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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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Bostanci BE, Tetik C, Özer Ş, Özden A. Posterior Approaches in Groin Hernia Repair with Prosthesis: Open or Closed. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- B. E. Bostanci
- Department of Surgery, Medical Faculty of Pamukkale University, Denizli
| | - C. Tetik
- Department of Surgery, Medical Faculty of Pamukkale University, Denizli
| | - Ş. Özer
- Department of Surgery, Kasimpaşa Naval Hospital, Istanbul, Turkey
| | - A. Özden
- Department of Surgery, Medical Faculty of Pamukkale University, Denizli
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair. Surg Res Pract 2018; 2018:7850671. [PMID: 29808170 PMCID: PMC5901827 DOI: 10.1155/2018/7850671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.
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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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Shakya VC, Sood S, Bhattarai BK, Agrawal CS, Adhikary S. Laparoscopic inguinal hernia repair: a prospective evaluation at Eastern Nepal. Pan Afr Med J 2014; 17:241. [PMID: 25170385 PMCID: PMC4145269 DOI: 10.11604/pamj.2014.17.241.2610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 02/24/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Inguinal hernias have been treated traditionally with open methods of herniorrhaphy or hernioplasty. But the trends have changed in the last decade with the introduction of minimal access surgery. Methods This study was a prospective descriptive study in patients presenting to Surgery Department of B. P. Koirala Institute of Health Sciences, Dharan, Nepal with reducible inguinal hernias from January 2011 to June 2012. All patients >18 years of age presenting with inguinal hernias were given the choice of laparoscopic repair or open repair. Those who opted for laparoscopic repair were included in the study. Results There were 50 patients, age ranged from 18 to 71 years with 34 being median age at presentation. In 41 patients, totally extraperitoneal repair was attempted. Of these, 2 (4%) repairs were converted to transabdominal repair and 2 to open mesh repair (4%). In 9 patients, transabdominal repair was done. The median total hospital stay was 4 days (range 3-32 days), the mean postoperative stay was 3.38±3.14 days (range 2-23 days), average time taken for full ambulation postoperatively was 2.05±1.39 days (range 1-10 days), and median time taken to return for normal activity was 5 days (range 2-50 days). One patient developed recurrence (2%). None of the patients who had laparoscopic repair completed complained of neuralgias in the follow-up. Conclusion Laparoscopic repair of inguinal hernias could be contemplated safely both via totally extra peritoneal as well as transperitoneal route even in our setup of a developing country with modifications.
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Affiliation(s)
- Vikal Chandra Shakya
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shasank Sood
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | | | - Shailesh Adhikary
- Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Sousa LHD, Ceneviva R, Coutinho Netto J, Mrué F, Sousa Filho LHD, Castro e Silva OD. Morphologic evaluation of the use of a latex prosthesis in videolaparoscopic inguinoplasty: an experimental study in dogs. Acta Cir Bras 2012; 26 Suppl 2:84-91. [PMID: 22030821 DOI: 10.1590/s0102-86502011000800016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
PURPOSE To evaluate the morphological aspects of the behavior of 4 types of latex biomembranes implanted in preperitoneal videolaparoscopic inguinoplasty. METHODS Sixteen inguinoplasties were performed in 12 dogs: group 1 received an impermeable latex biomembrane in the right inguinal region and a prolene prosthesis, as control, in the contralateral inguinal region; groups 2, 3 and 4 received latex biomembranes respectively containing impermeable polyamide, 1-mm thick porous polyamide and 0.5-mm thick porous polyamide. Macro- and microscopic evaluations of the inguinal region and of the removed implants were made on the 7th, 14th, 21st and 28th days in group 1 and on the 28th postoperative day in the other groups. RESULTS We observed absence of hematoma, seroma and infection; presence of tortuosities; induction of vascular neoformation, inflammatory reaction and collagen deposition, and full encystment of the latex biomembranes, except that with fine porous polyamide, which was partially incorporated, with the formation of microcysts. No latex biomembrane induced fibrosis as observed in the prolene control group. CONCLUSIONS The biomembranes maintain induction of the healing process without fibrosis, are fully encysted and, except for the one with fine porous polyamide, are not incorporated into adjacent tissues. The latex biomembrane, with or without polyamide, is not recommended as a separate material for preperitoneal inguinoplasty.
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Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L. Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study. Surg Endosc 2010; 25:1624-9. [PMID: 21170663 PMCID: PMC3071468 DOI: 10.1007/s00464-010-1462-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 10/13/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endoscopic inguinal hernia repair was introduced in the Netherlands in the early 1990s. The authors' institution was among the first to adopt this technique. In this study, long-term hernia recurrence among patients treated by the total extraperitoneal (TEP) approach for an inguinal hernia is described. A cohort study was conducted. METHODS Between January 1993 and December 1997, 346 TEP hernia repairs were performed for 318 patients. After a mean follow-up period of 13-years, a senior resident examined each patient. An experienced surgeon subsequently examined the patients with a diagnosis of recurrent hernia. Data were collected on an intention-to-treat basis, meaning that conversions were included in the analysis. Univariant tests were used to analyze age older than 50 years, chronic obstructive pulmonary disease, body mass index, smoking habit, hernia type, history of open hernia repair, conversion, and surgeon as potential risk factors. RESULTS The analysis included 191 patients (62%) with 213 hernias. Of the original 318 patients, 59 patients died, and 68 were lost to follow-up evaluation. Perioperatively, 105 lateral, 55 medial, and 53 pantalon hernias were observed. Of the 213 hernias, 176 were primary and 37 were recurrent. The overall recurrence rate was 8.9% (8.5% for primary and 10.8% for recurrent hernias). Of the total study group, 48% of the patients experienced a bilateral inguinal hernia during their lifetime. No predicting factor for recurrent hernia could be identified. CONCLUSIONS The current long-term results for TEP repair of primary and secondary inguinal hernia show an overall recurrence rate of 8.9%, which is slightly higher than in previous studies. The thorough examination at follow-up assessment, the learning curve effect, and the intention-to-treat-analysis may have influenced the observed recurrence rate. Also, the percentage of bilateral hernias was higher than known to date. Therefore, examination of the contralateral side should be standard procedure.
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Mainik F, Quast G, Flade-Kuthe R, Kuthe A, Schroedl F. The preperitoneal loop in inguinal hernia repair following the totally extraperitoneal technique. Hernia 2010; 14:361-7. [PMID: 20213455 DOI: 10.1007/s10029-010-0644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 02/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND With increasing experience in totally extraperitoneal (TEP) hernia repair, we observed an anatomical structure not described in the literature. It is a loop-like structure under the ductus deferens or ligamentum teres uteri anchored laterally and medially to the peritoneum. Relatively constant in distance to the inner inguinal ring and individual in the grade of prominence, it inhibits correct patch placement medially. To identify and describe this so-called preperitoneal loop (pl), we performed this study. METHODS Between February 2nd and July 15th 2006, all patients undergoing a TEP procedure at our institution in primary inguinal hernia without previous operations in the lower abdomen were included. The main topic was the prominence and distance to the inner inguinal ring of the pl and histological examinations were made. RESULTS A total of 219 patients (194 male, 25 female) were included, with 97 right-side, 64 left-side and 58 bilateral hernias. The pl could be shown in 206 cases (94%), the distance to the inner ring was up to 1.5 cm in 60, between 1.5 and 3.0 cm in 112, and over 3 cm in 34 cases. Anatomical examinations showed smaller blood vessels embedded in fatty tissue and surrounded by collagen fibres (standard haematoxylin eosin [HE]) and collagen connective tissue strongly filled with elastic fibres and, occasionally, nerve fibres and lymphatic capillaries (van Gieson). CONCLUSIONS The pl is a very constant structure that is independent of gender and hernia type and size. In most cases, it is found close to the inner inguinal ring and, therefore, has to be cut for adequate parietalisation of cord structures/ligamentum teres uteri and correct mesh placement medially. As no mesothel was found, the origin of pl might be the deeper sheet of transversalis fascia.
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Affiliation(s)
- F Mainik
- Department for General and Trauma Surgery, DRK, Krankenhaus Clementinenhaus (German Red Cross Hospital Clementinenhaus), Lützerodestr. 1, 30161 Hanover, Germany.
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Misra MC, Bansal VK, Kumar S, Prashant B, Bhattacharjee HK. Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center. Hernia 2007; 12:65-71. [PMID: 17828462 DOI: 10.1007/s10029-007-0281-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 08/17/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND The laparoscopic repair of groin hernia is increasingly being used. However, the relative merits and demerits of laparoscopic repair are debatable. The present study was undertaken to evaluate the total extra-peritoneal (TEP) repair of groin hernia. METHODS This prospective study was undertaken at a single surgical unit between January 2004 and June 2006. Consecutive patients with elective groin hernias were offered laparoscopic TEP repair. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Polypropylene mesh was used in all of the patients and mesh fixation was performed with tackers. RESULTS A total of 185 patients with age range 18-92 years were included; 180 were males. TEP repair was attempted in 298 groin hernias in 185 patients with a success rate of 89.5%. Indigenous balloon or telescopic dissection was used to create extra-peritoneal space. Thirty-one (31, 10.5%) TEP repairs were converted to transabdominal pre-peritoneal or open repair. Two patients developed recurrence during follow-up. CONCLUSION TEP is an excellent technique for laparoscopic groin hernia repair, with acceptable rates of complication.
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Affiliation(s)
- M C Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Lopes RI, Dias AR, Lopes SI, Cordeiro MD, Barbosa CM, Lopes RN. A calcified foreign body in the bladder after laparoscopic inguinal hernia repair. Hernia 2007; 12:91-3. [PMID: 17541491 DOI: 10.1007/s10029-007-0243-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 04/23/2007] [Indexed: 11/26/2022]
Abstract
In this paper, we report an exceedingly rare complication after laparoscopic inguinal hernioplasty. A 57-year-old man was submitted to transurethral resection of the prostate followed by laparoscopic "bikini mesh" hernia repair. One year later, he presented with miccional irritative symptoms. Ultrasonography showed a vesical intraluminal foreign body and computerized tomography revealed a calcified foreign body on the anterior bladder wall. On reoperation, it was noted that there occurred mesh transfixation of the bladder. The lateral segments were removed and the patient recovered uneventfully. This is a, thus far, unpublished complication of this technique.
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Affiliation(s)
- R I Lopes
- Sociedade Beneficente Hospital Sírio Libanês, São Paulo, Brazil.
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Berndsen FH, Petersson U, Arvidsson D, Leijonmarck CE, Rudberg C, Smedberg S, Montgomery A. Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia 2007; 11:307-13. [PMID: 17440795 DOI: 10.1007/s10029-007-0214-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 02/26/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse. METHODS One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation. RESULTS Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found. CONCLUSION There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.
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Eklund A, Rudberg C, Leijonmarck CE, Rasmussen I, Spangen L, Wickbom G, Wingren U, Montgomery A. Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 2007; 21:634-40. [PMID: 17364153 DOI: 10.1007/s00464-006-9163-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 10/10/2006] [Accepted: 10/25/2006] [Indexed: 01/04/2023]
Abstract
BACKGROUND The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. METHODS This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. RESULTS A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23-165 min) for the TAPP group and 64 min (range, 25-135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. CONCLUSION The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.
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Affiliation(s)
- A Eklund
- Department of Surgery, Västerås Hospital, 721 89, Västerås, Sweden.
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Butler RE, Burke R, Schneider JJ, Brar H, Lucha PA. The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial. Surg Endosc 2007; 21:387-90. [PMID: 17235721 DOI: 10.1007/s00464-006-9123-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
Abstract
For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair (1,200 dollars less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair (125 dollars more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics.
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Affiliation(s)
- Ralph E Butler
- Department of General Surgery, Naval Medical Center, Portsmouth, VA 23708-2197, USA
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Totté E, Van Hee R, Kox G, Hendrickx L, van Zwieten KJ. Surgical anatomy of the inguinal region: implications during inguinal laparoscopic herniorrhaphy. Eur Surg Res 2005; 37:185-90. [PMID: 16088185 DOI: 10.1159/000085967] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 02/28/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In laparoscopic inguinal hernia repair the inguinal region is approached and hernia repair performed from the interior side instead of the classical open external access. Exploration and placement of staplers in the internal inguinal region during laparoscopic hernia repair may sever different anatomical structures, or induce specific complications such as nerve entrapment, neuralgia, hematomas or osteitis. The incidence of these complications may be reduced by careful dissection of the preperitoneal tissues and by placing a prosthetic mesh without the use of stapling. As laparoscopic techniques evolved, different sizes of meshes have been used. An exact determination of mesh size was hitherto not investigated. AIM Cadaver studies of the topography of blood vessels and nerves in the preperitoneal tissue in this region were carried out in order to assess a safe position and adequate size of the prosthetic mesh. METHODS Dissection in 6 preserved human female cadavers was performed to define the actual surface of the internal inguinal region. A physical model was developed to formulate the ideal size of the prosthesis. Specific measurements were used to define the maximal size of the meshes, so as to place them without stapling, and without inducing neurovascular complications. RESULTS The designed physical formula defines the size of the mesh as a function of the maximum intra-abdominal pressure, the size of the abdominal wall defect and the abdominal wall tension. CONCLUSION On mathematical and physical grounds our study points out that the size of the currently used prosthetic mesh (10 x 15 cm) is large enough to be placed without stapling so that with proper placement no recurrences should occur.
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Affiliation(s)
- E Totté
- Academic Surgical Center Stuivenberg, General Centrum Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 2004; 90:1479-92. [PMID: 14648725 DOI: 10.1002/bjs.4301] [Citation(s) in RCA: 256] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair. METHODS A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January 1990 and the end of October 2000. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, time to discharge from hospital, return to normal activity and return to work, postoperative complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences. RESULTS Twenty-nine trials were considered suitable for meta-analysis. Some 3017 hernias were repaired laparoscopically and 2972 hernias were repaired using an open method in 5588 patients. For four of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 38 per cent in the relative odds of postoperative complications (odds ratio 0.62 (95 per cent confidence interval (c.i.) 0.46 to 0.84); P = 0.002), 4.73 (95 per cent c.i. 3.51 to 5.96) days in time to return to normal activity (P < 0.001), 6.96 (95 per cent c.i. 5.34 to 8.58) days in time to return to work (P < 0.001) and 3.43 (95 per cent c.i. 0.35 to 6.50) h in time to discharge from hospital (P = 0.029). There was a significant increase of 15.20 (95 per cent c.i. 7.78 to 22.63) min in the mean operating time for LIHR (P < 0.001). The relative odds of short-term recurrence were increased by 50 per cent for LIHR compared with OIHR, although this result was not statistically significant (odds ratio 1.51 (95 per cent c.i. 0.81 to 2.79); P = 0.194). CONCLUSION LIHR was associated with earlier discharge from hospital, quicker return to normal activity and work, and significantly fewer postoperative complications than OIHR. However, the operating time was significantly longer and there was a trend towards an increase in the relative odds of recurrence after laparoscopic repair.
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Affiliation(s)
- M A Memon
- Department of Surgery, Nottingham City Hospital, Nottingham, UK.
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Read RC. Milestones in the history of hernia surgery: prosthetic repair. Hernia 2003; 8:8-14. [PMID: 14586774 DOI: 10.1007/s10029-003-0169-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Accepted: 09/05/2003] [Indexed: 11/29/2022]
Abstract
Billroth (1878) envisaged prostheses before Bassini's sutured cure (1887). Phelps (1894) reinforced with silver coils. Metals were replaced by plastic (Aquaviva 1944). Polypropylene (Usher 1962), resisting infection, became popular. Usher instituted tensionless, overlapping preperitoneal repair. Spermatic cord was parietalized, to obviate keyholing. Stoppa (1969) championed the sutureless Cheatle-Henry approach encasing the peritoneum. His technique, "La grande prosthese de renforcement du sac visceral" (GPRVS), was adopted by laparoscopists. Newman (1980) and Lichtenstein (1986) pioneered subaponeurotic positioning. Kelly (1898) inserted a plug into the femoral canal; Lichtenstein and Shore (1974) followed. Gilbert (1987) plugged the internal ring, and Robbins and Rutkow (1993) treated all groin herniae thus. Incisional herniation has been controlled by prefascial, retrorectus prosthetic placement (Rives-Flament 1973). ePTFE (Sher et al. 1980) is useful intraperitoneally, since it evokes few adhesions. Here, laparoscopy (Ger 1982) is competitive. Beginning in 1964 (Wirtschafter and Bentley), experimental and clinical studies have shown herniation may be associated with aging and genetic or acquired (smoking, etc.) systemic disease of connective tissue. These data, with prospective trials, all but mandate tensionless prosthetic repair.
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Affiliation(s)
- Raymond C Read
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Safadi BY, Duh QY. Minimally invasive approaches to inguinal hernia repair. J Laparoendosc Adv Surg Tech A 2001; 11:361-6. [PMID: 11814126 DOI: 10.1089/10926420152761879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The technique of laparoscopic inguinal hernia repair has evolved during the past decade to become an effective and safe alternative for inguinal herniorrhaphy. In experienced hands, the procedure can be performed with low morbidity and with recurrence rates comparable to those following open repair using mesh. Several studies have shown a significant advantage for the laparoscopic approach, with less postoperative analgesic requirement and earlier return to work. Its limitations continue to be higher cost and complexity and the requirement for general anesthesia. The results and cost-effectiveness are maximized when applied to properly chosen patients by surgeons experienced in the procedure.
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Affiliation(s)
- B Y Safadi
- Department of Surgery, Stanford University and VA Medical Center, Palo Alto, California, USA
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Abstract
Laparoscopic inguinal herniorrhaphy (LIHR) was introduced with the following potential advantages: less postoperative discomfort and pain, reduced recovery time that allows earlier return to full activity, easier repair of a recurrent hernia, the ability to treat bilateral hernias concurrently, the performance of a simultaneous diagnostic laparoscopy, ligation of the hernia sac at the highest possible site, improved cosmesis, and decreased incidence of recurrence. Potential disadvantages include complications, such as bowel, bladder, and vascular injuries; potential adhesive complications at sites where the peritoneum has been breached or prosthetic material has been placed; the apparent need, at least at the present, for a general anesthetic; and the increased cost because of expensive equipment needs. Most surgeons agree that LIHR has a role in the management of patients with a recurrent hernia after a conventional inguinal herniorrhaphy (CIHR), bilateral inguinal hernia, or a need for laparoscopy for another procedure, such as laparoscopic cholecystectomy. The routine use of LIHR for the unilateral, uncomplicated hernia is a more contentious issue.
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Affiliation(s)
- M A Memon
- Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131, USA.
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Sebbag H, Brunaud L, Collinet-Adler S, Ulmer M, Marchal F, Grosdidier G. Long-term follow-up of totally extraperitoneal laparoscopic treatment of inguinal hernia at a single center. Hernia 2000. [DOI: 10.1007/bf01201087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
PURPOSE The aim of this study was to document the authors' experience with laparoscopy in the treatment of inguinal hernia in girls and boys. METHODS The internal inguinal ring was closed with 1 or 2 stitches of 4-0 monofilamentous material. Two 2-mm needle holders were inserted through the inferolateral abdominal wall. The laparoscope was advanced through the umbilicus. A total of 129 children underwent surgery. RESULTS Once the technique of intracorporeal suturing is mastered, the procedure is straightforward, requiring 22 minutes for bilateral and 16 minutes for unilateral hernias. Age and size are not factors because of the magnifying effect of the laparoscope. In almost half our patients, the preoperative diagnosis could not be matched unequivocally with the intraoperative findings. There was 1 recurrence of hernia in a boy. No serious complications and no hydroceles occurred. Five direct hernias were found in this group (5%). CONCLUSIONS The technique is easy for experienced laparoscopists. Bilaterality is of no concern. Cosmesis is superb. For recurrences, the technique is preferable to the open technique.
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Affiliation(s)
- F Schier
- Department of Pediatric Surgery, University Medical Center, Jena, Germany
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Halkic N, Ksontini R, Corpataux JM, Bekavac-Beslin M. Laparoscopic inguinal hernia repair with extraperitoneal double-mesh technique. J Laparoendosc Adv Surg Tech A 1999; 9:491-4. [PMID: 10632509 DOI: 10.1089/lap.1999.9.491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Totally extraperitoneal laparoscopic hernia repair is an efficient but technically demanding procedure. As mechanisms of hernia recurrence may be related to these technical difficulties, we have modified a previously described double-mesh technique in an effort to simplify the procedure. Extraperitoneal laparoscopic hernia repairs were performed in 82 male and 17 female patients having inguinal, femoral, and recurrent bilateral hernias. A standard propylene mesh measuring 15 x 15 cm was cut into two pieces of 4 x 15 cm and 11 x 15 cm. The smaller mesh was placed over both inguinal rings without splitting. The larger mesh was then inserted over the first mesh and stapled to low-risk zones, reinforcing the large-vessel area and the nerve transition zone. The mean procedure duration was 60 minutes for unilateral and 100 minutes for bilateral hernia repair. Patients were discharged from the hospital within 48 hours. The mean postoperative follow-up was 22 months, with no recurrences, neuralgia, or bleeding complications. Over a 2-year period, this technique was found to be satisfactory without recurrences or significant complications. In our hands, this technique was easier to perform: it allows for a less than perfect positioning of the meshes and avoids most of the stapling to crucial zones.
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Affiliation(s)
- N Halkic
- Department of Surgery, University Hospital, Lausanne-CHUV, Switzerland.
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Abstract
Groin hernias represent one of the most common procedures performed in general hospitals. The rapid changes that have been witnessed in prosthetic materials, open-approach surgeries, and laparoscopic techniques have made hernia surgery a most interesting field of endeavor that demands renewed discipline and dedication.
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Affiliation(s)
- R Bendavid
- Department of Surgery, Shouldice Hospital, Thornhill, Ontario, Canada
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Tsimoyiannis E, Tassis A, Glantzounis G, Jabarin M, Siakas P, Tzourou H. Surg Laparosc Endosc Percutan Tech 1998; 8:360-362. [DOI: 10.1097/00019509-199810000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Smith CD, Tiao G, Beebe T. Intraoperative events common to videoscopic preperitoneal mesh inguinal herniorrhaphy. Am J Surg 1997; 174:403-5. [PMID: 9337162 DOI: 10.1016/s0002-9610(97)00127-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Videoscopic preperitoneal mesh (VPM) inguinal herniorrhaphy avoids the entry into the abdominal cavity, which is necessary with other videoscopic techniques. Despite this advantage, surgeons have been slow to adopt this technique. We reviewed our experience with VPM inguinal herniorrhaphy, specifically investigating the technical aspects of this approach. METHODS Data were collected prospectively. Operative notes were reviewed retrospectively detailing intraoperative events not "typical" with the VPM technique. RESULTS One hundred consecutive patients undergoing VPM repair of 127 hernias were studied. The repair was completed in all but 2 patients. Mean operating time was 120 minutes (60 to 146). In 36 repairs there were 59 intraoperative "events" requiring specific maneuvers to correct. Events identified were the need for transection of the hernia sac, creation and repair of a peritoneal tear, and need to divide the inferior epigastric vessels. No complications related to these events occurred. When events occurred, operative times were significantly longer (146+/-45 versus 83+/-23 minutes; P <0.05). CONCLUSION Intraoperative events are common with VPM herniorrhaphy. These events significantly prolong operating time. A surgeon's lack of familiarity with such events and how to deal with them may in part explain the reluctance to widely apply the VPM technique.
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Affiliation(s)
- C D Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30365-2225, USA
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Leroy J, Barthélémy R. Laparoscopic repair of inguinal hernias with wide prosthesis using Stoppa's principles: analysis of 920 sites operated in 800 patients. Hernia 1997. [DOI: 10.1007/bf02426419] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Corcione F, Cristinzio G, Maresca M, Cascone U, Titolo G, Califano G. Primary inguinal hernia: The held-in mesh repair. Hernia 1997. [DOI: 10.1007/bf02426387] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liem MSL, van Vroonhoven TJMV. Laparoscopic inguinal hernia repair. Br J Surg 1996. [DOI: 10.1046/j.1365-2168.1996.02496.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lukaszczyk JJ, Preletz RJ, Morrow GJ, Lange MK, Tachovsky TJ, Krall JM. Laparoscopic herniorrhaphy versus traditional open repair at a community hospital. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1996; 6:203-8. [PMID: 8877736 DOI: 10.1089/lps.1996.6.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over a 2-year period 157 inguinal hernias in 151 patients were consecutively entered in this descriptive, observational study to determine any difference in outcome between a laparoscopic inguinal hernia repair versus an open inguinal hernia repair in a community hospital setting. The laparoscopic transabdominal preperitoneal technique was utilized in 50 cases. A conventional open repair was used in 107 cases. There were statistically significant differences when the laparoscopic and open groups were compared for the number of days until driving a car (p < 0.01), the number of days until getting in and out of bed comfortably (p = 0.01), the number of days until working on a limited basis (p = 0.01), and the number of days until working on a full-time basis (p < 0.05), although these differences may be due to confounding factors in this nonrandomized study. The average length of operating time was 72.2 min laparoscopic versus 51.6 min open (p < 0.001). We have shown that laparoscopic inguinal hernia repairs may have benefits over conventional hernia repairs. This may make its use more widespread than it has already become.
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Affiliation(s)
- J J Lukaszczyk
- Department of Surgery, St. Luke's Hospital, Bethlehem, Pennsylvania 18015, USA
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Abstract
There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent unilateral or bilateral hernias, and patients who, because of economic pressures, must return to work within 10 days of surgery. Within these limitations we feel that the laparoscopic approach definitely has a place in repair of inguinal hernias. In the future new techniques, decreased equipment costs, and the ability to use local anesthesia may increase the applicability of laparoscopic herniorrhaphy.
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Affiliation(s)
- L L Swanstrom
- Department of Minimally Invasive Surgery, Legacy Portland Hospital, Oregon, USA
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Amid PK, Shulman AG, Lichtenstein IL. Simultaneous repair of bilateral inguinal hernias under local anesthesia. Ann Surg 1996; 223:249-52. [PMID: 8604904 PMCID: PMC1235112 DOI: 10.1097/00000658-199603000-00004] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The authors confirm the advantages of simultaneous repair of bilateral inguinal hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral inguinal hernias. SUMMARY BACKGROUND DATA Between 1971 and 1995, simultaneous repair of bilateral inguinal hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect hernias underwent the traditional tissue approximation repair. Those with direct hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect hernias were repaired using the open tension-free hernioplasty procedure. METHOD The 2953 patients underwent simultaneous repair of bilateral inguinal hernias under local anesthesia in a private practice setting in general hospitals. RESULTS In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. CONCLUSIONS Uncomplicated bilateral inguinal hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less.
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Affiliation(s)
- P K Amid
- Lichtenstein Hernia Institute, Los Angeles, California 90069, USA
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White SI, O'Rourke N, Fielding GA. Laparoscopic mesh repair of recurrent inguinal hernia. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:91-3. [PMID: 8602822 DOI: 10.1111/j.1445-2197.1996.tb01119.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pre-peritoneal mesh repair has been a long-standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year. METHODS The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery. RESULTS There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications. CONCLUSIONS At early follow up, this is a satisfactory technique for recurrent hernias.
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Affiliation(s)
- S I White
- Medical Specialist Cenre, Wesley Hospital, Auchenflower, Queensland, Australia
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Abstract
Approximately 700,000 herniorrhaphies are performed annually in the United States for primary, recurrent, and bilateral inguinal hernias. This article describes the components of cost regarding the approach and management of groin hernias. The trends toward outpatient procedures, regional anesthetic agents, and early return to work are analyzed. The common types of repair are compared with reference to recurrence and complication rates. The advances and results of laparoscopic hernia are reviewed. In summary, a cost-effective approach for the management of inguinal hernias is presented that could reduce the yearly cost of hernia repair by hundreds of millions of dollars.
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Affiliation(s)
- K W Millikan
- Department of Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA
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Liem MS, van Steensel CJ, Boelhouwer RU, Weidema WF, Clevers GJ, Meijer WS, Vente JP, de Vries LS, van Vroonhoven TJ. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. Am J Surg 1996; 171:281-5. [PMID: 8619468 DOI: 10.1016/s0002-9610(97)89569-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several laparoscopic techniques have been introduced to re pair inguinal hernia, the newest and most promising being a totally extraperitoneal approach. Nevertheless, the surgeon may encounter several complications and technical difficulties associated with the transition from the conventional anterior operation. METHODS In late 1993 and 1994, 120 patients were operated on for inguinal hernia using the totally extraperitoneal approach by four laparoscopic surgeons inexperienced in this new technique in a secondary referral setting. Their learning curve was assessed through operation time, perioperative and postoperative complications, and technical difficulties. RESULTS Median operative time decreased significantly (P = 0.0003) when going through the learning curve. During the initial part of the learning curve, conversion to another technique was necessary in 10 (8%) cases, and in 6 of these cases, conversion was needed for a peritoneal tear (relative risk for conversion if peritoneal tear was present: 4.0; 95% confidence interval 1.2 to 13.1, P = 0.025). The median operative time for Nyhus type IIIb and IVb hernias was significantly longer than for other types (70 versus 55 minutes, P = 0.003). Median postoperative stay was 2 days (range 0 to 7). There were 10 recurrences within 6 months due to technical or judgement errors. CONCLUSIONS For surgeons, the learning curve for totally extraperitoneal laparoscopic hernia repair can be overcome; however, the presence of an experienced surgeon during the procedure is vital, as this may prevent unnecessary recurrences.
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Affiliation(s)
- M S Liem
- Department of General Surgery, University Hospital Utrecht, The Netherlands
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Ramshaw BJ, Tucker JG, Conner T, Mason EM, Duncan TD, Lucas GW. A comparison of the approaches to laparoscopic herniorrhaphy. Surg Endosc 1996; 10:29-32. [PMID: 8711601 DOI: 10.1007/s004649910006] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are a variety of accepted techniques for herniorrhaphy. With the advent of laparoscopic general surgery, new endoscopic techniques using the transabdominal and total extraperitoneal approaches have been added to the many options for the repair of inguinal hernia. The purpose of this study was to compare the early results of these approaches at a single institution. METHODS Between May 1991 and August 1994, 600 laparoscopic herniorrhaphies were performed on 493 patients. Three hundred hernias were repaired using the transabdominal preperitoneal approach and 300 were repaired using the total extraperitoneal approach. A retrospective review was performed with emphasis on the comparison of recurrence rates and complication rates between these two approaches to laparoscopic herniorrhaphy. RESULTS The recurrence rates were 2.0% (6/300) for the transabdominal approach and 0.3% (1/300) for the total extraperitoneal approach. The complication rate for the transabdominal approach was 10.7% and included thigh paresthesias (6), inferior epigastric artery injuries (4), enterotomy (1), bowel obstruction (1), bladder injury (1), and urinary retention (14). The complication rate for the total extraperitoneal approach was 3.7% and included enterotomies (2), bladder injury (1), paresthesia (1), and urinary retention (6). The recurrence, the enterotomies, and the bladder injury in the total extraperitoneal group were all in patients who had previous lower abdominal operations. CONCLUSIONS Although both the transabdominal preperitoneal and total extraperitoneal approaches to laparoscopic herniorrhaphy have acceptable recurrence and complication rates, there were significant advantages to the total extraperitoneal approach in our institution. Previous lower abdominal surgery may be a relative contraindication to the total extraperitoneal approach.
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Affiliation(s)
- B J Ramshaw
- Department of Surgery, Georgia Baptist Medical Center, Atlanta 30312-1266, USA
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Deans GT, Wilson MS, Royston CM, Brough WA. Laparoscopic 'bikini mesh' repair of bilateral inguinal hernia. Br J Surg 1995; 82:1383-5. [PMID: 7489172 DOI: 10.1002/bjs.1800821029] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic hernia repair using a single piece of mesh was performed in 150 patients with bilateral inguinal hernia. The median operating time was 43 (range 30-90) min with a median hospital stay of 1 (range 1-10) days. In all, 138 patients were discharged within 24 h of operation. The median time for return to normal activity was 7 (range 2-60) days and that for return to work 14 (range 2-60) days. One patient required surgery for a port-site hernia and another for a Veress needle injury to the small bowel. Additional complications included bruising in nine patients, cord seromas in seven and urinary retention in two. There have been no recurrences after a median follow-up of 18 (range 1-38) months. The cost benefits of a short hospital stay and rapid return to work afforded by laparoscopic bilateral hernia repair warrant further evaluation.
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Affiliation(s)
- G T Deans
- Stockport Unit for Minimally Invasive Therapy, Stepping Hill Hospital, UK
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Tagaya N, Mikami H, Kogure H, Ohyama O. Laparoscopic repair of an abdominal hernia using an expanded polytetrafluoroethylene patch secured by a four-corner tacking technique. Surg Today 1995; 25:930-1. [PMID: 8574064 DOI: 10.1007/bf00311763] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An improved technique for performing laparoscopic repair of an abdominal hernia is described herein. To ensure a successful repair, it is most important that adequate tension of the expanded-polytetrafluoroethylene (e-PTFE) patch be achieved, and that the defect be completely covered and securely stapled. Our technique involves tacking the four corners of the patch to the abdominal wall with a 2-0 nylon suture using a straight needle, then stapling it to the anterior abdominal wall over the defect with a laparoscopic stapler. We believe that this technique is a safe and reliable method which will prove useful for laparoscopic surgery.
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Affiliation(s)
- N Tagaya
- Second Department of Surgery, Dokkyo University School of Medicine, Tochigi, Japan
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Windsor JA, McCay H. Inguinal hernia repair by laparoscopic surgeons: early experience and attitudes. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:470-4. [PMID: 7611965 DOI: 10.1111/j.1445-2197.1995.tb01788.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%), 74 were from laparoscopic surgeons, 26 of whom had performed 564 (201 public, 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR, and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons, the extraperitoneal technique by eight (31%), and the transabdominal onlay technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies, seven (1.2%) conversions, four (0.7%) major perforations, and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long-term results, 14 (54%) considered that the optimal technique had not been established, 13 (50%) were concerned about the unique complications associated with LIHR, 11 (42%) were less enthusiastic about performing LIHR than previously, 10 (38%) were doubtful about its advantages, and six (23%) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determined.
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Affiliation(s)
- J A Windsor
- Centre for Minimally Invasive Surgery, University Department of Surgery, Auckland Hospital, New Zealand
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Toouli J, Cox MR. Minimal access surgery of the gastrointestinal tract. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:525-32. [PMID: 7611975 DOI: 10.1111/j.1445-2197.1995.tb01799.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the last 5 years, surgery of the gastrointestinal tract has been revolutionized by the application of minimal access techniques. Following initial enthusiasm, which suggested that most abdominal surgery would ultimately be done via this approach, there is now need for appraisal and evaluation of the role of a number of these minimal access techniques when compared with open surgery. Undoubtedly, the most convincing and total application of minimal access techniques has been in the treatment of gallstone disease. Laparoscopic cholecystectomy is now standard therapy for cholelithiasis and endoscopic sphincterotomy with stone extraction is standard therapy for choledocholithiasis. Where the two conditions co-exist, operative cholangiography allows for the recognition of stones in the bile duct at the time of laparoscopic cholecystectomy and provides the potential avenue for treatment. Most major centres also would recommend routine operative cholangiography during laparoscopic cholecystectomy for the detection of unsuspected stones and as an extra safety procedure in the early identification of potential bile duct injuries. The efficacy of laparoscopic appendicectomy and laparoscopic or thoracoscopic treatment of achalasia of the oesophagus also is supported by data from well conducted prospective studies. Doubt remains regarding the advantage of laparoscopic surgery over other approaches in the treatment of gastro-oesophageal reflux, inguinal hernias and jaundice due to non-resectable cancer. For all three of these conditions, prospective trials are underway and the results of these trials should be assessed prior to widespread adoption of the laparoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Toouli
- Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia
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GOULDING S. Laparoscopic inguinal hernia repair: quality of recovery following the use of intraperitoneal bupivacaine. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0966-6532(95)00009-h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neugebauer E, Troidl H, Kum CK, Eypasch E, Miserez M, Paul A. The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements--September 1994. The Educational Committee of the European Association for Endoscopic Surgery. Surg Endosc 1995; 9:550-63. [PMID: 7676385 DOI: 10.1007/bf00206852] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.
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Affiliation(s)
- E Neugebauer
- II. Department of Surgery, University of Cologne, Germany
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