Inguinal hernia repair in general surgical practice in 2004: more than laparoscopy, training is the keyword

Laparoscopic transabdominal inguinal hernia repair in community hospital settings: a general surgeon's last 10 years experience

Numerous studies have documented the laparoscopic TransAbdominal Pre-Peritoneal (TAPP) approach as an excellent choice for inguinal hernia repair, especially with an experienced surgeon. A cohort population of patients who underwent TAPP laparoscopic surgery for inguinal hernias over the last 10 years, with follow-up, were evaluated, focusing on the feasibility, safety and benefits of this procedure in a community hospital setting.

MATERIALS AND METHODS

A total of 533 patients underwent TAPP for inguinal hernias between January 2003 and March 2013 in two community hospitals in the Northeast of Italy-"Civil Hospital" in Vittorio Veneto (TV) and "Civil Hospital" in Adria (RO).

RESULTS

The total number of hernias treated was 1,000. The overall mean operative time was 43.50 min (±13.2). All but three of the procedures were done on a day surgery basis. There were no conversions to open repair or deaths in our series. We had two cases of small bowel obstruction and eight relapses (0.8 %) in our series. The mean follow-up was 59.4 months (±5.6; range 3-120). No patients reported severe pain at 10 days, 21 patients (3.9 %) reported mild pain at 3-month follow-up. Over 90 % of the patients had a return of physical work capacity within 2 weeks, the remaining within 30 days. All patients were completely satisfied (numerical rating scale 10/10) 3 months after the operation.

CONCLUSIONS

The analysis of the short- and long-term post-operative outcomes of our experience enabled us to conclude that in an appropriate setting, TAPP is feasible, effective, safe and beneficial for patients. It should be incorporated into general surgeons' expertise and selectively used for the management of patients with hernias, as long as adequate training is obtained and appropriate preparation performed.

Inguinal-scrotal hernias in young patients: is laparoscopic repair a possible answer? Preliminary results of a single-institution experience with a transabdominal preperitoneal approach

OBJECTIVES

The laparoscopic trans-abdominal preperitoneal (TAPP) approach to inguinal hernia repair is well documented as an excellent choice in numerous studies, especially when conducted by an experienced surgeon. Its full list of specific indications is still under debate. Generally, the repair of scrotal hernias demands a higher level of experience on the part of the surgeon, irrespective of the applied surgical technique. In this report, we evaluate our preliminary experience of TAPP laparoscopic repair for inguinoscrotal hernias in young patients in a Community Hospital setting, focusing on the feasibility of the technique and the incidence of complications.

MATERIALS AND METHODS

Between January 2008 and January 2009 a total of ten consecutive young patients at the "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic repair of bilateral inguinoscrotal hernias.

RESULTS

The overall mean operative time was 65 (+/-15) min. All procedures were performed on a day surgery basis. There were no conversions to open repair, no mortality/morbidity or relapsing hernias. The mean follow-up was 14 (+/-2) months. No patients reported severe pain at 10 days, There were no reports of night pain at 30 days. All patients had a return to physical-work capacity within 14 days. All patients were completely satisfied at the 3-month follow up.

CONCLUSIONS

Analysis of the short-term post-operative outcomes of our experience enabled us to conclude that, in the proper setting, TAPP can be performed for inguinoscrotal hernia repair with an efficiency comparable to that of normal inguinal hernia repair.

Inguinal hernia repair in a community hospital setting--have attitudes changed because of laparoscopy? A review of a general surgeon's experience over the last 5 years

OBJECTIVES

The laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair is well documented in numerous studies as an excellent choice when performed by an experienced surgeon. In this report we wish to evaluate our experience of TAPP laparoscopic inguinal repair performed in a Community Hospital over the last 5 years, focusing on the feasibility of the technique and the incidence of complications when performed by general surgeons in this setting. We also wish to report and discuss how our attitudes concerning inguinal hernia repair have changed since we adopted the laparoscopic approach.

MATERIALS AND METHODS

Between January 2003 and January 2008 a total of 193 patients, at "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic inguinal hernia repair. The total hernias repaired were 362.

RESULTS

The overall mean operative time was 45.58 min. (+/-15.2 min). All the procedures were performed in day surgery. There were no conversions to open repair or deaths in our series. We had 2 cases of small bowel occlusion and 5 relapsing hernias (1.3%), which we preferred to treat with an anterior approach. The mean follow-up was 30.4 (+/-5.6; range: 1 to 60 mo) months. No patients reported severe pain at 10 days, 7.2% (14 cases) reported mild pain at 3 months. There were no reports of night pain at 30 days. Approximately 90% of the patients had a return to physical-work capacity within 7 days, the remainder within 14 days. All patients were completely satisfied at 3 months.

CONCLUSIONS

The analysis of the short-term postoperative outcomes of our experience enabled us to conclude that in the proper setting TAPP is feasible, effective, safe, and beneficial for patients and should be a routine part of any surgical practice providing adequate training has been undertaken and proper preparation observed.

European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.