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Andreou C, Maksimovic S, Riboni C, Eisner L, Kudsi OY, Dietz UA. Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP). Cir Esp 2023; 101 Suppl 1:S3-S10. [PMID: 38042590 DOI: 10.1016/j.cireng.2023.01.010] [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: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 12/04/2023]
Abstract
In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.
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Affiliation(s)
- Christos Andreou
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Sladjana Maksimovic
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Cristiana Riboni
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., Brockton, MA 02301, USA
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland.
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Towards automatic verification of the critical view of the myopectineal orifice with artificial intelligence. Surg Endosc 2023:10.1007/s00464-023-09934-7. [PMID: 36828887 DOI: 10.1007/s00464-023-09934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Visualization of key anatomical landmarks is required during surgical Trans Abdominal Pre Peritoneal repair (TAPP) of inguinal hernia. The Critical View of the MyoPectineal Orifice (CVMPO) was proposed to ensure correct dissection. An artificial intelligence (AI) system that automatically validates the presence of key and marks during the procedure is a critical step towards automatic dissection quality assessment and video-based competency evaluation. The aim of this study was to develop an AI system that automatically recognizes the TAPP key CVMPO landmarks in hernia repair videos. METHODS Surgical videos of 160 TAPP procedures were used in this single-center study. A deep neural network-based object detector was developed to automatically recognize the pubic symphysis, direct hernia orifice, Cooper's ligament, the iliac vein, triangle of Doom, deep inguinal ring, and iliopsoas muscle. The system was trained using 130 videos, annotated and verified by two board-certified surgeons. Performance was evaluated in 30 videos of new patients excluded from the training data. RESULTS Performance was validated in 2 ways: first, single-image validation where the AI model detected landmarks in a single laparoscopic image (mean average precision (MAP) of 51.2%). The second validation is video evaluation where the model detected landmarks throughout the myopectineal orifice visual inspection phase (mean accuracy and F-score of 77.1 and 75.4% respectively). Annotation objectivity was assessed between 2 surgeons in video evaluation, showing a high agreement of 88.3%. CONCLUSION This study establishes the first AI-based automated recognition of critical structures in TAPP surgical videos, and a major step towards automatic CVMPO validation with AI. Strong performance was achieved in the video evaluation. The high inter-rater agreement confirms annotation quality and task objectivity.
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Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP). Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Amaral PHDEF, Pivetta LGA, Dias ERM, Carvalho JPVDE, Furtado M, Malheiros CA, Roll S. Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair. Rev Col Bras Cir 2022; 49:e20223063. [PMID: 35239851 PMCID: PMC10578846 DOI: 10.1590/0100-6991e-20223063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. METHODS patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. RESULTS nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. CONCLUSIONS on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
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Affiliation(s)
- Pedro Henrique DE Freitas Amaral
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | | | - Eduardo Rullo Maranhão Dias
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - João Paulo Venancio DE Carvalho
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Marcelo Furtado
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
| | - Carlos Alberto Malheiros
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Sergio Roll
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
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Fernandez-Alberti J, Iriarte F, Croceri RE, Medina P, Porto EA, Pirchi DE. Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair. Hernia 2021; 25:1301-1307. [PMID: 33400027 DOI: 10.1007/s10029-020-02357-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following previous laparo-endoscopic repair. Laparoscopic treatment of recurrences after previous LR is controversial. The purpose of this study was to determine the safety, feasibility, and reliability of a repeated transabdominal preperitoneal laparoscopic repair (reTAPP) for a recurrent hernia. METHODS We analyzed and compared a series of patients with recurrent inguinal hernia after LR who underwent repair by a conventional approach with similar patients who underwent reTAPP between January 2010 and December 2018. RESULTS Between January 2010 and December 2018, 2488 transabdominal preperitoneal laparoscopic inguinal hernia (TAPP) repairs were performed. Recurrence was observed in 46 (1.8%). Of these patients, 18 (39%; Group 1; G1) underwent conventional open repair (Lichtenstein technique) and 28 (61%; Group 2; G2) reTAPP. In G2, repair was successful in 24 patients (86%); however, four cases (14%) needed conversion to OS because of technical difficulties. Two patients re-recurred (4.3%), one in G1 which was resolved in a third approach with a reTAPP and the other in G2 which was resolved with OS. CONCLUSION ReTAPP surgery for recurrences after previous TAPP repair proved to be safe and was associated with a shorter length of hospital stay and morbidity and recurrence rates comparable to OS at a highly specialized center. Randomized studies with a larger number of cases are necessary to confirm these findings and draw more robust and objective conclusions.
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Affiliation(s)
- Joaquin Fernandez-Alberti
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina.
| | - Facundo Iriarte
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Raul Eduardo Croceri
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Pablo Medina
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Eduardo Agustin Porto
- Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Daniel Enrique Pirchi
- General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, Buenos Aires, Argentina
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Sato M, Nozawa M, Watanabe T, Onoda T, Matsuyama A, Shiiya N, Wada H. Insufficiency of prosthetic posterolateral overlap related to recurrence after laparoscopic transabdominal preperitoneal inguinal hernioplasty, as assessed by video review. BMC Surg 2020; 20:27. [PMID: 32041581 PMCID: PMC7011534 DOI: 10.1186/s12893-020-0690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Technical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear. METHODS Five surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored. RESULTS The lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period (p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period (p = 0.006). CONCLUSIONS Fully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia.
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Affiliation(s)
- Masanori Sato
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Masashi Nozawa
- Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
| | - Takahiro Watanabe
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.,Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
| | - Takanobu Onoda
- Department of Surgery, Yaizu City Hospital, 1000 Dobara, Yaizu, Shizuoka, Japan
| | - Atsuko Matsuyama
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hidetoshi Wada
- Department of Surgery, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka, Japan
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Primary unilateral not complicated inguinal hernia: our choice of TAPP, why, results and review of literature. Hernia 2019; 23:417-428. [PMID: 31069580 DOI: 10.1007/s10029-019-01959-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/21/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Currently, three different techniques are favored for repair of an inguinal hernia: (1) The suture repair described by Shouldice. (2) An open mesh repair according to Lichtenstein. (3) Laparo-endoscopic techniques TAPP and TEP. The aim of the presented paper was to describe the ranking of the Transabdominal Preperitoneal Patch Plasty (TAPP) in comparison to the other techniques for inguinal hernia repair. METHODS The manuscript is based on the experiences gained in more than 15,000 TAPPs and numerous own studies as well. The technique of TAPP is described in detail and also the results which can be achieved with special reference to primary unilateral inguinal hernias in male patients. Moreover, a systematic review of the literature is done for the comparison with the other techniques. RESULTS According to own experiences, 98% of all patients with an inguinal hernia admitted for surgery to Marienhospital Stuttgart could be operated on using the TAPP technique. The recurrence rate and the rate of severe chronic pain in this setting were below 1%. Due to the limited quality of most of the published studies an evidence-based comparison which is the best of the currently most recommended techniques is questionable. Therefore, when comparing TAPP with TEP, no definite conclusion about superiority of one technique over the other is possible. Both techniques are safe and effective if properly performed. The guidelines recommend that the surgeon should use the technique he had learned best and is familiar with. The comparison between TAPP and the Shouldice repair shows less pain and a higher effectivity after TAPP. The recurrence rate after Lichtenstein repair and after TAPP is similar, but pain and recovery time are significantly less after TAPP. CONCLUSION Analyzing the own abundant experiences and the reports in the literature, the TAPP technique has the potential to become the standard operative technique for repair of inguinal hernias in future. However, due to the low level of evidence of most of the studies definite conclusions are difficult to draw at this point of time.
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Alexey VA, Bashankaev B. Laparoscopic round ligament preserving repair for groin hernia in women: A critical appraisal. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_23_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Persoon AM, Bökkerink WJV, Akkersdijk WL, van Laarhoven CJHM, Koning GG. Case series of recurrent inguinal hernia after primary TREPP repair: re-TREPP seems feasible and safe. Int J Surg Case Rep 2018; 51:292-295. [PMID: 30243262 PMCID: PMC6148736 DOI: 10.1016/j.ijscr.2018.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022] Open
Abstract
Recurrent inguinal hernias are preferably treated via an alternative route, e.g. posterior after anterior. Endoscopic preperitoneal repair techniques are common for groin hernias after Lichtenstein’s plasty. The TREPP technique is a minimal access, open variant of these preperitoneal techniques. The TREPP technique seems to be a safe and feasible technique to use for recurrence after previous TREPP for inguinal hernia repair.
Introduction The Trans REctussheath PrePeritoneal (TREPP) mesh repair was introduced in 2006 to decrease the risk of postoperative inguinal pain in hernia surgery. For the repair of a recurrent inguinal hernia after a primary TREPP an alternative open anterior route (Lichtenstein) may seem the most logical option, but coincides with an increased risk of chronic postoperative inguinal pain. Therefore, this study aimed to evaluate the feasibility of a second TREPP procedure to repair a recurrent inguinal hernia after an initial TREPP repair. Methods Consecutive patients with a recurrent inguinal hernia after a primary TREPP, repaired by a re-TREPP were retrospectively included in the study. Data, retrieved from the electronic patient files, were combined with the clinical findings at the outpatient department where the patients were physically investigated according to a priorly written and registered protocol. Results Overall about 1800 TREPPs were performed between 2006 and 2013. Since the introduction of TREPP in 2006, 40 patients presented with a recurrence in our center. From this group 19 patients were re-operated with the TREPP technique. No intraoperative complications occurred. There was one conversion from re-TREPP to Lichtenstein and no re-recurrences occurred to date. Ten out of 19 patients could be clinically evaluated with a mean follow-up period of 37 months (range 11–95). None of these patients (n=10) complained of chronic postoperative inguinal pain. Two patients reported discomfort. One patient died non procedure related, three weeks after re-TREPP of sudden cardiac death. Conclusion These first experiences with re-TREPP for secondary inguinal hernia repair are encouraging for the aspects of feasibility and safety, particularly in experienced surgical hands.
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Affiliation(s)
- A M Persoon
- Dept of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, the Netherlands.
| | - W J V Bökkerink
- Dept of Surgery, Radboud UMC, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - W L Akkersdijk
- Dept of Surgery, St. Jansdal Hospital, Wethouder Jansenlaan 90, 3844 DG Harderwijk, the Netherlands.
| | - C J H M van Laarhoven
- Dept of Surgery, Radboud UMC, Geert Grootteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - G G Koning
- Dept of Surgery, Noordwest Hospital Group, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands.
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Bracale U, Andreuccetti J, Sodo M, Merola G, Pignata G. Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single centre, case matched study. BMC Surg 2018; 18:75. [PMID: 30236096 PMCID: PMC6148989 DOI: 10.1186/s12893-018-0409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background During laparoscopic trans-abdominal pre-peritoneal hernia repair (TAPP) the positioning of the mesh around the spermatic cord could provide an additional anchoring point and ensure better defect closure, thereby preventing mesh movement and recurrence. The primary aim of our retrospective study was to determine if, during a TAPP procedure, an advantageous difference for mesh placement exists between the slit and the non-slit techniques in terms of recurrence rate. Secondary aims were intra and post-operative complications and the time required to return to normal activity. Methods From January 2010 to December 2015, data from patients who had undergone TAPPs at our Institution were prospectively collected. We performed a retrospective case control matched study of two homogenous (BMI, Age, type of hernia) groups of 100 patients who underwent respectively TAPP with no slit mesh placement (Group NS) and slit mesh placement (Group S). Statistical analysis was carried out using a SPSS 20. To compare continuous variables, an independent sample T-test was performed. A Chi-square test was employed for categorical data. Results No differences were found between the slit and non-slit groups in terms of biometric features and intra and post-operative outcomes were found to be similar in both groups as well. In particular, at mean follow-up of 57.34 ± 10.56 months for Group NS and 55.66 ± 8.61 months for Group S months only one recurrence per group was found. Conclusion Our study failed to prove a superiority of the slit mesh technique over the no-slit mesh technique during TAPP. However, in light of its not being a randomized study, a subsequent, well-designed RCT would be desirable in order to better determine if the Slit mesh technique could prove to be advantageous enough to justify its routine use during the TAPP procedure.
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Affiliation(s)
- Umberto Bracale
- Department of Surgical Specialities and nephrology, University Federico II Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Jacopo Andreuccetti
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
| | - Maurizio Sodo
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
| | - Giovanni Merola
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy.,Department of Surgical Specialities and nephrology, University Federico II Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giusto Pignata
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
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Siddaiah-Subramanya M, Ashrafi D, Memon B, Memon MA. Causes of recurrence in laparoscopic inguinal hernia repair. Hernia 2018; 22:975-986. [PMID: 30145622 DOI: 10.1007/s10029-018-1817-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/21/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Recurrence after laparoscopic inguinal herniorrhaphy is poorly understood. Reports suggest that up to 13% of all inguinal herniorrhaphies worldwide, irrespective of the approach, are repaired for recurrence. We aim to review the risk factors responsible for these recurrences in laparoscopic mesh techniques. METHODS A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English language, peer reviewed articles on the causes of recurrence following laparoscopic mesh inguinal herniorrhaphy published between 1990 and 2018. The search terms included 'Laparoscopic methods', 'Inguinal hernia; Mesh repair', 'Recurrence', 'Causes', 'Humans'. RESULTS The literature revealed several contributing risk factors that were responsible for recurrence following laparoscopic mesh inguinal herniorrhaphy. These included modifiable and non-modifiable risk factors related to patient and surgical techniques. CONCLUSIONS Recurrence can occur at any stage following inguinal hernia surgery. Patients' risk factors such as higher BMI, smoking, diabetes and postoperative surgical site infections increase the risk of recurrence and can be modified. Amongst the surgical factors, surgeon's experience, larger mesh with better tissue overlap and careful surgical techniques to reduce the incidence of seroma or hematoma help reduce the recurrence rate. Other factors including type of mesh and fixation of mesh have not shown any difference in the incidence of recurrence. It is hoped that future randomized controlled trials will address some of these issues and initiate preoperative management strategies to modify some of these risk factors to lower the risk of recurrence following laparoscopic inguinal herniorrhaphy.
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Affiliation(s)
- Manjunath Siddaiah-Subramanya
- Sir Charles Gairdner Hospital, Perth, Australia
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Darius Ashrafi
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia
- Department of Surgery, Sunshine Coast University Hospital, Buderim, QLD, Australia
| | - Breda Memon
- South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank, QLD, Australia
| | - Muhammed Ashraf Memon
- Mayne Medical School, University of Queensland, Brisbane, QLD, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
- School of Agricultural, Computing and Environmental Sciences, International Centre for Applied Climate Science, University of Southern Queensland, Toowoomba, QLD, Australia.
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.
- South East Queensland Surgery and Sunnybank Obesity Centre, McCullough Centre, Suite 9, 259 McCullough Street, Sunnybank, QLD, 4109, Australia.
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Lee SR, Park PJ. Novel Transabdominal Preperitoneal Hernioplasty Technique for Recurrent Inguinal Hernia: Overlapping of Whole Posterior Wall with Newly Added Mesh and Pre-Existing Mesh by Closing Hernia Defect. J Laparoendosc Adv Surg Tech A 2018; 28:1503-1509. [PMID: 30106640 DOI: 10.1089/lap.2018.0325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Purpose: In some patients with recurrent inguinal hernias who have undergone previous laparoscopic herniorrhaphy, dissecting the entire posterior wall is difficult due to mesh adhesion. We applied a novel transabdominal preperitoneal (TAPP) hernioplasty technique that involves closing of the hernia defect and implantation of a newly added mesh while preserving the pre-existing mesh for inguinal hernia recurrence after laparoscopic herniorrhaphy. This study was performed to evaluate this novel technique for treatment of recurrent inguinal hernias. Methods: We evaluated 24 adult patients (23 male, 1 female; mean age, 55.8 ± 14.0 years; range, 26-77 years) with recurring inguinal hernias. A modified TAPP (mTAPP) procedure involving closing of the defect and implantation of an 8 × 6-cm2 newly added mesh was performed. The new technique covered the whole posterior wall with pre-existing mesh. Results: Among the 24 patients, there were 12 direct hernias and 12 indirect hernias. The mean postoperative pain scores after 1 week were 2.5 and 2.0 in patients with direct and indirect hernias, respectively, and the mean duration until return to normal activities was 8.5 and 7.5 days in patients with direct and indirect hernias, respectively. The mean follow-up period was 21.0 ± 17.0 (range, 2-56) months. No chronic inguinodynia or rerecurrence was observed. Conclusions: In this novel mTAPP procedure for recurring inguinal hernias, closing sutures prevented mesh migration, and complete posterior wall overlap was possible using the pre-existing mesh and newly added mesh. The mTAPP procedure was an effective operation with few recurrences and complications.
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Affiliation(s)
- Sung Ryul Lee
- 1 Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
| | - Pyoung Jae Park
- 2 Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in patients with previous lower abdominal surgery. Surg Endosc 2018; 32:4757-4762. [PMID: 29761278 DOI: 10.1007/s00464-018-6223-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20 years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. METHODS From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. RESULTS Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. CONCLUSION The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.
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Yaguchi Y, Inaba T, Kumata Y, Horikawa M, Kiyokawa T, Fukushima R. Two cases of early recurrence after transabdominal preperitoneal inguinal hernia repair. Asian J Endosc Surg 2018; 11:71-74. [PMID: 28707383 DOI: 10.1111/ases.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/13/2017] [Accepted: 06/04/2017] [Indexed: 11/26/2022]
Abstract
We performed transabdominal preperitoneal inguinal hernia repair in 46 patients (58 diseases), two of whom experienced early recurrence after mesh repair. Case 1 was a 76-year-old man with a bilateral inguinal hernia (recurrence site, left indirect hernia) after appendectomy. The recurrence occurred 1 month after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using the direct Kugel® patch with an anterior technique. Case 2 was a 79-year-old man with a bilateral inguinal hernia (recurrence site, right direct hernia with an orifice >3 cm) after appendectomy. The recurrence occurred 3 months after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using an ULTRAPRO® Plug with an anterior technique under laparoscopic observation. We believe the recurrences resulted from insufficient internal exfoliation and fixation affected by complicated exfoliation of the preperitoneal space with omental adhesion after intraperitoneal surgery.
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Affiliation(s)
- Yoshihisa Yaguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Inaba
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshimasa Kumata
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Horikawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Kiyokawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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15
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A simplified surgical technique for recurrent inguinal hernia repair following total extraperitoneal patch plastic. Hernia 2017; 21:799-801. [PMID: 28616709 DOI: 10.1007/s10029-017-1629-4] [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: 10/15/2016] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To present a new and alternative method for surgical treatment of recurrent inguinal hernia after total extraperitoneal patch plastic (TEP). METHODS From January 2005 to September 2015, 35 patients (34 male, 1 female; mean age 65 ± 12.6 years) with recurrent inguinal hernia following TEP were operated at the Kliniken Essen-Mitte using a simplified method consisting of re-fixation of the primary mesh to the inguinal ligament by an anterior approach. RESULTS The mean operating time was 47 ± 22 min. All complications were minor with an overall incidence of 6%. After a mean follow-up of 54 months one re-recurrence was observed. CONCLUSIONS This Simplified Hernia Repair is safe and avoids additional foreign body implantation. Therefore, it is our method of choice for recurrent inguinal hernias after TEP.
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Muschalla F, Schwarz J, Bittner R. Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result. Surg Endosc 2016; 30:4985-4994. [DOI: 10.1007/s00464-016-4843-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/23/2016] [Indexed: 12/31/2022]
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Ramakrishnan P, Bansal S, Deuri B, Subbiah R, Palanisamy S, Palanivelu PR, Chinusamy P. A single-centre experience of relaparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes. Surg Endosc 2015; 30:2308-14. [PMID: 26423411 DOI: 10.1007/s00464-015-4387-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/01/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of complications of laparoscopic inguinal hernia repair remains challenging as well as debatable. Relaparoscopy in management of these complications is relatively newer concept. We tried to analyse the feasibility of relaparoscopy (transabdominal preperitoneal approach) in management of complications of laparoscopic inguinal hernia repair. MATERIALS AND METHODS The study group included 61 patients (referral cases) from a prospectively maintained database of previous laparoscopic inguinal hernia surgery with majority of the patients of recurrence (n = 39). Other complications were mesh infections (n = 15), pubic osteitis (n = 3), migration of mesh into adjacent viscera (n = 3) and meralgia paresthetica (n = 1). All patients underwent transabdominal preperitoneal approach (TAPP) between January 2007 and December 2013. RESULTS AND OUTCOME Most of the patients had previous TEP repair (n = 49) with variable complications detected in the range of 9 days to 38 months. Small-sized mesh (n = 12) and rolled up mesh (n = 10) were the causes of recurrence in 57 % cases. Mycobacterium tuberculosis (40 %) and mixed bacterial infections (33 %) strains were detected in the infected mesh. Pubic osteitis and meralgia paresthetica were tackers induced. All patients dealt with TAPP approach. Recurrent hernia cases underwent mesh placement and infected mesh was removed in mesh infection. Tackers were removed in cases of osteitis pubis and meralgia paraesthesia. Median operative time was 62 min (42-126 min) and hospital stay 3 days (2-13 days). The relaparoscopy was accomplished in 95.1 % of cases with no major intraoperative complications and minimal postoperative morbidity. CONCLUSION Relaparoscopy through TAPP approach remains safe and feasible option to deal with primary laparoscopic hernia repair complications. Surgical techniques during primary laparoscopic repair are important cause for aforementioned complications. Though, surgical expertize remains warranted for relaparoscopy.
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Affiliation(s)
- Parthasarthi Ramakrishnan
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Saurabh Bansal
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India.
| | - Biswajit Deuri
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Rajapandian Subbiah
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Senthilnathan Palanisamy
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Praveen Raj Palanivelu
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
| | - Palanivelu Chinusamy
- Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, 641045, India
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Zhu X, Cao H, Ma Y, Yuan A, Wu X, Miao Y, Guo S. Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: A meta-analysis of outcomes of our current knowledge. Surgeon 2014; 12:94-105. [DOI: 10.1016/j.surge.2013.11.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/10/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022]
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Relaparoscopic treatment of recurrences after previous laparoscopic inguinal hernia repair. Minim Invasive Surg 2013; 2013:260131. [PMID: 24379974 PMCID: PMC3863525 DOI: 10.1155/2013/260131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/13/2013] [Indexed: 12/05/2022] Open
Abstract
Background. Relaparoscopic treatment of inguinal hernia recurrences has become a relatively new concept with favourable results. The purpose of this study was to examine a series of relaparoscopic repair, present technical experiences, and the clinical outcomes in this subset of patients. Patients and Methods. The medical records of five patients who underwent relaparoscopic repair (TAPP or TEP) for a recurrence between March 2005 and September 2012 were retrospectively reviewed. Results. All the patients were male with a mean age of 45 years. Technical failures in the previous repairs were the main factors contributing to recurrences. In two re-TEP cases with no previous mesh fixation, the old mesh remained on the peritoneal side during preperitoneal dissection and this greatly facilitated surgical manipulation. The mean operative time was 93 min (range, 45–120 min). There were no conversions, no intraoperative complications, and no morbidity or rerecurrence after a mean follow-up period of 17 months (range, 7–24 months). Conclusion. Relaparoscopic repair appears to be safe and effective in the treatment of recurrent inguinal hernia and repeated TEP could be a simpler approach than expected in the presence of no prior mesh fixation.
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Gopal SV, Warrier A. Recurrence after groin hernia repair-revisited. Int J Surg 2013; 11:374-7. [PMID: 23557981 DOI: 10.1016/j.ijsu.2013.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/20/2013] [Accepted: 03/23/2013] [Indexed: 10/27/2022]
Abstract
One of the commonly performed operations all over the world is hernia repair. Various open and laparoscopic procedures are available now for hernia repair. They are judged mainly by the recurrence rate following operation. The recognition of the causes of recurrence makes their prevention/elimination possible. Articles on hernia recurrence published in various journals over the past 40 years have been analysed. This review article mainly focuses on the causes of recurrence of hernia and their prevention. The causes of recurrence following open and laparoscopic hernia repair have been analysed. In open repair, early recurrences are due to faults in operative technique and postoperative infection. Late recurrences are due to patient factors like collagen defects, age and medical morbidities. In laparoscopic repair, technical aspects of surgery like dissection, mesh placement and fixation are the important factors which decide hernia recurrence.
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Affiliation(s)
- Sri Vengadesh Gopal
- Department of General Surgery, Coffs Harbour Hospital, Coffs Harbour, NSW 2450, Australia.
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23
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Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc 2012; 27:795-800. [DOI: 10.1007/s00464-012-2514-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022]
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24
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Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg 2011; 397:271-82. [PMID: 22116597 DOI: 10.1007/s00423-011-0875-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
Affiliation(s)
- R Bittner
- Department of General, Visceral and Vascular Surgery, Herniacenter, EuromedClinic Fürth, Europaallee 1, 90763, Fürth, Germany.
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25
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Abstract
AIM The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal. MATERIALS AND METHODS The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report. SUMMARY Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh. CONCLUSION Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.
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26
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Uchida H, Matsumoto T, Endo Y, Kusumoto T, Muto Y, Kitano S. Repeat Laparoscopic Totally Extraperitoneal Hernia Repair After Primary Laparoscopic Totally Extraperitoneal Hernia Repair for Inguinal Hernia. J Laparoendosc Adv Surg Tech A 2011; 21:233-5. [DOI: 10.1089/lap.2010.0257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hiroki Uchida
- Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
- Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Toshifumi Matsumoto
- Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
- Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Yuichi Endo
- Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
- Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Tetsuya Kusumoto
- Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
- Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Yoichi Muto
- Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
- Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Seigo Kitano
- Department of Gastrointestinal Surgery, Oita University Faculty of Medicine, Yufu, Japan
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27
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Mcmahon M, Kehdy F. Article Commentary: Laparoscopic Repair of Inguinal and Incisional Hernias. Am Surg 2011. [DOI: 10.1177/000313481107700411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Meredith Mcmahon
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Farid Kehdy
- Department of Surgery, University of Louisville, Louisville, Kentucky
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28
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Chan G, Chan CK. The characteristics of inguinal hernia recurrence in the modern era and the long-term outcomes after re-operation. Hernia 2011; 15:193-9. [PMID: 21267616 DOI: 10.1007/s10029-010-0771-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/12/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Re-operative hernia surgery has become more technically challenging due to the use of mesh. In addition, there has been a paucity of clinical studies. A common recommendation has been to avoid the previous site and to use a different approach. METHODS In this study of 218 patients, the anatomical characteristics of inguinal hernia recurrences were studied in relation to the previous technique of repair, including Mesh (n = 100), Laparoscopic (n = 61) and Shouldice (n = 57). RESULTS The most common site of recurrence was direct (58.5%) in all three groups. Femoral recurrences were significantly lower in the Laparoscopic group. Indirect and multiple recurrences were significantly lower in the Shouldice group. The operative time in the Mesh group was significantly longer due to the dissection required of the previous mesh. A pro-peritoneal mesh repair was performed for the re-operation in 13.8%, while a Shouldice repair was performed in the others. The overall follow-up rate was 75.2% for a mean of 4.8 years. The re-recurrence rate was 1.8%. CONCLUSION The distinct patterns of recurrence reflect the relative strengths and weaknesses of the different techniques of repair and present the anatomical and technical basis for future improvements. A safe and durable repair of an inguinal hernia recurrence can be achieved through an anterior trans-inguinal approach.
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Affiliation(s)
- G Chan
- Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
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29
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Spray application of fibrin sealant with an angled spray tip device in laparoscopic inguinal hernia repair. Eur Surg 2010. [DOI: 10.1007/s10353-010-0550-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Itani KMF, Fitzgibbons R, Awad SS, Duh QY, Ferzli GS. Management of recurrent inguinal hernias. J Am Coll Surg 2009; 209:653-8. [PMID: 19854408 DOI: 10.1016/j.jamcollsurg.2009.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 07/17/2009] [Accepted: 07/17/2009] [Indexed: 11/27/2022]
Affiliation(s)
- Kamal M F Itani
- Department of Surgery, Boston Veterans Affairs Health Care System and Boston University, Boston, MA, USA.
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31
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Kocijan R, Sandberg S, Chan YW, Hollinsky C. Anatomical changes after inguinal hernia treatment: a reason for chronic pain and recurrent hernia? Surg Endosc 2009; 24:395-9. [DOI: 10.1007/s00464-009-0595-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/30/2009] [Indexed: 12/01/2022]
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32
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Recurrent indirect scrotal hernia with incarcerated urinary bladder tamponade. Eur Surg 2009. [DOI: 10.1007/s10353-009-0465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hollinsky C, Kolbe T, Walter I, Joachim A, Sandberg S, Koch T, Rülicke T. Comparison of a new self-gripping mesh with other fixation methods for laparoscopic hernia repair in a rat model. J Am Coll Surg 2009; 208:1107-14. [PMID: 19476899 DOI: 10.1016/j.jamcollsurg.2009.01.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 12/22/2008] [Accepted: 01/21/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microhooks are small structures on the surface of the Progrip (PG; Sofradim Corp) mesh to ensure its anchorage in tissue. Additional fixation is not required. The aim of this animal study was to compare the strength of incorporation, foreign body reaction, and changes in material after implantation of this novel mesh with the current fixation alternatives, namely the hernia stapler (HS) and fibrin glue (FG). STUDY DESIGN Forty Sprague-Dawley rats were used in this two-phase, prospective randomized study. Polypropylene meshes (Parietene light; Sofradim Corp) were positioned bilaterally on the abdominal muscle. The randomized mesh fixation groups were named HS, FG, PG, and UM (unfixed mesh). Half of the rats in each group were sacrificed and analyzed 5 days after implantation, and the second half were sacrificed and analyzed after 2 months. Measured parameters were strength of incorporation, foreign-body reaction to, and potential degradation of, mesh and fixation systems. RESULTS After 5 days, strength of incorporation was substantially higher for PG (3.2 N/cm(2)) and HS (2.7 N/cm(2)) compared with FG (0.9 N/cm(2)) or UM (1.5 N/cm(2)). After 2 months, PG had a much greater strength of incorporation (14.8 N/cm(2)) compared with all other groups (HS 11.7 N/cm(2); FG 11.4 N/cm(2); UM 8.7 N/cm(2)). Inflammatory reactions were considerably more severe after 5 days than after 2 months. No significant differences in foreign-body reactions were found between groups. At neither time point were signs of degradation detected by scanning electron microscopy. CONCLUSIONS PG demonstrated a substantially stronger strength of incorporation in muscle tissue compared with other fixation systems and is an economic alternative to HS or FG. Laparoscopic mesh placement of PG requires some practice because of the microhooks. Clinical studies will have to be performed before the value of this mesh can be established for laparoscopic application.
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Hollinsky C, Sandberg S, Koch T, Seidler S. Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates. Surg Endosc 2008; 22:2679-85. [PMID: 18443869 DOI: 10.1007/s00464-008-9936-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 02/06/2008] [Accepted: 03/04/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic inguinal hernia repair can be performed using light- or heavyweight meshes. Apart from the size of the mesh, its friction coefficient (mu(0)) and flexural stiffness are of crucial importance to avoidance of hernia recurrence. METHODS In the current biomechanical study, tensile tests were performed to determine the ultimate tensile strength and modulus of elasticity of six lightweight meshes and six heavyweight meshes for laparoscopic inguinal hernia repair. To determine their friction coefficient (mu(0)), the meshes were placed between a resected peritoneum and groin muscles during an autopsy. Meshes measuring 15 x 10 cm in size then were used in a hernia model with an opening size of 1.5, 3, or 5 cm. RESULTS The ultimate tensile strength and modulus of elasticity were significantly lower in the lightweight mesh group than in the heavyweight mesh group. The mean friction coefficient (mu(0)) of the meshes was 0.4. Given an opening of 1.5 cm, all meshes remained adequately stable. At opening sizes of 3 and 5 cm, the lightweight meshes flexed on the average by 3.16 +/- 0.4 mm and 10.40 +/- 2.5 mm, respectively. Heavyweight meshes, on the other hand, were significantly less flexible. Their mean flexure was, respectively, 0.34 +/- 0.2 mm and 3.97 +/- 0.7 mm (p < 0.001). CONCLUSION Stable meshes are characterized by a small degree of flexure and do not slide into the gap even when subjected to repetitive loads. Therefore, in terms of hernia recurrence, meshes with greater flexural stiffness or well-fixed lightweight meshes that adequately overlap the hernia defect can be used for laparoscopic treatment of large inguinal hernias.
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Affiliation(s)
- Christian Hollinsky
- Department of Surgery, Kaiserin Elisabeth Hospital, Huglgasse 1-3, 1150, Vienna, Austria.
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35
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Re-recurrence After Operation for Recurrent Inguinal Hernia. A Nationwide 8-Year Follow-up Study on the Role of Type of Repair. Ann Surg 2008; 247:707-11. [DOI: 10.1097/sla.0b013e31816b18e3] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Lau H. Recurrence following endoscopic extraperitoneal inguinal hernioplasty. Hernia 2007; 11:415-8. [PMID: 17610025 DOI: 10.1007/s10029-007-0246-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 04/24/2007] [Indexed: 11/26/2022]
Abstract
Recurrence rate is the utmost outcome parameter in determining the clinical effectiveness of any hernia surgery. Between June 1999 and September 2004, six patients presented with recurrent hernia after endoscopic totally extraperitoneal inguinal hernioplasty (TEP). Four of the six recurrences (67%) occurred within a few months after TEP, indicating a technical failure. Of the 1,093 TEPs performed by the author, a total of three patients developed recurrence, giving an overall recurrence rate of 0.27%. All six patients underwent open Lichtenstein hernioplasty. Intraoperative findings showed recurrent indirect inguinal hernia in all patients. Half of the recurrence (n=3) was due to a sliding lipoma without a peritoneal hernial sac. Untreated herniated retroperitoneal adipose tissue into the internal inguinal ring during initial TEP constitutes the leading cause of recurrence after TEP. Routine exploration of internal ring for any herniated retroperitoneal adipose tissue during TEP is recommended. Herniated retroperitoneal adipose tissue should be resected whenever feasible.
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Affiliation(s)
- H Lau
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
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37
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Schwab R, Conze J, Willms A, Klinge U, Becker HP, Schumpelick V. [Management of recurrent inguinal hernia after previous mesh repair: a challenge]. Chirurg 2006; 77:523-30. [PMID: 16514540 DOI: 10.1007/s00104-006-1158-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Since the use of prosthetic mesh for the surgical repair of inguinal hernias has become increasingly popular, mesh material introduced during a previous operation is being detected in a growing number of patients undergoing surgery for recurrent hernia. This applies to at least 10% of recurrences. Needed is a therapeutic algorithm for the surgical management of recurrent hernias after previous mesh repair. MATERIAL AND METHODS A total of 672 recurrent hernia repairs performed in hospitals in the German cities Aachen and Koblenz were analysed in order to review clinical practice. In 92 patients (13.7%) who underwent surgery for recurrent hernia, mesh had been used in the previous hernia repairs. Attention was focused on the location of the recurrence in relation to the site of mesh implantation and on the advantages and disadvantages of the various surgical procedures for repairing recurrent hernias. Re-examination was performed with a mean follow-up of 3 years. RESULTS Surgeons mostly decided during operation which procedure to use. A transinguinal approach was preferred for patients presenting with recurrent hernia and pain, and mesh material introduced during a previous operation was then explanted. In the case of multiple recurrences, a minimal direct suture repair was used for small defects or a preperitoneal approach for inserting a new, large mesh. The majority of recurrences were medial or suprapubic, especially those occurring after a Lichtenstein repair. After re-examining 87 of 92 patients, nine recurrences (10.3%) were found. Mesh-free suturing methods were affected most frequently. Moderate complaints were reported by 39.1%, and 4.6% suffered from medical chronic pain. CONCLUSION The surgical management of recurrent hernias after previous mesh repair is a particular challenge for surgeons. We introduce a therapeutic algorithm for recurrent hernia surgery after previous mesh implantation based on analysis of clinical practice.
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Affiliation(s)
- R Schwab
- Chirurgische Klinik und Poliklinik der RWTH Aachen.
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Abstract
Groin pain is a common and often frustrating problem in athletes who engage in sports involving kicking, rapid accelerations and decelerations, and sudden direction changes. The most common problems are adductor strain, osteitis pubis, and sports hernia. Other causes must be considered, including nerve pain, stress fractures, and intrinsic hip pathology. There is significant overlap and multiple problems frequently coexist. Accurate diagnosis leads to directed treatment, with rehabilitation focused on functional closed-chain strengthening and core stability.
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Affiliation(s)
- Jim Macintyre
- Center of Orthopedic and Rehabilitation Excellence, 3584 West 9000 South, Suite 405, West Jordan, UT 84088, USA.
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Ferzli GS, Khoury GE. Treating recurrence after a totally extraperitoneal approach. Hernia 2006; 10:341-6. [PMID: 16819562 DOI: 10.1007/s10029-006-0106-2] [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: 12/27/2005] [Accepted: 05/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND One of today's most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. METHODS The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. RESULTS From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. CONCLUSIONS A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.
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Affiliation(s)
- G S Ferzli
- Department of Surgery, Lutheran Medical Center, The State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA.
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Arvidsson D, Berndsen FH, Larsson LG, Leijonmarck CE, Rimbäck G, Rudberg C, Smedberg S, Spangen L, Montgomery A. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 2005; 92:1085-91. [PMID: 16106480 DOI: 10.1002/bjs.5137] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The Shouldice technique is the 'gold standard' of open non-mesh hernia repair. The aim of this study was to compare 5-year recurrence rates after Shouldice and laparoscopic transabdominal preperitoneal patch (TAPP) repair for primary inguinal hernia. METHOD Men with a primary unilateral inguinal hernia were randomized to either Shouldice or TAPP operation. An independent observer scored the surgeons' performance. Follow-up comprised clinical examination after 1 year, a questionnaire after 2 and 3 years, and a clinical examination after 5 years. RESULTS Between February 1993 and March 1996, 1183 patients were included. Nine hundred and twenty patients were followed for 5 years, 454 in the TAPP group and 466 in the Shouldice group. Recurrences were evenly distributed between groups throughout the follow-up period. The cumulative recurrence rate after 5 years was 6.6 per cent in the TAPP group and 6.7 per cent in the Shouldice group. Postoperative pain was a risk factor for recurrence after Shouldice operation but not after TAPP repair. There was a correlation between a low surgeon's performance score and recurrence. CONCLUSION The 5-year recurrence rate is acceptable, with no difference between TAPP and Shouldice repair. Poor operative performance resulted in a higher recurrence rate. The TAPP operation represents an excellent alternative for primary inguinal hernia repair.
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Affiliation(s)
- D Arvidsson
- Department of Surgery, Karolinska Hospital, Stockholm, Sweden
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Leibl BJ, Jäger C, Kraft B, Kraft K, Schwarz J, Ulrich M, Bittner R. Laparoscopic hernia repair?TAPP or/and TEP? Langenbecks Arch Surg 2005; 390:77-82. [PMID: 15711997 DOI: 10.1007/s00423-004-0532-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 10/05/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Of various endoscopic hernia repair procedures, TAPP and TEP have been selected for routine use. METHODS Results from Medline research were analysed. RESULTS There is a similar risk for postoperative morbidity for both techniques. The recurrence rate in large single-centre series is between 0% and 3.4%. There were numerous indications for both procedures, whereby a transperitoneal TAPP can also be applied in cases of previous preperitoneal operations. CONCLUSION Randomised trials comparing both methods of hernia repair are lacking. Seven non-randomised studies showed no differences in recurrence rate and morbidity. In general the learning curve for is shorter in favour of TAPP repair.
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Affiliation(s)
- B J Leibl
- Department for General and Visceral Surgery, Marien Hospital, Stuttgart, Germany.
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42
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Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 2004; 19:188-99. [PMID: 15578250 DOI: 10.1007/s00464-004-9126-0] [Citation(s) in RCA: 269] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 06/24/2004] [Indexed: 12/21/2022]
Abstract
BACKGROUND For the scientific evaluation of the endoscopic and open mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials (RCT) are necessary. The Lichtenstein repair is one of the most common open mesh techniques and therefore of special interest. METHODS After an extensive search of the literature and a quality assessment, a total of 34 RCT comparing endoscopic procedures both transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP)--with various open mesh repairs were deemed to be suitable for a formal meta-analysis of the relevant parameters. These studies included data for 7,223 patients. Trials that used the Lichtenstein repair for the control group (23 of 34 trials) were analyzed-separately. RESULTS Significant advantages for the endoscopic procedures compared with the Lichtenstein repair include a lower incidence of wound infection (Peto odds ratio, 0.39; 95% confidence interval, 0.26, 0.61), a reduction in hematoma formation (0.69 [0.54, 0.90]) and nerve injury (0.46 [0.35, 0.61]), an earlier return to normal activities or work (-1.35[-1.72, -0.97]), and fewer incidences of chronic pain syndrome (0.56[0.44, 0.70]). No difference was found in total morbidity or in the incidence of intestinal lesions, urinary bladder lesions, major vascular lesions, urinary retention and testicular problems. Significant advantages for the Lichtenstein repair include in a shorter operating time (5.45[1.18, 9.73]), a lower incidence of seroma formation (1.42[1.13, 1.79]), and fewer hernia recurrences (2.00[1.46, 2.74]). Similar results are seen when endoscopic procedures are compared with other open mesh repairs. However, in this comparison, total morbidity was lower with the endoscopic operations (0.73[0.61, 0.89]). The incidence of seroma formation, chronic pain syndromes, and hernia recurrence was not significantly different. CONCLUSION Endoscopic repairs do have advantages interms of local complications and pain-associated parameters. For more detailed evaluation further well-structured trials with improved standardization of hernia type, operative technique, and surgeons' experience are necessary.
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Affiliation(s)
- C G Schmedt
- Department of Surgery, University of Munich, Nussbaumstrasse 20, D-80336 Munich, Germany.
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Kes E, Lange J, Bonjer J, Stoeckart R, Mulder P, Snijders C, Kleinrensink G. Protrusion of prosthetic meshes in repair of inguinal hernias. Surgery 2004; 135:163-70. [PMID: 14739851 DOI: 10.1016/s0039-6060(03)00386-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although techniques with prosthetic meshes have improved results of inguinal hernia repair, the problem of recurrence remains. In addition to patient- and surgeon-related causes, protrusion of prosthetic mesh through the hernia defect can be considered as a factor of recurrence. METHODS To simulate inguinal hernia, porcine tissue with standardized defects (3, 4, and 5 cm) was used. Nine different meshes (9 cm diameter) were positioned on the defects. In a pressure chamber the depth of protrusion through the defect was assessed. Both sides of each mesh were measured. Protrusion at a pressure representing Valsalva pressure was used for statistical analysis. RESULTS Protrusion, including the incidence of collapse, increased with larger defect sizes. Significant protrusion differences were found between different meshes and occasionally between the 2 sides of the same mesh. CONCLUSIONS The differences between the effects of the various meshes emphasize the importance of material characteristics when developing new surgical techniques. The 3 meshes showing least protrusion are considered especially suitable when repairing large defects or when preferring a small mesh when repairing inguinal hernias with a preperitoneal sublay approach.
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Affiliation(s)
- Erik Kes
- Lowlands Institute of Surgical and Applied Surgery, Department of Neurosciences, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Ferzli GS, Shapiro K, DeTurris SV, Sayad P, Patel S, Graham A, Chaudry G. Totally extraperitoneal (TEP) hernia repair after an original TEPIs it safe, and is it even possible? Surg Endosc 2004; 18:526-8. [PMID: 14752649 DOI: 10.1007/s00464-003-8211-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Accepted: 10/23/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are only scant published reports of totally extraperitoneal (TEP) repair of recurrence after a primary TEP procedure. Furthermore, at least two authors have made the statement that such an operation is virtually impossible. METHODS We have been performing TEP repair of recurrence after TEP since we 1996, and here we present a retrospective review of our experience with the procedure. We employ a method not varying greatly from the standard TEP done for primary hernia. RESULTS All cases were started laparoscopically, and only one of 20 had to be converted to open. Of these cases, 12 were for same-side recurrence and eight for a contralateral new hernia. With a follow-up of 28-74 months, there have been no fatalities, no complications, and no re-recurrence. CONCLUSION We have found that TEP repair of recurrent inguinal hernia after a primary TEP repair is entirely feasible technically as well as entirely safe.
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Affiliation(s)
- G S Ferzli
- Department of Surgery, Staten Island University Hospital, 65 Cromwell Avenue, Staten Island, NY 10304, USA.
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45
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Kraft BM, Kolb H, Kuckuk B, Haaga S, Leibl BJ, Kraft K, Bittner R. Diagnosis and classification of inguinal hernias. Surg Endosc 2003; 17:2021-4. [PMID: 14577028 DOI: 10.1007/s00464-002-9283-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Accepted: 05/07/2003] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this prospective clinical study was to determine whether the presence of a hernia, its size, and its type can be established preoperatively by clinical and ultrasound, examination. METHODS The study population comprised 220 consecutive patients referred to our department for the surgical management of an inguinal hernia. On admission, both inguinal regions were examined clinically and by ultrasound. All patients were operated on laparoscopically. RESULTS In regard to the intraoperative findings for both inguinal regions, clinical and ultrasound examination for the diagnosis of inguinal hernia yielded a high total rate of accuracy of 93% respective 94%. However, when the same methods were used to differentiate between lateral and medial hernia, the total rate of accuracy fell to only 54% respective 62%. In the determination of inguinal hernia size, it was even lower: 50% respective 53%. CONCLUSIONS Although a diagnosis of inguinal hernia can be established reliably by clinical and ultrasound examination, only an approximate classification is possible by these methods.
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Affiliation(s)
- B M Kraft
- Department of General and Visceral Surgery, Marienhospital Stuttgart, Böheimstrasse 37, D-70199 Stuttgart, Germany.
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Sahin C, Yakut G, Haholu A. Laparoscopic Orchiectomy and Simultaneous Inguinal Herniorrhaphy Technique by the Transperitoneal Route in Adult Patients. J Laparoendosc Adv Surg Tech A 2003; 13:301-4. [PMID: 14617386 DOI: 10.1089/109264203769681664] [Citation(s) in RCA: 4] [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
In recent years, laparoscopy has begun to be widely used in many clinics for the diagnosis and repair of nonpalpable testes. Because the technique is noninvasive, it is also used to repair inguinal hernias via the retroperitoneal route. The technique and results of performing laparoscopic orchiectomy and herniorrhaphy simultaneously by the transperitoneal route in patients with abdominal testis and ipsilateral inguinal hernia were addressed in this clinical study. Between 1996 and 2001, laparoscopic intervention was applied in 44 patients ranging in age from 20 to 27 years (average, 23 years) who had both unilateral nonpalpable testis and ipsilateral inguinal hernia. The patients underwent laparoscopic orchiectomy and transperitoneal herniorrhaphy. They were followed for 6 to 24 months postoperatively (average, 16 months). No complications developed during the operation or early postoperative period in any of the patients. No case of recurrent hernia was encountered during the followup period. Efficient laparoscopic transperitoneal hernia repair can be achieved during laparoscopic orchiectomy performed in patients with abdominal testis and ipsilateral inguinal hernia. When this method is used, patients can be discharged on the day after the operation and are able to resume their daily activities within a very short time.
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Affiliation(s)
- Coskun Sahin
- Department of Urology, Gümüşsuyu Military Hospital, Istanbul, Turkey.
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Leibl BJ, Kraft B, Redecke JD, Schmedt CG, Ulrich M, Kraft K, Bittner R. Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial. World J Surg 2002; 26:1481-4. [PMID: 12297933 DOI: 10.1007/s00268-002-6204-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
It is unknown at present what the best method is among mesh implantation, central incision, reconstructing the deep inguinal ring, or a non-incised mesh implant in laparoscopic hernia surgery. Further, it is unproven to what extent a circular enclosure of the cremasteric structures by an incised mesh implant could cause postoperative complications and complaints. To evaluate the possible effects of different configurations and fixation techniques of mesh implants in transperitoneal repair of inguinal hernias, a randomized trial (phase IIIa study) was conducted to compare incised versus non-incised mesh and clip fixation versus suturing the mesh. A total of 360 male patients with unilateral primary hernias were randomized to 3 groups. Postoperative complaints were documented by means of a visual analog scale. These values showed no significant differences between study arms. At the first postoperative control, on day 3, patients after repair of Nyhus type II hernias had significantly fewer complaints than those after Nyhus type IIIa and IIIb repair. To gain additional facts, a duplex flow examination of testicular vessels was performed pre- and postoperatively. Testicular perfusion was not influenced by mesh configurations in the trial. There were no statistical differences in postoperative complications and recurrence rates between groups. In conclusion no influence on postoperative complaints and complications could be demonstrated by different mesh fashioning and fixation alternatives studied in this trial.
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Affiliation(s)
- Bernhard J Leibl
- Clinic for General and Visceral Surgery, Marienhospital, Böheimstrasse 37, D-70199, Stuttgart, Germany.
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Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ. Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 2002; 89:1062-6. [PMID: 12153636 DOI: 10.1046/j.1365-2168.2002.02178.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic transperitoneal hernioplasty (TAPP) repair of inguinal hernias is thought to be a difficult surgical technique with high complication rates. The present study evaluated TAPP based on prospective documentation. METHODS The primary aim of the study was analysis of the individual learning curve, comparing consultants with trainees. Secondary endpoints included postoperative morbidity, time of disability and rate of recurrence. RESULTS A total of 8050 TAPP repairs have been performed since 1993. By 2001, 99.9 per cent of all hernia repairs were done by TAPP. The median operation time dropped from 50 min in the first 600 cases to 42 min thereafter. The morbidity rate decreased from 9.3 to 2.6 per cent, and the rate of recurrence from 4.8 to 0.4 per cent. Within the same interval the proportion of training procedures increased from 1.7 to 44.9 per cent in 2001. Morbidity and recurrence rates were similar for trainees and consultants. CONCLUSION TAPP is an effective and safe technique. It can be performed in a standard way for all inguinal and femoral hernias. The present results indicate that TAPP is possible in a routine setting, as well as in the training situation for young surgeons.
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Affiliation(s)
- R Bittner
- Department of General Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, D-70199 Stuttgart, Germany.
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50
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Hawasli A, Thao U, Chapital A. Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair for Recurrent Inguinal Hernia. Am Surg 2002. [DOI: 10.1177/000313480206800316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laparoscopic transabdominal preperitoneal inguinal herniorrhaphy (TAPP) was attempted on 989 hernias in 708 patients. Of these 137 (14%) hernias were recurrent after conventional anterior repair. Laparoscopic repair was performed on 135 recurrences in 120 patients (the study cohort). There were 119 males and three females with an average age of 59 years (22–83 years). One hundred twelve (83%) were the first recurrences, and 23 (17%) were multiple recurrences. In 90 recurrences (66.7%) the last repair was performed more than 10 years previously. Seventy-seven patients (64%) had a prior or concomitant repair of a contralateral hernia. Direct recurrences and right-side recurrences were more common (73% and 61% respectively). Postoperative complications occurred in 18 repairs (13%). These included 15 hematomas, two seromas, and one urinary retention. Re-recurrence occurred in one patient (0.7%) in whom hernia staples were not used. No recurrence has occurred since the hernia staples became available. We conclude that the overall incidence of recurrent inguinal hernia is high (14%). Patients with recurrent hernia have a tendency toward a contralateral hernia (64%). Most recurrences occurred 10 or more years after the previous repair (66.7%). The laparoscopic repair (TAPP) offers a good repair for recurrent inguinal hernia avoiding the scar tissue and with low complication and recurrence rates.
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Affiliation(s)
- Abdelkader Hawasli
- From the Department of Surgery [Division of Laparoscopic Surgery, St. John Hospital and Medical Center, Detroit, Michigan
| | - Umeng Thao
- From the Department of Surgery [Division of Laparoscopic Surgery, St. John Hospital and Medical Center, Detroit, Michigan
| | - Alyssa Chapital
- From the Department of Surgery [Division of Laparoscopic Surgery, St. John Hospital and Medical Center, Detroit, Michigan
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