augmented. The question whether the material reduction and the titanium coating of the mesh may bring about a reduction in postoperative chronic pain and the sensation of rigidity in the inguinal area via an improvement in biocompatibility must await the results of the scheduled follow-up examination 1 year after the surgical procedure.
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Affiliation(s)
- C Tamme
- Department of Surgery, Center for Minimally Invasive Surgery, Hanover, Hospital, Roesebeckstrasse 15 (Siloah), 30449 Hanover, Germany.
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Lau H, Patil NG, Lee FCW. Systematic review and meta-analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1442-2034.2003.00155.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Literature watch. J Endourol 2003; 17:117-24. [PMID: 12689407 DOI: 10.1089/08927790360587469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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