Feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages

The impact of value-driven outcomes initiative on endo-laparoscopic groin hernia repair

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.

Seroma-prevention strategies in minimally invasive inguinal hernia repair

BACKGROUND:

The rise of minimally invasive inguinal hernia repair has seen both the laparoscopic and robotic approaches increase in popularity in recent years. Despite this, seroma formation remains a common complication, and the aim of this study is to evaluate the current evidence on seroma-prevention strategies in minimally invasive inguinal hernia repair.

MATERIALS AND METHODS:

Four databases (PubMed, Scopus, Embase, and Cochrane Library) were searched from inception to November 15, 2021. All studies describing the use of intraoperative adjuncts to reduce postoperative seroma formation in patients undergoing laparoscopic or robotic inguinal and inguinoscrotal hernia repair were included. Meta-analyses were performed using Review Manager (Version 5.4).

RESULTS:

2,382 articles were identified in the initial database search, and 40 articles were included in the final analysis. In this analysis, there was a significantly lower incidence of seroma formation in the drain group when compared to the no-drain group (P < 0.00001). Other strategies aimed at reducing the dead space involving the transversalis fascia (TF) and hernia sac such as TF inversion with tacking, Endoloop closure of TF, barbed suture closure of TF, distal sac fixation, and complete dissection of the sac have shown promising results as well.

CONCLUSIONS:

While there is currently insufficient evidence to recommend the routine use of any one of the interventions analyzed, the use of drains, the management of the TF, and the hernia sac have showed potential in reducing seroma formation.