Lloyd Nyhus and Rene Stoppa: preperitoneal inguinal pioneers

Comparative Study of Self-Gripping Mesh vs. Polypropylene Mesh in Lichtenstein's Open Inguinal Hernioplasty

Background Inguinal hernia is one of the most common conditions in India, and history has many repair techniques recorded in it. Postoperative pain still remains a problem despite tension-free hernioplasty being accepted as the gold standard. Increased duration of surgery not only exposes the patient to unwanted increased chances of mesh infection but also reduces the surgeon's productivity if continued persistently. In this study, the main aim was to compare the fixation techniques of polypropylene mesh vs. self-gripping mesh in inguinal hernia surgery in terms of duration of surgery, postoperative pain, seroma, recurrence, foreign body sensation, and wound infections. Methods It is a prospective, comparative, and quantitative study conducted at Sri Ramachandra Institute of Higher Education and Research in the Department of General Surgery. Patients presenting with inguinal hernia to the OPD were included in the study. The sampling technique used in this study is simple, convenient sampling. As a result, the calculation of the margin of error and confidence levels may be difficult. Nevertheless, the sample accurately represents the population. Patients were divided into two groups: the study group (25), patients undergoing hernioplasty with self-gripping mesh, and the control group (25), patients undergoing hernioplasty with polypropylene mesh using conventional suturing. The duration of surgery, postoperative pain, seroma, recurrence, foreign body sensation, and wound infections were compared and analyzed between the two groups. Results In this study, the duration of surgery was less than one hour for three patients (12%) in the control group (polypropylene), compared to 13 (52%) patients in the study group (self-gripping), which is statistically significant. The early postoperative pain on POD 0 was greater than 4 (visual analogue score) in 8 (32%) patients in the control group and two (8%) patients in the study group. There were no significant differences in chronic pain, recurrence rate, seroma rate, or wound infection between the two groups. Conclusions In our study, we conclude that self-gripping mesh is superior to polypropylene mesh in surgery of inguinal hernia in terms of shorter duration of surgery. There is also reduced pain in the immediate postoperative period though not statistically significant. There is no significant difference in both the groups in terms of seroma formation, wound infection, foreign body sensation, and recurrence.

A new approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair

BACKGROUND

To investigate the feasibility, safety and efficacy of the right-side approach to enter Retzius space in laparoscopic transabdominal preperitoneal bilateral inguinal hernia repair.

METHODS

Retrospective analysis was performed on 189 patients who were diagnosed with bilateral inguinal hernia preoperatively or intraoperatively and underwent selective TAPP in the General Surgery I Section of Shaanxi Provincial People's Hospital from January 2015 to September 2020. 94 cases were performed using the right-side approach (research group), and 95 cases with conventional approach (control group). Intraoperative and postoperative conditions of the two groups were observed and compared.

RESULTS

All operation were completed successfully. The operative time of research group was significantly shorter than that of control group (128.8 ± 35.4 vs 144.1 ± 40.9 min, P = 0.006). There were no significant differences in postoperative hospital stay, VAS score on first postoperative day, incidence of seroma and hematoma, urinary retention and other complications (P > 0.05). None of the patients occured hernia recurrence, mesh infection, intestinal obstruction and other complications.

CONCLUSIONS

The right-side approach to enter Retzius space is safe and feasible in TAPP surgery of bilateral inguinal hernia. Compared with the conventional approach, it can shorten the operative time and has certain advantages.

Scaffolds for Pelvic Floor Prolapse: Logical Pathways

Pelvic organ prolapse (POP) has borrowed principles of treatment from hernia repair and in the last two decades we saw reinforcement materials to treat POP with good outcomes in terms of anatomy but with alarming complication rates. Polypropylene meshes to specifically treat POP have been withdrawn from market by manufactures and a blank space was left to be filled with new materials. Macroporous monofilament meshes are ideal candidates and electrospinning emerged as a reliable method capable of delivering production reproducibility and customization. In this review, we point out some pathways that seem logical to be followed but have been only researched in last couple of years.