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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:S0039-6060(24)00562-2. [PMID: 39191601 DOI: 10.1016/j.surg.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Towards automatic verification of the critical view of the myopectineal orifice with artificial intelligence. Surg Endosc 2023:10.1007/s00464-023-09934-7. [PMID: 36828887 DOI: 10.1007/s00464-023-09934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos. METHODS Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data. RESULTS Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%. CONCLUSION This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity.
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Prevention and management of intraoperative complication during single incision laparoscopic totally extraperitoneal repair. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:36-39. [PMID: 35603343 PMCID: PMC8977495 DOI: 10.7602/jmis.2022.25.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022]
Abstract
Serious complications related to hernia surgeries have rarely been reported. One meta-analysis comparing laparoscopic and open mesh repair reported that 0.4% of potentially serious operative complications were reported. Previous studies have reported that uncommon serious intraoperative complications more frequently occur during laparoscopic inguinal hernia repairs. One study has shown that patients with history of lower abdominal surgery are at an increased risk of visceral injury during laparoscopic hernia repair. Vascular injuries at dissection and mesh fixation or suturing in the preperitoneal space typically involve the epigastric or aberrant obturator vessels crossing the Cooper’s ligament. However, complications can occur at every step of the operation, although only few are reported. Therefore, we report our experiences of intraoperative complications during single-incision laparoscopic totally extraperitoneal hernia repair and how to prevent and manage intraoperative complications.
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Amaral PHDEF, Pivetta LGA, Dias ERM, Carvalho JPVDE, Furtado M, Malheiros CA, Roll S. Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair. Rev Col Bras Cir 2022; 49:e20223063. [PMID: 35239851 PMCID: PMC10578846 DOI: 10.1590/0100-6991e-20223063] [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: 05/14/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. METHODS patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. RESULTS nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. CONCLUSIONS on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
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Affiliation(s)
- Pedro Henrique DE Freitas Amaral
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | | | - Eduardo Rullo Maranhão Dias
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - João Paulo Venancio DE Carvalho
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Marcelo Furtado
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
| | - Carlos Alberto Malheiros
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Sergio Roll
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
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Cyanoacrylate Glue Versus Absorbable Tacks in Mesh Fixation for Laparoscopic Extraperitoneal Inguinal Hernia Repair: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2021; 31:291-297. [PMID: 34047299 DOI: 10.1097/sle.0000000000000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cyanoacrylate glue (Glubran 2) is a synthetic adhesive mesh fixation material. Its utility is being evaluated in laparoscopic total extraperitoneal (TEP) inguinal hernia repair (IHR). A multicentre randomized controlled trial was performed comparing Glubran 2 to standard of care absorbable tacks, particularly assessing chronic postoperative inguinal pain and its effects. MATERIALS AND METHODS Patients undergoing elective TEP IHR at 2 centers from 2017 to 2019 were randomly assigned to Glubran 2 or absorbable tack mesh fixation, and followed for 6 months. All other aspects of surgery and aftercare remained the same. Surgeons documented operative and fixation time, and the placement of fixation on standardized diagrams. Via a questionnaire, aspects of inguinal pain were evaluated before surgery, and at various time-points postoperatively over 6 months. Postoperative clinical factors were also collected. RESULTS A total of 106 operative sides were randomized to either glue (51) or tack (55) mesh fixation over a 14-month period. Similar median operative times between tack (83.0 min) and glue fixation (75.0 min) were observed. There were no significant surgical complications or observed hernia recurrences in either group. There was no significant difference in pain scores between the 2 groups at all time-points after analysis through mixed effects modeling. Temporal pain profiles over time were also similar. Totally, 55% of patients in the glue group had returned to work within 2 weeks of surgery. There was no increase in complications or pain scores despite regular lateral fixation of glue in these patients. CONCLUSION Adding to known data, we observed no significant difference in postoperative pain, demonstrating that cyanoacrylate glue is a viable and safe alternative fixation method to absorbable tacks in laparoscopic TEP IHR. As secondary outcomes, cyanoacrylate glue permits some patients to return to work early, and we observed regular lateral mesh glue fixation without increased pain or complications.
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Gallyamov EA, Agapov MA, Busyrev YB, Kakotkin VV, Kubyshkin VA, Donchenko KA, Gadlevskiy GS, Wu Z. [Outcomes of various techniques of mesh prosthesis fixation in laparoscopic hernia repair]. Khirurgiia (Mosk) 2021:34-41. [PMID: 33395510 DOI: 10.17116/hirurgia202101134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare early and long-term results of various mesh prosthesis fixation methods in laparoscopic inguinal hernia repair. MATERIAL AND METHODS It is a prospective clinical non-randomized trial. The study included 212 patients. Conventional stapler fixation (112 patients), self-gripping mesh implants (48 patients) and n-butyl cyanoacrylate adhesive fixation (52 patients) were compared. We estimated surgery time, pain syndrome severity in early and long-term postoperative period, postoperative morbidity and recurrence rate were evaluated. RESULTS Early postoperative morbidity, activation of patients and hospital-stay were similar in all groups. Pain syndrome within 6 postoperative hours in the first group exceeded the same parameter in the second group by 1.23 times (95% CI 1.15-1.31, p<0.05) and by 1.19 times in the third group (95% CI 1.12-1.26, p<0.05). Within 12 hours, pain syndrome in the first group was 1.27 times more severe compared to the third group (95% CI 1.20-1.34, p<0.05). Pain syndrome in long-term period was similar in all groups. In the first group, one recurrence was detected (0.9%). CONCLUSION There were no significant between-group differences. However, we found the correlation of postoperative pain syndrome with mesh implant fixation technique.
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Affiliation(s)
- E A Gallyamov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Agapov
- Lomonosov Moscow State University, Moscow, Russia
| | - Yu B Busyrev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V V Kakotkin
- Lomonosov Moscow State University, Moscow, Russia
| | | | | | - G S Gadlevskiy
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Z Wu
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Fernandez-Alberti J, Iriarte F, Croceri RE, Medina P, Porto EA, Pirchi DE. Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair. Hernia 2021; 25:1301-1307. [PMID: 33400027 DOI: 10.1007/s10029-020-02357-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following previous laparo-endoscopic repair. Laparoscopic treatment of recurrences after previous LR is controversial. The purpose of this study was to determine the safety, feasibility, and reliability of a repeated transabdominal preperitoneal laparoscopic repair (reTAPP) for a recurrent hernia. METHODS We analyzed and compared a series of patients with recurrent inguinal hernia after LR who underwent repair by a conventional approach with similar patients who underwent reTAPP between January 2010 and December 2018. RESULTS Between January 2010 and December 2018, 2488 transabdominal preperitoneal laparoscopic inguinal hernia (TAPP) repairs were performed. Recurrence was observed in 46 (1.8%). Of these patients, 18 (39%; Group 1; G1) underwent conventional open repair (Lichtenstein technique) and 28 (61%; Group 2; G2) reTAPP. In G2, repair was successful in 24 patients (86%); however, four cases (14%) needed conversion to OS because of technical difficulties. Two patients re-recurred (4.3%), one in G1 which was resolved in a third approach with a reTAPP and the other in G2 which was resolved with OS. CONCLUSION ReTAPP surgery for recurrences after previous TAPP repair proved to be safe and was associated with a shorter length of hospital stay and morbidity and recurrence rates comparable to OS at a highly specialized center. Randomized studies with a larger number of cases are necessary to confirm these findings and draw more robust and objective conclusions.
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Affiliation(s)
- Joaquin Fernandez-Alberti
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina.
| | - Facundo Iriarte
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Raul Eduardo Croceri
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Pablo Medina
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Eduardo Agustin Porto
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Daniel Enrique Pirchi
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
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Vanclooster P, Smet B, Gheldere CD, Segers K. Laparoscopic Inguinal Hernia Repair : Review of 6 Years Experience. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- P. Vanclooster
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - B. Smet
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - C. de Gheldere
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
| | - K. Segers
- Department of general and abdominal surgery, Hospital H. Hart, Kolveniersvest 20, 2500 Lier, Belgium
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Köckerling F, Schug-Pass C. Spermatic Cord Lipoma-A Review of the Literature. Front Surg 2020; 7:39. [PMID: 32793626 PMCID: PMC7393947 DOI: 10.3389/fsurg.2020.00039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: A spermatic cord lipoma is found in 20–70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual indirect hernia sac may become manifest in up to 8% of these cases. Missed spermatic cord lipoma can result in recurrence or pseudo-recurrence. This review presents the relevant literature on this topic. Materials and Methods: A systematic search of the available literature was performed in February 2020 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals and reference lists. Forty-two publications were identified as relevant for this topic. Results: Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI. In the absence of a real hernia sac, a spermatic cord lipoma is classified as a lateral inguinal hernia with a defect size <1.5 cm according to the European Hernia Society (EHS LI). Missed or inadequately treated spermatic cord lipoma results in recurrence or pseudo-recurrence. Since spermatic cord lipoma obtains its vascular supply from the preperitoneal space, it can be reduced or resected. Conclusion: Spermatic cord lipoma is a common finding in inguinal hernia repairs and must be properly diagnosed and treated with care respecting the anatomy of the spermatic cord.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
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Fixation versus no fixation in laparoscopic totally extraperitoneal repair of primary inguinal hernia-a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2020; 405:435-443. [PMID: 32533360 DOI: 10.1007/s00423-020-01899-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh fixation versus no fixation in laparoscopic TEP repair for primary inguinal hernia. MATERIALS AND METHODS PubMed, EMBASE, and Cochrane databases were searched for relevant articles from January 1992 until May 2020. All trials that compared fixation versus no fixation in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence while secondary outcomes included postoperative pain at 24 h, mean operative time, urinary retention, and seroma rates. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also carried out. RESULTS Eight randomized controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between fixation and no fixation with respect to recurrence (RD 0.00, 95% CI = - 0.01 to 0.01, p = 1.00), operative time (MD 1.58 min, 95% CI = - 0.22 to 3.37, p = 0.09), seroma (OR = 0.70, 95% CI = 0.28 to 1.74, p = 0.44), or urinary retention (RD 0.09, 95% CI = - 0.18 to 0.36, p = 0.53). However, fixation was associated with more pain at 24 h (MD 0.93, 95% CI = 0.20 to 1.66, p = 0.01). CONCLUSIONS Mesh fixation in laparoscopic TEP repair for primary inguinal herniae is associated with increased postoperative pain at 24 h but similar recurrence, seroma, and urinary retention. Therefore, it may be omitted.
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Coratti F, Trafeli M, Barbato G, Maggioni C, Manetti A, Cianchi F. The Gauze technique: a simple method of dissection in laparoscopic inguinal hernia repair. MINERVA CHIR 2020; 75:426-429. [PMID: 32456400 DOI: 10.23736/s0026-4733.20.08335-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hernia repair is one of the most frequent operation in general surgery. The aim of this is study is to present a new preperitoneal atraumatic dissection of peritoneal flap during laparoscopic transabdominal preperitoneal inguinal hernia repair. METHODS From January 2019 to December 2019, 30 patients (19 male, 11 female) attended TAPP inguinal hernia repairs. The inclusion's criteria were: patients from 32 to 88 years; male and woman; bilateral inguinal hernia. RESULTS The median age of patients was 46,46 (32-88). The median time of operation was 63,8 (45-100) minutes. All procedures were performed without complications and convertions. CONCLUSIONS Based on our experience the soft technique is a safe and feasible way to create a preperitoneal flap. Operating time is drastically reduced and the learning curve is reduced even for less experienced surgeons.
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Affiliation(s)
- Francesco Coratti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy -
| | - Martina Trafeli
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Giuseppe Barbato
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Cristina Maggioni
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Andrea Manetti
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Department of Surgery and Translational Medicine, University Hospital of Florence, University of Florence, Florence, Italy
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Seelig MH, Winkels R, Wiese M, Weyhe D. Spermatic cord liposarcomas incidentally found during hernia surgery: is histology of any lipoma mandatory? A review of the literature. Acta Chir Belg 2020; 120:79-84. [PMID: 31690184 DOI: 10.1080/00015458.2019.1689645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Liposarcomas found incidentally during open or laparoscopic inguinal hernia surgery are extremely rare. It is unclear, whether any adipose tissue being removed during inguinal hernia surgery must be sent for histology due to the potential risk of liposarcoma of the spermatic cord. This study aims to evaluate the frequency of liposarcomas incidentally found in the inguinal canal during hernia surgery and tries to derive evidence-based recommendations regarding the optimal management of any fatty tissue found in the inguinal canal.Methods: A literature review of the PubMed/Medline electronic databases between January 1980 and January 2019 was performed using the search terms 'inguinal hernia' and 'liposarcoma'. There was only one study available on this topic. Therefore, an additional literature review was performed analyzing all reports on patients with incidentally detected liposarcomas of the spermatic cord in the inguinal canal during hernia surgery.Results: There was only one retrospective study evaluating the frequency of inguinal liposarcoma found at hernia operations with a frequency of less than 0.1%. There were 18 cases of spermatic cord liposarcomas that were truly found incidentally during operation for an unsuspected symptomatic or incarcerated inguinal hernia. These included 16 case reports with a total of 18 patients and 19 liposarcomas. All patients were male with a median age of 62.5 years (range: 24-86 years) years. Median size of liposarcoma was 10.5 cm (range: 3-30 cm). In seven patients, the inguinal liposarcoma was an extension of a retroperitoneal sarcoma. Treatment consisted of radical orchidectomy during the primary operation in 12 patients. Three out of the seven patients with retroperitoneal extension of the tumor underwent a secondary operation with complete resection of the tumor.Conclusions: Currently, there is no evidence-based recommendation available regarding the management of lipomas detected during open or laparoscopic inguinal hernia surgery. Due to the extremely low risk of the presence of a liposarcoma, routine histologic examination cannot be recommended unless the diameter exceeds 10 cm.
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Affiliation(s)
- Matthias H. Seelig
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, Kliniken Frankfurt-Main-Taunus, Bad Soden Am Taunus, Germany
| | - Raphael Winkels
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, Kliniken Frankfurt-Main-Taunus, Bad Soden Am Taunus, Germany
| | | | - Dirk Weyhe
- Department for Human Medicine, Pius Hospital, Medical Campus University of Oldenburg, University Hospital for Visceral Surgery, Oldenburg, Germany
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Chan SB. Transfascial suture fixation technique in laparoscopic repair of inguinal hernia. Asian J Endosc Surg 2020; 13:246-249. [PMID: 31099180 PMCID: PMC7187364 DOI: 10.1111/ases.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study presents the initial results of a transfascial suture mesh fixation technique. This method was devised to reduce operative costs and foreign body-associated risks while embracing the benefits of fixation in laparoscopic inguinal hernia repair. MATERIALS AND SURGICAL TECHNIQUE Patients undergoing laparoscopic inguinal hernia repair with transfascial suture fixation (TRANSFIX) in our center between March 2017 and March 2018 were retrospectively reviewed. The procedure is orchestrated by a reusable fascial closure device sequentially puncturing the fascia vertically through the inferior port site and guiding a polypropylene thread through the mesh. The thread is retrieved from the extraperitoneal plane with the device, creating an extracorporeal suture loop to embed a surgical knot at the subcutaneous layer of the port site. DISCUSSION In its first year after introduction, 16 TRANSFIX were performed. All patients were men (mean age, 62.6 years). Thirteen hernias (81.3%) were first occurrence, and three (18.8%) were recurrent. Twelve (75.0%) were direct hernias, and three (18.8%) were indirect hernias; one patient presented with concurrent direct and indirect hernia. Median operating time was 41.5 minutes for unilateral repair and 73.0 minutes for bilateral. Median blood loss was 5 mL. One patient had a seroma after unilateral indirect hernia repair. After a median follow-up of 15.5 months (range, 9-21 months), no patient had chronic pain, wound infection, hematoma, or recurrence. Instrumental cost reduction per operation was between $150 and $300. TRANSFIX appears to be a safe and economical mesh fixation method.
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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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Tosun S, Ekinci O. Missed Inguinal Cord Lipoma May Mimic Recurrence Following Endoscopic Repair of Groin Hernias. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02078-1] [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] Open
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Richmond BK, Totten C, Roth JS, Tsai J, Madabhushi V. Current strategies for the management of inguinal hernia: What are the available approaches and the key considerations? Curr Probl Surg 2019; 56:100645. [PMID: 31581983 DOI: 10.1016/j.cpsurg.2019.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan K Richmond
- Division of General Surgery, West Virginia University - Charleston Division, Charleston, WV.
| | - Crystal Totten
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, University of Kentucky, Lexington, KY
| | - John Scott Roth
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Center for Advanced Training and Simulation, University of Kentucky, Lexington, KY
| | - Jonathon Tsai
- Charleston Area Medical Center, West Virginia University - Charleston Division, Charleston, WV
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Kumar A, Pal AK, Choudhary A, Anand A, Sonkar AA, Pahwa HS. Transfascial suture versus tack fixation of mesh in totally extraperitoneal repair of inguinal hernia: A prospective comparative study. J Minim Access Surg 2019; 16:132-137. [PMID: 30777988 PMCID: PMC7176006 DOI: 10.4103/jmas.jmas_192_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose: Among laparoscopic surgeries in inguinal hernias, totally extraperitoneal (TEP) repair has demonstrated favourable results in reduction of post-operative pain and mean operative times with early return to physical activity. We have done a prospective comparative study on two different techniques of mesh fixation, i.e., transfascial suture and tack fixation. Materials and Methods: It was a prospective, non-randomised comparative study done on inguinal hernia patients operated by TEP repair from October 2014 to September 2016. These data were compared in two techniques of mesh fixation (tack and transfascial sutures) in terms of post-operative complications, pain scores by visual analogue scale (VAS) and cost analysis of the procedure. Results: Our study on 69 total patients (44 tack fixation and 25 suture fixation group) revealed that mean VAS scores for post-operative pain were not having any statistically significant difference in the tack group versus suture group (2.42 ± 0.24 vs. 2.2 ± 0.24) at 24 h, but VAS scores in the follow-up period at 1 week, 1 month, 3 months and 6 months were 1.14 ± 0.33 versus 0.67 ± 0.27; 0.78 ± 0.24 versus 0.07 ± 0.06; 0.42 ± 0.17 versus 0.07 ± 0.06 and 0.5 ± 0.11 versus 0.07 ± 0.06, respectively, which showed significant difference at 1 and 3 months, suggesting less pain in the suture group. No significant difference was noted in other post-operative complications. Conclusion: Transfascial suture fixation of mesh in TEP repair of inguinal hernia can be a cost-effective procedure with a comparable safety profile as compared to tack fixation.
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Affiliation(s)
- Awanish Kumar
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Pal
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anuraag Choudhary
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Akshay Anand
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Abhinav Arun Sonkar
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Harvinder Singh Pahwa
- Department of Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
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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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Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery. Surg Endosc 2018; 32:4757-4762. [PMID: 29761278 DOI: 10.1007/s00464-018-6223-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20 years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. METHODS From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. RESULTS Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. CONCLUSION The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.
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Kumar A, Kaistha S, Gangavatiker R. Non-fixation Versus Fixation of Mesh in Totally Extraperitoneal Repair of Inguinal Hernia: a Comparative Study. Indian J Surg 2018; 80:128-133. [PMID: 29915478 PMCID: PMC5991014 DOI: 10.1007/s12262-018-1730-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
Two major issues with laparoscopic inguinal hernia (IH) repair are recurrences and chronic groin pain (CGP). The procedure involves fixing the mesh with the tackers which is believed to increase the rate of CGP due to nerve injuries. Thus, non-fixation of mesh is being proposed but concerns remain regarding increased recurrences. We sought to look at our outcomes after we switched over to non-fixation of mesh in totally extraperitoneal repair (TEP). Retrospective review of prospectively maintained database of 171 repairs was done on 122 patients (fixation 59 and non-fixation 112) during a period of 4 years with an endeavor to complete a minimum of 1 year of clinical follow-up. The primary objective was to assess the recurrence rates and CGP and the secondary objective was to assess operative times, immediate post-op pain, incidence of urinary retention, duration of hospital stay, days taken to return to activity, and cost. The mean operative times for unilateral IH for the fixation and non-fixation groups were 41.8 ± 11.4 and 35.9 ± 9.7 min, respectively (p = 0.021), whereas for bilateral were 66.2 ± 15.6 and 55.3 ± 14.2 min, respectively (p = 0.018). The mean pain score was 3.44 ± 1.2 versus 3.01 ± 1.0; (p = 0.037) in the two groups, respectively. At a mean follow-up of 33.2 ± 17.0 and 18.7 ± 6.2 months, the incidence of CGP was 02 (3.4%) and 3 (2.7%) (p = 1.000) and recurrences were 02 (3.4%) in the two groups, respectively (p = 0.118). Non-fixation of mesh in TEP does not lead to increased recurrence though it does not decrease the incidence of chronic groin pain. Collateral advantage would be decreased operative times, lesser post-operative pain, and decreased costs.
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Affiliation(s)
- Ameet Kumar
- Department of GI Surgery, Surgical Division, Command Hospital Air Force, Bangalore, 560007 India
| | - Sumesh Kaistha
- Department of GI Surgery, Surgical Division, Command Hospital Air Force, Bangalore, 560007 India
| | - Rajesh Gangavatiker
- Department of GI Surgery, Surgical Division, Command Hospital Air Force, Bangalore, 560007 India
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Miyaki A, Yamaguchi K, Kishibe S, Ida A, Miyauchi T, Naritaka Y. Diagnosis of inguinal hernia by prone- vs. supine-position computed tomography. Hernia 2017; 21:705-713. [PMID: 28812202 DOI: 10.1007/s10029-017-1640-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair. METHODS Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings. RESULTS The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively]. CONCLUSIONS Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.
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Affiliation(s)
- A Miyaki
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan.
| | - K Yamaguchi
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - S Kishibe
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - A Ida
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - T Miyauchi
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - Y Naritaka
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
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Schjøth-Iversen L, Refsum A, Brudvik KW. Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study. Hernia 2017; 21:729-735. [PMID: 28752424 DOI: 10.1007/s10029-017-1634-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/01/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic total extraperitoneal repair (TEP) of inguinal hernia has been associated with higher rates of recurrence compared to open methods. The aim of the present study was to determine independent risk factors for recurrence within 2 years after TEP. METHODS This was a single-centre prospective cohort study with consecutive inclusion of patients undergoing inguinal hernia repair from 2010 to 2014. Systematic follow-up was conducted 6 months and 2 years postoperatively. Risk factors for recurrence after 2 years were analysed in univariate and multivariate analyses. RESULTS A total of 1194 patients underwent TEP for inguinal or femoral hernia in the study period, of which 1047 were eligible for analyses. After 2 years, 56 (5.3%) patients had presented with recurrence. The following factors were associated with recurrence in univariate analyses: body mass index (BMI) >30 (HR 3.64; p = 0.011), medial vs. lateral hernia (HR 2.37; p = 0.004), repair of recurrent hernia vs. primary repair (HR 2.12; p = 0.049), and length of stay >1 day (HR 1.77; p = 0.043). In multivariate analyses, factors independently associated with recurrence after 2 years were BMI >30 (HR 3.74; p = 0.026) and medial vs. lateral hernia (HR 2.39; p = 0.004). CONCLUSION The recurrence rate after TEP is higher than reported after open hernia repair. Attempts to decrease the rate should be persuaded. Good surgical technique with precise dissection and correct placement of the mesh, especially in medial hernias and obese patients, may be key points to improve outcomes after TEP.
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Affiliation(s)
- L Schjøth-Iversen
- Department of Surgery, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway.
| | - A Refsum
- Department of Surgery, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway
| | - K W Brudvik
- Department of Surgery, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway
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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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Ferrarese A, Bindi M, Rivelli M, Solej M, Enrico S, Martino V. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients. Open Med (Wars) 2016; 11:497-508. [PMID: 28352842 PMCID: PMC5329874 DOI: 10.1515/med-2016-0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/19/2016] [Indexed: 12/29/2022] Open
Abstract
Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Matteo Rivelli
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
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Staple Fixation Against Adhesive Fixation in Laparoscopic Inguinal Hernia Repair. Surg Laparosc Endosc Percutan Tech 2015; 25:471-7. [DOI: 10.1097/sle.0000000000000214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hayakawa T, Eguchi T, Kimura T, Shigemitsu Y, Suzuki K, Wada H, Wada N, Takehara H, Nagae I, Matsufuji H, Morotomi Y. Hernia. Asian J Endosc Surg 2015; 8:382-9. [PMID: 26708582 DOI: 10.1111/ases.12262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 11/24/2022]
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Issa N, Ohana G, Bachar GN, Powsner E. Long-Term Outcome of Laparoscopic Totally Extraperitoneal Repair of Bilateral Inguinal Hernias with a Large Single Mesh. World J Surg 2015; 40:291-7. [PMID: 26470702 DOI: 10.1007/s00268-015-3277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A totally extraperitoneal (TEP) approach is currently the technique of choice for the laparoscopic repair of bilateral inguinal hernias in our institution. Most other surgeons use two meshes for the TEP repair, one for each side. We prefer a large single mesh when possible since it allows for easier correct placement of the mesh in one stage. We compared our long-term results of both techniques in terms of late complications and recurrence rates. METHODS This study retrospectively evaluated the medical records of 108 patients who underwent bilateral laparoscopic TEP repair in our institution between January 2002 and December 2003. Excluded were patients who had a conversion to a transabdominal preperitoneal or open approach. A total of 73 (67 %) patients fulfilled study entrance criteria and were enrolled: 39 had undergone single mesh repair and 34 had undergone double mesh repair. RESULTS There were no significant group differences in demographics, operating time, postoperative morbidity, or hospital stay. Likewise, after a median follow-up of 102 months (range 94–115 months), there were no significant group differences between the single and double mesh groups in persistent pain (5.8 vs 2.5 %, respectively; p = 0.476) and recurrence (7.6 vs 8.8 %, respectively; p = 0.55). CONCLUSION The use of a large single mesh is an effective and safe alternative technique for TEP repair of bilateral inguinal hernias, and is technically easy to perform.
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Ramakrishnan P, Bansal S, Deuri B, Subbiah R, Palanisamy S, Palanivelu PR, Chinusamy P. A single-centre experience of relaparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes. Surg Endosc 2015; 30:2308-14. [PMID: 26423411 DOI: 10.1007/s00464-015-4387-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/01/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of complications of laparoscopic inguinal hernia repair remains challenging as well as debatable. Relaparoscopy in management of these complications is relatively newer concept. We tried to analyse the feasibility of relaparoscopy (transabdominal preperitoneal approach) in management of complications of laparoscopic inguinal hernia repair. MATERIALS AND METHODS The study group included 61 patients (referral cases) from a prospectively maintained database of previous laparoscopic inguinal hernia surgery with majority of the patients of recurrence (n = 39). Other complications were mesh infections (n = 15), pubic osteitis (n = 3), migration of mesh into adjacent viscera (n = 3) and meralgia paresthetica (n = 1). All patients underwent transabdominal preperitoneal approach (TAPP) between January 2007 and December 2013. RESULTS AND OUTCOME Most of the patients had previous TEP repair (n = 49) with variable complications detected in the range of 9 days to 38 months. Small-sized mesh (n = 12) and rolled up mesh (n = 10) were the causes of recurrence in 57 % cases. Mycobacterium tuberculosis (40 %) and mixed bacterial infections (33 %) strains were detected in the infected mesh. Pubic osteitis and meralgia paresthetica were tackers induced. All patients dealt with TAPP approach. Recurrent hernia cases underwent mesh placement and infected mesh was removed in mesh infection. Tackers were removed in cases of osteitis pubis and meralgia paraesthesia. Median operative time was 62 min (42-126 min) and hospital stay 3 days (2-13 days). The relaparoscopy was accomplished in 95.1 % of cases with no major intraoperative complications and minimal postoperative morbidity. CONCLUSION Relaparoscopy through TAPP approach remains safe and feasible option to deal with primary laparoscopic hernia repair complications. Surgical techniques during primary laparoscopic repair are important cause for aforementioned complications. Though, surgical expertize remains warranted for relaparoscopy.
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Affiliation(s)
- Parthasarthi Ramakrishnan
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Saurabh Bansal
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India.
| | - Biswajit Deuri
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Rajapandian Subbiah
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Senthilnathan Palanisamy
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Praveen Raj Palanivelu
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Palanivelu Chinusamy
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
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Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre. Indian J Surg 2015; 78:197-202. [PMID: 27358514 DOI: 10.1007/s12262-015-1341-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/02/2015] [Indexed: 10/23/2022] Open
Abstract
One of the major reasons for laparoscopy not having gained popularity for repair of groin hernia is the perceived steep learning curve. This study was conducted to assess the learning curve and to predict the number of cases required for a surgeon to become proficient in laparoscopic groin hernia repair, by comparing two laparoscopic surgeons. The learning curve evaluation parameters included operative time, conversions, intraoperative complications and postoperative complications, and these were compared between the senior and the junior surgeon. One hundred thirty-eight cases were performed by the senior surgeon, and 63 cases by the junior surgeon. Both were comparable in terms of intraoperative and postoperative complications. Using the moving average method, minimum of 13 laparoscopic hernia repairs are required to reach at par the operating time of an experienced surgeon. For total extraperitoneal (TEP) repair, the number of cases was 14; and for transabdominal preperitoneal (TAPP) repair, this number was 13.
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Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh. Surg Endosc 2015; 30:1134-40. [PMID: 26092029 DOI: 10.1007/s00464-015-4314-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Repair of inguinal hernia is one of the most common elective operations performed in general surgery practice. Mesh hernia repair became the gold standard because of its low recurrence rate in comparison with non-tension-free repair. Laparoscopic approach seems to have potential advantages over open techniques, including faster recovery and reduced acute and chronic pain rate. Laparoscopic mesh fixation is usually performed using staples, which is associated with higher cost and risk for chronic pain. Recently, the role of mesh fixation has been questioned by several surgeons. AIM To evaluate mesh displacement in patients undergoing laparoscopic inguinal hernia repair comparing mesh fixation with no fixation. METHODS From January 2012 to May 2014, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups: control group--10 patients underwent totally extraperitoneal (TEP) repair with mesh fixation; NO FIX group-50 patients underwent TEP repair with no mesh fixation. Mesh was marked with three 3-mm surgical clips at its medial inferior, medial superior and lateral inferior corners. Mesh displacement was measured by comparing an initial X-ray, performed in the immediate postoperative period, with a second X-ray obtained 30 days later. RESULTS The mean displacement of all three clips in control group was 0.1-0.35 cm (range 0-1.2 cm), while in NO FIX group was 0.1-0.3 cm (range 0-1.3 cm). The overall displacement of control and NO FIX group did not show any difference (p = 0.50). CONCLUSION Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.
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Zhang G, Zhang X, Zhan H, Hu S. Vacuum suction fixation versus staple fixation in TAPP laparoscopic hernia repair: introduction of a new technique for mesh fixation. Surg Endosc 2015; 30:114-20. [DOI: 10.1007/s00464-015-4168-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 03/14/2015] [Indexed: 12/20/2022]
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Follow-up after laparoscopic inguinal hernia repair, can it be done by phone? A prospective study in 300 patients, the PINQ-PHONE. Surg Endosc 2015; 29:3292-7. [PMID: 25631113 DOI: 10.1007/s00464-015-4080-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 08/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most important long-term complications after inguinal hernia repair are chronic pain and recurrence. Previous follow-up studies showed that physical examination is the only reliable method of follow-up to detect recurrences. However, physical examination is laborious and time consuming. We designed a telephone questionnaire as a method of follow-up after laparoscopic inguinal hernia surgery; the PINQ-PHONE (Post-INguinal-repair-Questionnaire by telePHONE). The aim of this study is to validate the PINQ-PHONE for detecting both asymptomatic and symptomatic recurrences. METHODS This prospective study contained 300 randomly selected patients after laparoscopic inguinal hernia repair. All patients were contacted by telephone and the PINQ-PHONE was carried out. The PINQ-PHONE contains four elements; three questions and a do-it-yourself Valsalva maneuvre. Subsequently, all patients were seen in clinic and physical examination (gold standard) was done. RESULTS The majority (96 %) was male and the mean age was 66 (range 26-93) years old. The mean interval between surgery and study inclusion was 58 (range 6-141) months. In five (1.7 %) patients, a recurrence was found. All of them replied positively to one or more elements of the PINQ-PHONE. Two-hundred-fifty-two (84 %) patients replied negatively to all elements and none of them had a recurrence. The overall sensitivity was 1.00 and the overall specificity was 0.86. CONCLUSION This study validated the PINQ-PHONE. It is a reliable, practical, and simple method of follow-up after laparoscopic inguinal hernia repair to detect both symptomatic and asymptomatic recurrences.
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Mesh Fixation at Laparoscopic Inguinal Hernia Repair: A Meta-Analysis Comparing Tissue Glue and Tack Fixation. World J Surg 2014; 38:2558-70. [DOI: 10.1007/s00268-014-2547-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Li J, Ji Z, Li Y. Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results. Am J Surg 2014; 207:602-12. [DOI: 10.1016/j.amjsurg.2013.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/29/2013] [Accepted: 05/16/2013] [Indexed: 01/25/2023]
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Relaparoscopic treatment of recurrences after previous laparoscopic inguinal hernia repair. Minim Invasive Surg 2013; 2013:260131. [PMID: 24379974 PMCID: PMC3863525 DOI: 10.1155/2013/260131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/13/2013] [Indexed: 12/05/2022] Open
Abstract
Background. Relaparoscopic treatment of inguinal hernia recurrences has become a relatively new concept with favourable results. The purpose of this study was to examine a series of relaparoscopic repair, present technical experiences, and the clinical outcomes in this subset of patients. Patients and Methods. The medical records of five patients who underwent relaparoscopic repair (TAPP or TEP) for a recurrence between March 2005 and September 2012 were retrospectively reviewed. Results. All the patients were male with a mean age of 45 years. Technical failures in the previous repairs were the main factors contributing to recurrences. In two re-TEP cases with no previous mesh fixation, the old mesh remained on the peritoneal side during preperitoneal dissection and this greatly facilitated surgical manipulation. The mean operative time was 93 min (range, 45–120 min). There were no conversions, no intraoperative complications, and no morbidity or rerecurrence after a mean follow-up period of 17 months (range, 7–24 months). Conclusion. Relaparoscopic repair appears to be safe and effective in the treatment of recurrent inguinal hernia and repeated TEP could be a simpler approach than expected in the presence of no prior mesh fixation.
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Mesh fixation in TAPP laparoscopic hernia repair: introduction of a new method in a prospective randomized trial. Surg Endosc 2013; 28:531-6. [PMID: 24196538 DOI: 10.1007/s00464-013-3198-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Mesh fixation is a critical step in TAPP laparoscopic hernia repair because tackers used for this purpose are associated with possible neuralgia. METHODS For the present study, 70 patients referred with unilateral inguinal or femoral hernia were divided in two groups for hernia repair. In first group mesh was fixed with titanium tacker. In the second group mesh was fixed with a single suture of Vicryl. RESULTS Patients in the Vicryl group experienced less postoperative pain and analgesic consumption. Six month follow-up demonstrated no hernia recurrence either. CONCLUSIONS According to results, use of Vicryl suture instead of a titanium tacker is beneficial owing to reduced pain, less analgesic consumption, and lower cost.
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Modified Kugel herniorrhaphy using standardized dissection technique of the preperitoneal space: long-term operative outcome in consecutive 340 patients with inguinal hernia. Hernia 2013; 17:699-707. [PMID: 23813118 DOI: 10.1007/s10029-013-1132-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome, with a special reference to recurrence and postoperative chronic pain, of the modified Kugel herniorrhaphy (MKH) using standardized dissection of the preperitoneal space. PATIENTS AND METHODS Operative results were examined based on medical records and questionnaire surveys in 340 consecutive cases of MKH performed at a single institution. The operation was performed with an original 3-stage dissection of the preperitoneal space only via the internal inguinal ring. RESULTS The mean follow-up period was 50.5 ± 24.3 months. The mean operating time was 42.2 ± 13.1 min, and by Nyhus classification, significant difference was observed between types IIIA and IIIB (39.5 ± 10.8 vs. 45.6 ± 15.6 min, P = 0.0279). Eight surgeons performed 10 or more operations, and no significant difference was found in their operating time. Thirty-one patients used additional analgesics postoperatively (9.1 %) and the length of postoperative stay was 1.2 ± 0.7 days. Seven patients (2.1 %) developed complications related to the hernia operation, but none of them required re-operation. The period required to return to normal daily activities was 3 ± 3.2 days. Questionnaire forms were returned from 77.7 % of all the patients, in which 12 patients reported chronic pain (4.7 %). Visual analog scale for patients with chronic pain scored 3.8 ± 2.4, with no patient indicating restrictions on daily life. Recurrence was observed in only one case (0.3 %). CONCLUSION MKH using standardized dissection of the preperitoneal space is a highly reproducible procedure with acceptable rate of postoperative chronic pain and recurrence.
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EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc 2013; 27:3505-19. [PMID: 23708718 DOI: 10.1007/s00464-013-3001-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
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Influence of Type of Mesh Fixation in Endoscopic Totally Extraperitoneal Hernia Repair (TEP) on Long-term Quality of Life. World J Surg 2013; 37:1249-57. [DOI: 10.1007/s00268-013-1974-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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: 32] [Impact Index Per Article: 2.9] [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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Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc 2012; 27:795-800. [DOI: 10.1007/s00464-012-2514-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022]
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Choi YY, Kim Z, Hur KY. Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study. Surg Today 2012; 43:603-7. [PMID: 22850985 DOI: 10.1007/s00595-012-0276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 03/05/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation. METHODS This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005. RESULTS There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014). CONCLUSIONS An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.
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Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Soonchunhyang University Hospital, Seoul 140-743, Korea
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Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal (TEP) groin hernia repairs using fibrin glue (Tisseel™): a United Kingdom experience. Hernia 2012; 16:647-53. [DOI: 10.1007/s10029-012-0936-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
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Sajid M, Ladwa N, Kalra L, Hutson K, Sains P, Baig M. A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repair. Int J Surg 2012; 10:224-31. [DOI: 10.1016/j.ijsu.2012.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
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Abstract
AIM The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal. MATERIALS AND METHODS The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report. SUMMARY Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh. CONCLUSION Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.
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Bhandarkar DS, Shankar M, Udwadia TE. Laparoscopic surgery for inguinal hernia: Current status and controversies. J Minim Access Surg 2011; 2:178-86. [PMID: 21187993 PMCID: PMC2999782 DOI: 10.4103/0972-9941.27735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Repair of inguinal hernia is one of the commonest operations performed by surgeons around the world. The treatment of this common problem has seen an evolution from the pure tissue repairs to the prosthetic repairs and in the recent past to laparoscopic repair. The fact that so many hernia repairs are practiced is a testimony to the fact that probably none is distinctly superior to the other. This review assesses the current status of surgery for repair of inguinal hernia and examines the various controversial issues surrounding the subject.
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Affiliation(s)
- Deepraj S Bhandarkar
- Department of Minimal Access Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
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