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Brucchi F, Ferraina F, Masci E, Ferrara D, Cassini D, Faillace G. To close, not to close, or to act bigger? Managing the defect of large direct inguinal hernia to reduce the risk of recurrence during laparoscopic TAPP repair: a retrospective cohort study. Updates Surg 2024:10.1007/s13304-024-01870-y. [PMID: 38733485 DOI: 10.1007/s13304-024-01870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
Hernia recurrence is a common complication after inguinal hernia repair. Recent studies suggest that laparoscopic mesh repair with closure of direct hernia defects can reduce recurrence rates. Our study examines the effectiveness of this approach. A retrospective, multi-center cohort study was conducted on cases performed from January 2013 to April 2021. Patients with direct inguinal hernias (M3 according to EHS classification) undergoing TAPP were included. Three groups were present: closed-defect group, non-closed placing a standard-sized mesh group or non-closed placing an XL-sized mesh group. A 2-year follow-up was recorded. A total of 158 direct M3 inguinal hernias in 110 patients who underwent surgery were present. After propensity score matching at a 1:1 ratio, 22 patients for each group were analyzed. The mean age of patients was 62 years (41-84); with the majority being male (84.8%). 22 patients (40 hernias) underwent closure of the defect; 22 patients (39 hernias) did not undergo closure and used a standard-sized mesh; 22 patients (27 hernias) did not undergo closure and used an XL-sized mesh. There were 5 recurrences at 1 year post-operatively: all in the non-closure group with standard-sized mesh. This difference was statistically significant (p = 0.044). There were 7 recurrences (6.6%) at 2 years post-operatively: 6 in the non-closure group with standard-sized mesh and 1 in the non-closure group with XL-sized mesh (p = 0.007). Closing large direct inguinal hernia defects has shown promise in reducing early recurrence rates. However, conducting larger RCTs in the future could provide more conclusive evidence that might impact the way we approach laparoscopic inguinal hernia repair.
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Affiliation(s)
- F Brucchi
- University of Milano Statale, via Festa del Perdono, 7, 20122, Milan, MI, Italy.
| | - F Ferraina
- University of Milano Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - E Masci
- ASST Nord Milano- Department of General Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni, MI, Italy
| | - D Ferrara
- ASST Nord Milano Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy
| | - D Cassini
- ASST Nord Milano- Department of General Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni, MI, Italy
| | - G Faillace
- ASST Nord Milano- Department of General Surgery, Sesto San Giovanni Hospital, Sesto San Giovanni, MI, Italy
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Park JH, Kim DJ. Laparoscopic transabdominal preperitoneal herniorrhaphy performed using an articulating laparoscopic instrument is feasible and more efficient. Front Surg 2024; 10:1305320. [PMID: 38239671 PMCID: PMC10794576 DOI: 10.3389/fsurg.2023.1305320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Ipsilateral left-sided-approach laparoscopic transabdominal preperitoneal herniorrhaphy (LA-TAPP) is a procedure used for inguinal hernia. However, conventional laparoscopic instruments may limit the operator's ability to approach certain areas during the procedure. This study aims to assess the feasibility of using an articulating bipolar grasper (ArtiSential®). Material and methods Between January 2017 and May 2022, 184 patients with inguinal hernia underwent LA-TAPP and were divided into an articulating group (AG) and a conventional group (CG). The two groups were compared for clinical characteristics, surgical outcomes, and recurrence rates. Learning curve analysis was also performed using the CUSUM score. Results The AG and CG included 72 and 112 patients, respectively. Both groups had similar age, sex, BMI, hernia location, and hernia type. The AG had a significantly shorter operation time (59.2 ± 29.4 vs. 77.8 ± 22.4 min, p < 0.001) than the CG. The duration of hospitalization was slightly shorter in the AG (2.2 ± 0.5 vs. 2.5 ± 1.4 days, p = 0.056). Postoperative complications were lower in the AG (5.6%) than in the CG (9.8%). Scrotal neuralgic pain was observed in 1.4% of patients in the AG and 3.6% of patients in the CG. Learning curve analysis revealed that 24 cases were needed to overcome the learning curve for using an articulating device. Conclusion IP-TAPP with an articulating instrument is a safe and efficient procedure. The operation time can be reduced by improving the surgeon's procedural autonomy and reducing collisions between the instruments and the patient's ribs.
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Śmietański M, Zamkowski M, Karbowski K, Kujawa MJ. Development and Implantation of 3D Anatomically Tailored Polypropylene Mesh for Laparoscopic Inguinal Hernia Repair Designed on the Basis of CT Images (the ILAM Study). Surg Innov 2023; 30:703-710. [PMID: 37819833 DOI: 10.1177/15533506231208335] [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] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The aim of the ILAM (Individualized Laparoscopic Anatomical Mesh) study was to create and implant a fully individualized mesh based on CT scans, taking into account the published body of knowledge about the material and mechanical behavior of the implant for laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA The team creating and conducting this study consisted of surgeons and engineers. A specific project was made and divided into 4 phases. METHODS The process of development and implantation was divided into 4 milestones: CT scans and modeling based on predefined subgroups, mesh manufacture, certification and clinical evaluation. RESULTS The result of the study was the first individually designed hernia mesh to have been implanted in a human subject. After 12 months of follow-up, no recurrences or other complications were reported. CONCLUSIONS The new mesh provides a better anatomic fit to the patients' inguinal region geometry. Mechanical stability is ensured by the multiple contact points between the implant and the tissues, which generate friction forces. Together with the possibility of shape design (proper overlap), the authors believe that there is no need for mesh fixation. If so, the use of such design meshes can change the guidelines in laparoendoscopic hernia repair in the future.
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Affiliation(s)
- Maciej Śmietański
- Department of General Surgery and Hernia Center, Swissmed Hospital, Gdańsk, Poland
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Mateusz Zamkowski
- Department of General Surgery and Hernia Center, Swissmed Hospital, Gdańsk, Poland
| | - Krzysztof Karbowski
- Faculty of Mechanical Engineering, Cracow University of Technology, Cracow, Poland
| | - Mariusz J Kujawa
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Tan L, Lim J, Lee J, Loo L, Lomanto D, Parameswaran R, Shabbir A, Murphy D, Kumari S, Wijerathne S. The impact of value-driven outcomes initiative on endo-laparoscopic groin hernia repair. Hernia 2023; 27:1299-1306. [PMID: 36427167 DOI: 10.1007/s10029-022-02717-4] [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: 09/17/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Value driven outcome (VDO) initiative is a value-based, patient-focused tool which utilizes a clinical outcome-based approach to optimize value of care based on clinically relevant quality indicators and costs required to achieve the care. In this study, we evaluate the impact of a VDO initiative on groin hernia repair, a commonly performed elective surgery in our hospital. METHODS A VDO initiative was implemented in 2019 to encourage elective inguinal hernia repair to be performed at a day surgery setting. A comparison of outcomes was made between hernia surgeries performed in 2019 with those in 2020 and 2021. Pre-defined criteria were used to select patients that can be operated at a day surgery setting. Patients' expectations were addressed preoperatively about day surgery procedure and postoperative recovery. Day surgery bundles were used to standardize pre- and post-surgery protocols. Pain control was optimized using a specialized local anesthesia regime. RESULTS A total of 263 laparoscopic hernia surgeries were performed between May 2019 and December 2021. After implementation of VDO initiative, the percentage of patients discharged within 24 h increased from 78% in year 2019 to 97% in year 2020 and 99% in year 2021. Conversion rate for day surgery to short stay decreased from 9% in year 2019 to 1% in year 2020 and 2% in year 2021. In 2019 to 2021, there were no 30-day readmission, no hernia recurrence in 90 days, no conversion to open surgery. CONCLUSION VDO initiative is a promising tool to deliver better value-based care for patients undergoing endo-laparoscopic inguinal hernia repair.
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Affiliation(s)
- Lydia Tan
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Joseph Lim
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - James Lee
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lynette Loo
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Davide Lomanto
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Rajeev Parameswaran
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Asim Shabbir
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Diarmuid Murphy
- Value Driven Outcome Office, National University Health System, Singapore, Singapore
| | - Shikha Kumari
- Value Driven Outcome Office, National University Health System, Singapore, Singapore
| | - Sujith Wijerathne
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore.
- Department of Surgery, National University of Singapore, Singapore, Singapore.
- Department of Surgery, National University Hospital, Level 8, NUHS Tower Block,1E Kent Ridge Rd, Singapore, 119228, Singapore.
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Binyu L, Qin Z, Xiao Z, Daquan Z, Qing G, Jing Y, Yunhong T, Mingyang R. Clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia. Front Surg 2023; 10:1190788. [PMID: 37255745 PMCID: PMC10225536 DOI: 10.3389/fsurg.2023.1190788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose The incidence of seroma and postoperative pain after Gilbert type III inguinal hernia repair is high. To reduce postoperative complications, this study investigated the clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia. Methods Through a prospective randomized controlled study, a total of 193 patients with Gilbert type III indirect inguinal hernia admitted to Nanchong Central Hospital affiliated with Chuanbei Medical College from May 2020 to December 2021 were selected and randomly divided into the inner ring closed group (85 patients) and the inner ring non-closed group (95 patients). The patients in both groups underwent laparoscopic tension-free repair of their inguinal hernias. General information such as operative time, postoperative hospital stay, and hospital cost were compared between the two groups, and the patients were followed up at 1, 7, 14, 21, and 28 days and then 3, 6, and 12 months after surgery to compare complications such as incidence of seroma, volume of the seroma fluid, incidence of pain, and visual analogue scale (VAS) pain score. Results There was no conversion to open procedures in any of the patients. The operation time of the closed group was significantly longer than that of the non-closed group (64.2 ± 12.2 vs. 55.3 ± 9.5 min, P < 0.01). The proportion of patients with postoperative pain in the two groups was 39 (46%) vs. 59 (62%), P = 0.029 on 7 days; 17 (20%) vs. 33 (35%), P = 0.028 on 14 days; and 6 (7%) vs. 22 (23%), P = 0.003 on 21 days in the postoperative closed group and was significantly lower than that in the non-closed group, while we found that the non-closed group had a higher VAS pain score than that of the closed group (2.36 ± 0.61 vs. 1.95 ± 0.71, P = 0.003 on 7 days and 2.12 ± 0.49 vs. 1.65 ± 0.49, P = 0.002 on 14 days) after surgery according to the statistical results of the VAS pain score. The incidence of postoperative seroma and the amount of seroma fluid decreased gradually in both groups, but when comparing the two groups, the proportion of cases of seroma in the closed group on 7 days [45 (53%) vs. 79 (83%), P < 0.01]; 14 days [23 (27%) vs. 43 (45%), P = 0.011]; and 21 days [10 (12%) vs. 29 (31%), P = 0.002] after the operation were significantly less than that in the non-closed group. For the comparison of the amount of seroma fluid between the groups, the seroma fluid volume in the non-closed group was greater than that in the closed group (34.48 ± 20.40 vs. 43.87 ± 16.40 ml, P = 0.006, 7 days) and (21.79 ± 8.42 vs. 30.74 ± 10.39 ml, P = 0.002, 14 days) after surgery. There were no differences in the length of stay, total hospital costs, or postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding, and infection) between the two groups, and the differences were not statistically significant (P > 0.05). The postoperative follow-up period was 3-20 months, and no chronic pain or recurrence occurred during the postoperative follow-up period in either group. Conclusions Closure of the hernia ring is safe and effective for laparoscopic hernia repair for Gilbert type III inguinal hernia, and it significantly reduces the incidence of postoperative seroma and further reduces the postoperative pain without increasing the risk of postoperative infection and recurrence.
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Affiliation(s)
- Luo Binyu
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Zhang Qin
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhang Xiao
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Zhang Daquan
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Guo Qing
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Yu Jing
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Tian Yunhong
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Ren Mingyang
- Department of Gastrointestinal Surgery, Affiliated Nanchong Central Hospital and The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
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Tai TE, Bai GH, Shiau CH, Wu JC, Hou WH. Fascia defect closure versus non-closure in minimal invasive direct inguinal hernia mesh repair: a systematic review and meta-analysis of real-world evidence. Hernia 2023; 27:459-469. [PMID: 36576667 DOI: 10.1007/s10029-022-02732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Laparoscopic and robotic inguinal hernia mesh repair are both common surgical procedures worldwide. Postoperative hernia recurrence and seroma formation are important concerns. In ventral hernia, primary defect closure in laparoscopic surgery reduces the recurrence rate. However, there is no synthetic evidence of direct inguinal hernia defect closure versus non-closure in minimal invasive surgery. Therefore, this study investigated the efficacy of defect closure in patients undergoing minimal invasive direct inguinal hernia mesh repair. METHODS Eligible studies were identified through a search of PubMed, Embase, Cochrane Library, and CINAHL from their inception until March 2022. Studies examining defect closure in laparoscopic direct inguinal hernia repair were included, and a meta-analysis was performed using the random-effect model. Sensitivity analyses were performed by removing one study at a time. The primary outcomes were hernia recurrence and seroma formation. Acute and chronic postoperative pain, operation time, and length of hospital stay were the secondary outcomes. RESULTS Five nonrandomized studies and one randomized controlled trial were included. Pooled analysis revealed defect closure might reduce the hernia recurrence rate (risk difference, - 0.02; 95% confidence interval [CI] - 0.04 to - 0.00; p = 0.02). The result of seroma formation (odds ratio, 0.49; 95% CI 0.17-1.46; p = 0.20) showed no significant difference. Moreover, no significant differences were observed in acute postoperative pain, chronic pain, length of hospital stay, and operation time. CONCLUSIONS Our study indicated defect closure seems to be an option to reduce the direct inguinal hernia recurrence rate. No significant benefits were shown in seroma formation and other secondary outcomes. Our study was mostly based on nonrandomized studies and underestimated the effect of defect closure; thus, further high-quality studies are required to draw definitive conclusions.
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Affiliation(s)
- Ting-En Tai
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Geng-Hao Bai
- Department of General Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chu-Hsuan Shiau
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Education, Taipei Medical University Hospital, Taipei, Taiwan.
- College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Geriatrics and Gerontology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study. Surg Endosc 2023; 37:1781-1788. [PMID: 36229552 DOI: 10.1007/s00464-022-09699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although international guidelines recommend not fixing the mesh in almost all cases of laparoendoscopic repairs, in case of large direct hernias (M3) mesh fixation is recommended to reduce recurrence risk. Despite lack of high-quality evidence, the recommendation was upgraded to strong by expert panel. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. METHOD The authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. RESULTS Heavyweight spatial meshes and lightweight spatial-individualized meshes showed no tendency to dislocate or move directly to the orifice, which was considered a rapid hernia recurrence. Lightweight meshes, both spatial and flat, underwent significant migration and shifting toward the hernial orifices. CONCLUSION Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved using a larger, more rigid, and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.
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Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta-analysis. Hernia 2022; 27:259-264. [PMID: 36495351 DOI: 10.1007/s10029-022-02724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Recurrence is a known complication to inguinal herniotomy with an incidence of 10 to 15 percent (Hernia Surge Group in Hernia 22:165, 2018). Previous studies have shown that direct hernia or large defects are risk factors for postoperative seroma formation (Morito et al. in Surg Endosc https://doi.org/10.1007/s00464-021-08814-2 , 2021). These types of defects are often closed during open herniotomy (Rosenberg et al. in Dan Med Bull 58: C4243, 2011). This is not routine during laparoscopic surgery. A recent study has indicated that closure of the medial defect during laparoscopy may reduce recurrence and seroma formation. As a result, we performed the present systematic review to evaluate the efficacy of this add on to the standard procedure. METHODS An extensive search was carried out in PubMed and Embase. All studies involving adults undergoing laparoscopic direct hernioplasty were enrolled and screened with predefined inclusion criteria, to be part of a systematic review with data synthesis and meta-analysis. RESULTS The search identified 108 publications of which four met the inclusion criteria. Two studies (Ng et al. in Hernia 24:1093-1098, 2020; Usmani et al. in Hernia 24:167-171, 2020) showed reduced risk of recurrence. The remaining studies (Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019; Li and Zhang in Surg Endosc 32:1082-1086, 2018) reported no recurrence in any of the patients included. Two articles (Usmani et al. in Hernia 24:167-171, 2020; Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18-21, 2019) showed a decrease in risk of postoperative seroma, one showed a significant increase (Ng et al. in Hernia 24:1093-1098, 2020). None of the included studies showed an increase in the risk of postoperative pain or postoperative complications. CONCLUSION This review suggests that closure versus non-closure of the medial hernia defect in laparoscopic inguinal hernioplasty reduces the risk of recurrence and seroma formation without an increase in postoperative pain or complications. Further randomized controlled trials are needed for further evaluation.
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Karabulut M, Donmez T, Sahbaz NA, Akarsu C, Ferahman S, Surek A, Gemici E, Aydin H, Sunamak O, Dural AC. Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty. Surg Laparosc Endosc Percutan Tech 2022; 32:373-379. [PMID: 35583552 DOI: 10.1097/sle.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. MATERIALS AND METHODS We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. RESULTS The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. CONCLUSION Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.
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Affiliation(s)
- Mehmet Karabulut
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Turgut Donmez
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
- Department of General Surgery, Lutfiye Nuri Bulat State Hospital
| | - Nuri A Sahbaz
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Cevher Akarsu
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Sina Ferahman
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Ahmet Surek
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Eyup Gemici
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Husnu Aydin
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
| | - Oguzhan Sunamak
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital
| | - Ahmet C Dural
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital
- Department of General Surgery, Faculty of Medicine, Istinye University
- Department of General Surgery, Liv Hospital, Istanbul, Turkey
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Wai L, Wijerathne S, Liew L, Venkatesan S, Lee J, Loh C, Lomanto D. Novel local anaesthesia technique 'NATURE' (Nerves And Transversalis-fascia Using RopivacainE) to improve outcomes during endo-laparoscopic inguinal hernia repair. Asian J Surg 2021; 45:1547-1552. [PMID: 34774400 DOI: 10.1016/j.asjsur.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of local anaesthesia infiltration techniques may attenuate pain following endo-laparoscopic inguinal hernia surgery. We aim to reduce post-operative pain and the subsequent need for analgesia using a novel technique of local anaesthesia infiltration 'NATURE' (Nerves And Transversalis-fascia Using RopivacainE). METHODS This is a retrospective study of patients who underwent endo-laparoscopic inguinal hernia repair in two institutions in Singapore. Patients who received the local anaesthesia according to the new technique (intervention group) were compared to patients who received local anaesthesia only over their surgical incisions (control group). RESULTS Data on 97 patients were analysed. There were 50 (51.5%) patients in the intervention group and 47 (48.5%) patients in the control group. No significant differences were observed in the two patient population's baseline characteristics, operative time and cumulative need for medications. The intervention group reported lower pain levels immediately after surgery (1.4 ± 1.7 versus 2.4 ± 1.9, p<0.01) and at 4 hours post-surgery (0.9 ± 1.1 versus 1.4 ± 1.2, p = 0.02). They also had lower levels of post-operative complications (4% versus 21.3%, p = 0.03). CONCLUSION Infiltration of local anaesthesia at specific anatomical locations during endo-laparoscopic inguinal hernia surgery can be effective in minimising post-operative pain. Prospective randomised controlled trials are needed to further substantiate this technique.
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Affiliation(s)
- Louis Wai
- Department of General Surgery, National University Health System, Singapore.
| | - Sujith Wijerathne
- Department of General Surgery, National University Health System, Singapore; General Surgery Service, Alexandra Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lydia Liew
- Department of Anaesthesia, National University Health System, Singapore
| | - Shree Venkatesan
- Department of Anaesthesia, National University Health System, Singapore
| | - James Lee
- Department of General Surgery, National University Health System, Singapore
| | - Clement Loh
- Department of General Surgery, National University Health System, Singapore
| | - Davide Lomanto
- Department of General Surgery, National University Health System, Singapore; General Surgery Service, Alexandra Hospital, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Morito A, Kosumi K, Kubota T, Yumoto S, Matsumoto T, Mima K, Inoue M, Mizumoto T, Miyanari N, Baba H. Investigation of risk factors for postoperative seroma/hematoma after TAPP. Surg Endosc 2021; 36:4741-4747. [PMID: 34713342 DOI: 10.1007/s00464-021-08814-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Seroma/hematoma formation is the most common postoperative complication after laparoscopic inguinal hernia repair. The occurrence of seroma/hematoma remains unclear. The aim of this study was to determine the risk factors for seroma/hematoma formation after transabdominal preperitoneal patch plasty (TAPP). METHODS The study enrolled 359 groin hernia patients treated by TAPP at Kumamoto Medical Center between 2014 and 2019. The primary outcome was risk factors for postoperative seroma/hematoma formation after TAPP. The secondary outcomes included recurrence of hernia, postoperative complications, and hospital stay. RESULTS Among the 359 patients, the incidence rate of seroma/hematoma was 16% (n = 69 patients), and the recurrence rate was 0.3% (n = 1 patient, both sides). In total, there were 452 lesions. Japan Hernia Society (JHS) type II was present in 23% (n = 106) of the total cases but was significantly more common in the postoperative seroma/hematoma group (40%; P = 0.0082). Meanwhile, JHS type I-3 comprised 27% of the total JHS type I group but was significantly higher in the postoperative seroma/hematoma JHS type I group (40%; P = 0.016). Compared with JHS type I, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS type II was 2.77 (95% CI 1.54-4.95). Compared with JHS grade 1/2, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS grade 3 was 2.27 (95% CI 1.28-4.03). CONCLUSIONS Internal inguinal hernia and hernia size ≥ 3 cm were considered risk factors for postoperative seroma/hematoma formation after TAPP.
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Affiliation(s)
- Atsushi Morito
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keisuke Kosumi
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Shinsei Yumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takashi Matsumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Wijerathne S, Wai L, Lee J, Loh C, Malik S, Lomanto D. Feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages. Hernia 2021; 26:627-634. [PMID: 34599718 DOI: 10.1007/s10029-021-02505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the feasibility of modified-TEP technique in reducing dead space in large inguinoscrotal and large femoral hernia to prevent seroma, reduce recurrence and complications. METHODS This is a case series of patients who have completed a minimum of 9 months follow-up after undergoing elective endo-laparoscopic inguinal hernia repair with modified-TEP technique for large inguinoscrotal and large femoral hernia in a single institution from June to October 2020. RESULTS 14 large inguinoscrotal hernia and 4 large femoral hernia were repaired using the modified-TEP technique in 15 patients. These patients reported minimal pain after surgery. There were no reported seroma, complications or recurrences up to 9 months follow-up period. CONCLUSION Modified-TEP technique for large inguinoscrotal and large femoral hernia has shown good outcomes and patients reported minimum levels of pain. In experienced hands, it is safe, feasible and effective in reducing seroma formation and hernia recurrence.
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Affiliation(s)
- S Wijerathne
- Department of General Surgery, National University Health System, Singapore, Singapore. .,General Surgery Service, Alexandra Hospital, National University Health System, Singapore, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, National University, Health System (NUHS), Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - L Wai
- Department of General Surgery, National University Health System, Singapore, Singapore
| | - J Lee
- Department of General Surgery, National University Health System, Singapore, Singapore
| | - C Loh
- Department of General Surgery, National University Health System, Singapore, Singapore
| | - S Malik
- Department of General Surgery, National University Health System, Singapore, Singapore
| | - D Lomanto
- Department of General Surgery, National University Health System, Singapore, Singapore.,General Surgery Service, Alexandra Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kudsi OY, Bou-Ayash N, Gokcal F, Chang K. Robotic Direct Inguinal Hernia Repair: To Plicate or Not to Plicate? Surg Laparosc Endosc Percutan Tech 2021; 31:716-721. [PMID: 34310555 DOI: 10.1097/sle.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Closure of the direct inguinal defect with plication in minimally invasive direct inguinal hernia repair may have potential benefits in terms of reducing postoperative surgical site events (SSEs) and recurrences. However, these advantages remain unclear, particularly in the robotic literature. This is the first comparative study to investigate the outcomes after robotic direct inguinal hernia repair (RDIHR) with defect plication. MATERIALS AND METHODS Among patients who underwent RIHR between 2013 and 2020, those who underwent RDIHR were selected. Patients were then stratified into 2 groups based on defect plication status, and univariate analyses were used to compare variables across preoperative, intraoperative, and postoperative timeframes. RESULTS A total of 225 RDIHRs were performed in 176 patients, where 74 were assigned to the Plication (+) group and 102 patients were assigned to the Plication (-) group. There was a significantly higher proportion of females in the Plication (-) group (10.8% vs. 1.4%, P=0.015), which accounts for the higher incidence of accompanying femoral hernias in this group. While most M1 hernia defects were left patent, most M2 and M3 hernias were plicated. Larger mesh sizes were used in the Plication (+) group (P<0.001). Three SSEs were observed in the Plication (-) group versus 2 SSEs in the Plication (+) group. No significant differences in postoperative outcomes were found between the 2 groups. CONCLUSIONS Postoperative seroma incidence, pain scores, and recurrence rates were similar between the 2 study groups. Multicenter studies with larger populations and higher complication counts are needed to establish the role of defect plication in RDIHR.
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Affiliation(s)
- Omar Y Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA
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14
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Does primary closure of direct inguinal hernia defect during laparoscopic mesh repair reduce the risk of early recurrence? Hernia 2020; 24:1093-1098. [PMID: 32638243 DOI: 10.1007/s10029-020-02257-9] [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: 11/28/2019] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hernia recurrence is an important complication following inguinal hernia repair. Primary closure of ventral hernia defects laparoscopically has been shown to reduce the risk of recurrence and seroma formation. The results for ventral hernias may potentially be applied to direct inguinal hernias. Our aim was to evaluate the value of primary closure of direct defects during laparoscopic inguinal hernia mesh repair in reducing the incidence of early recurrence. METHODS A retrospective, single-center cohort study was conducted on cases performed from August 2016 to February 2018. Patients with direct inguinal hernias undergoing elective laparoscopic mesh repair were included. When performed, the direct hernia defect was primarily closed with extracorporeal non-absorbable interrupted sutures followed by standard placement of a lightweight mesh covering myopectineal orifices. Early recurrence was defined as occurring within 1 year of surgery. RESULTS A total of 75 direct inguinal hernias in 53 patients who underwent surgery and completed at least 1 year of follow-up were analyzed. The mean age of patients was 63 years (range 44-82 years); with majority of patients being male (98.1%). There were no significant differences observed between the two patient populations in terms of demographics, mean operative time and risk factors. In 9 (16.9%) patients, the direct hernias were recurrent hernias and all underwent open mesh repair during the index hernia surgery. The majority of hernia repairs (63 hernias in 45 patients, 85%) were performed via the totally extraperitoneal (TEP) approach. 19 patients (35.8%) with 28 direct inguinal hernias underwent primary closure of the direct defect prior to mesh placement; while, 34 patients (64.2%) with 47 direct hernias did not undergo primary closure. There were 3 direct hernia recurrences (6.4%) at 1 year post-operatively, and all occurred in the non-closure group. In comparison, there were no recurrences in the closure group; however, this difference was not statistically significant (p = 0.289) in our study due to the small sample size. CONCLUSION Closure of direct inguinal hernia defects during laparoscopic mesh repair has been shown to reduce the incidence of early hernia recurrence in our retrospective study but future randomized controlled trials with large numbers would enable us to draw more robust conclusions and perhaps change the way we perform laparoscopic inguinal hernia repair.
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15
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Li J. Comment on "Effect of direct defect closure during laparoscopic inguinal hernia repair ("TEP/TAPP plus" technique) on post-operative outcomes". Hernia 2019; 24:1147-1149. [PMID: 31773550 DOI: 10.1007/s10029-019-02080-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- J Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
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