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Xu TQ, Higgins RM. The Minimally Invasive Inguinal Hernia: Current Trends and Considerations. Surg Clin North Am 2023; 103:875-887. [PMID: 37709393 DOI: 10.1016/j.suc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Inguinal hernias are one of the most common surgical pathologies faced by the general surgeon in modern medicine. The cumulative incidence of an inguinal hernia is around 25% in men and 3% in women. The majority of inguinal hernias can be repaired minimally invasively, utilizing either robotic or laparoscopic approaches.
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Affiliation(s)
- Thomas Q Xu
- Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Rana M Higgins
- Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Zhang H, Cao Z, Cao J, Chen J, Liu Y, Wang M. Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study. Asian J Surg 2023; 46:4222-4228. [PMID: 36642546 DOI: 10.1016/j.asjsur.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. MATERIALS AND METHODS The study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. RESULTS There were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). CONCLUSION The hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.
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Affiliation(s)
- Hongming Zhang
- Department of General Surgery, No.1 Hospital of Zhangjiakou, Hebei, Zhangjiakou, PR China
| | - Zhen Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
| | - Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, PR China.
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Zhou Z, Tong C, Tian L, Zhang X, Li Y, Xiao Y, Yan L. Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women. Hernia 2023; 27:1195-1202. [PMID: 36949269 PMCID: PMC10533639 DOI: 10.1007/s10029-023-02765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The processing of the round ligament of uterus in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia in women has contended. This study aimed to explore whether there is any difference in the surgical outcome and postoperative complications between the two processing modalities, preservation, and transection of the round ligament of uterus, in adult female inguinal hernia patients undergoing TAPP. METHODS Retrospective analysis of 84 female patients (117 sides) who underwent TAPP in XXX Hospital from July 2013 to August 2022. Patient characteristics and technical details of the surgical procedure were collected and divided into two groups according to whether the round ligament of uterus was severed intraoperatively or not. There were 52 cases (77 sides) in the group with preservation of the round ligament of uterus and 32 cases (40 sides) in the group with transection of the round ligament of uterus, comparing the general condition, surgical condition, and the occurrence of postoperative related complications between the 2 groups. RESULTS The operative time for unilateral primary inguinal hernia was (129.2 ± 35.1) and (89.5 ± 42.6) minutes in the preservation and transection groups, respectively. There were no statistical differences between the two groups in terms of age, length of hospital stay, ASA, BMI, history of lower abdominal surgery, type and side of hernia, intraoperative bleeding, and time to surgery for primary bilateral hernia (P > 0.05). In addition, there was likewise no statistical difference in the occurrence of postoperative Clavien-Dindo classification, VAS, seroma, mesh infection, labia majora edema, chronic pain or abnormal sensation in the inguinal region, and hernia recurrence in the two groups as well (P > 0.05). CONCLUSION There is no evidence that the transection of the round ligament of the uterus during TAPP has an impact on postoperative complications in patients. However, given the important role of the uterine round ligament in the surgical management of patients with uterine prolapse and the high incidence of uterine prolapse in older women, hernia surgeons should also be aware of the need to protect the round ligament of uterus in older women.
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Affiliation(s)
- Z Zhou
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
- Yan'an University, Yan'an, China
| | - C Tong
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - L Tian
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - X Zhang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Y Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Y Xiao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - L Yan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Hidalgo NJ, Guillaumes S, Bachero I, Butori E, Espert JJ, Ginestà C, Vidal Ó, Momblán D. Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP). BMC Surg 2023; 23:270. [PMID: 37674142 PMCID: PMC10481522 DOI: 10.1186/s12893-023-02177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. METHODS We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. RESULTS A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. CONCLUSIONS Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Eugenia Butori
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Juan José Espert
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - César Ginestà
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Óscar Vidal
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, Barcelona, Spain
| | - Dulce Momblán
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
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Chaouch MA, Hussain MI, Gouader A, Lahdhiri AA, Mazzotta A, da Costa AC, Krimi B, Noomen F, Oweira H. A systematic review and meta-analysis of hernia sac management in laparoscopic groin hernia mesh repair: reduction or transection? BMC Surg 2023; 23:249. [PMID: 37612674 PMCID: PMC10464031 DOI: 10.1186/s12893-023-02147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There is no consensus regarding hernia sac management during laparoscopic hernia repair, and this systematic review and meta-analysis aimed to compare the postoperative outcomes of sac reduction (RS) and sac transection (TS) during laparoscopic mesh hernia repair. METHODS We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 and AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) guidelines. We used the RevMan 5.4 statistical package from the Cochrane collaboration for meta-analysis. A random effects model was used. RESULTS The literature search yielded six eligible studies including 2941 patients: 821 patients in the TS group and 2120 patients in the RS group. In the pooled analysis, the TS group was associated with a lower incidence of seroma (OR = 1.71; 95% CI [1.22, 2.39], p = 0.002) and shorter hospital stay (MD = -0.07; 95% CI [-0.12, -0.02], p = 0.008). There was no significant difference between the two groups in terms of morbidity (OR = 0.87; 95% CI [0.34, 2.19], p = 0.76), operative time (MD = -4.39; 95% CI [-13.62, 4.84], p = 0.35), recurrence (OR = 2.70; 95% CI [0.50, 14.50], p = 0.25), and Postoperative pain. CONCLUSIONS This meta-analysis showed that hernia sac transection is associated with a lower seroma rate and shorter hospital stay with similar morbidity, operative time, recurrence, and postoperative pain compared to the reduction of the hernia sac. PROTOCOL The protocol was registered in PROSPERO with ID CRD42023391730.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia.
| | - Mohammed Iqbal Hussain
- Department of General Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Amine Gouader
- Department of Surgery, Perpignan Hospital Center, Perpignan, France
| | - Abdallah Amine Lahdhiri
- Department of Anesthesia and Intensive Care, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Alessandro Mazzotta
- Department of Digestive, Metabolic, and Oncologic Surgery, Institute Mutualist of Montsouris, Paris, France
| | - Adriano Carneiro da Costa
- Department of Digestive, Metabolic, and Oncologic Surgery, Institute Mutualist of Montsouris, Paris, France
| | - Bassem Krimi
- Department of Surgery, Perpignan Hospital Center, Perpignan, France
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Hani Oweira
- Department of Surgery, Universitäts medizin Mannheim, Heidelberg University, Mannheim, Germany
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Brucchi F, Ferraina F, Masci E, Ferrara D, Bottero L, Faillace GG. Standardization and learning curve in laparoscopic hernia repair: experience of a high-volume center. BMC Surg 2023; 23:212. [PMID: 37507714 PMCID: PMC10385909 DOI: 10.1186/s12893-023-02119-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Groin hernias are a common condition that can be treated with various surgical techniques, including open surgery and laparoscopic approaches. Laparoscopic surgery has several advantages but its use is limited due to the complexity of the posterior inguinal region and the need for advanced laparoscopic skills. This paper presents a standardized and systematic approach to trans-abdominal pre-peritoneal (TAPP) groin hernioplasty, which is useful for training young surgeons. METHODS The paper provides a detailed, step-by-step description of the TAPP based on evidence from literature, anatomical knowledge, and the authors' experience spanning over 30 years. The sample includes 487 hernia repair procedures, with 319 surgeries performed by experienced surgeons and 168 surgeries performed by young surgeons in training. The authors performed a descriptive analysis of their data to provide an overview of the volume of laparoscopic hernioplasty performed. RESULTS The analysis of the data shows a low complication rate of 0.41% (2/487) and a low recurrence rate of 0.41% (2/487). The median duration of the surgery was 55 min, while the median operation time for surgeons in training was 93 min, specifically 83 min for unilateral hernia and 115 min for bilateral hernia. CONCLUSIONS The TAPP procedure appears, to date, comparable to the open inguinal approach in terms of recurrence, postoperative pain and speed of postoperative recovery. In this paper, the authors challenge the belief that TAPP is not suitable for surgeons in training. They advocate for a training pathway that involves gradually building surgical skills and expertise. This approach requires approximately 100 procedures to achieve proficiency.
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Affiliation(s)
- Francesco Brucchi
- Department of General Surgery, Sesto San Giovanni Hospital, Viale Matteotti, 83, Milan, MI, 20099, Italy.
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy.
| | - Federica Ferraina
- Department of General Surgery, Sesto San Giovanni Hospital, Viale Matteotti, 83, Milan, MI, 20099, Italy
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy
| | - Emilia Masci
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy
| | - Davide Ferrara
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy
| | - Luca Bottero
- Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy
| | - Giuseppe G Faillace
- Department of General Surgery, Sesto San Giovanni Hospital, Viale Matteotti, 83, Milan, MI, 20099, Italy
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Lade C, Ford H, Venincasa K, Lewis S, Lee B, Harmon A, Choi P, Raines A. No prostate? No problem: robotic inguinal hernia repair after prostatectomy. J Robot Surg 2023:10.1007/s11701-023-01586-y. [PMID: 37022558 PMCID: PMC10078048 DOI: 10.1007/s11701-023-01586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023]
Abstract
Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1 month. Mean follow-up time was 8.0 months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.
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Affiliation(s)
- Caleb Lade
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA.
| | - Hunter Ford
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Kiran Venincasa
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Samara Lewis
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Benjamin Lee
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Allison Harmon
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Preston Choi
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
| | - Alexander Raines
- Department of General Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- College of Medicine (Department of Surgery), The University of Oklahoma, Oklahoma City, OK, USA
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Lima DL, Alcabes A, Viscarret V, Nogueira R, Malcher F. Incarcerated Epiploic Appendix in a Spigelian Hernia Treated by Robotic-Assisted Surgery. CRSLS 2023; 10:e2023.00008. [PMID: 37313356 PMCID: PMC10258872 DOI: 10.4293/crsls.2023.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction We report a case of a patient who presented with incarceration of the epiploic appendix in a spigelian hernia, subsequently treated by a robotic-assisted surgical approach. Case Description This is a case of a 52 year-old male patient who presented with nausea and two-week history of worsening left lower quadrant pain. On examination, the patient had an irreducible left lower quadrant mass. Computed tomography scan showed an epiploic appendagitis in a left Spigelian hernia. The patient underwent a robotic transabdominal preperitoneal hernia repair successfully and was discharged home the same day. Conclusion The robotic platform was a safe and effective approach to treating the patient with no postoperative complications.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, The Bronx, NY
| | - Analena Alcabes
- Department of Surgery, Montefiore Medical Center, The Bronx, NY
| | | | - Raquel Nogueira
- Division of General Surgery, NYU Langone Health, New York, NY
| | - Flavio Malcher
- Center for Abdominal Core Health, Division of General Surgery, NYU Langone Health, New York, NY
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Oshidari B, Ebrahimian M, Nakhaei M, Ghayebi N. Laparoscopic relief of reduction en-masse in an inguinal hernia: A case report. Int J Surg Case Rep 2021; 90:106724. [PMID: 34959090 PMCID: PMC8718655 DOI: 10.1016/j.ijscr.2021.106724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Reduction en-masse is an extremely rare condition that usually develops in prolonged hernias. Spontaneous or iatrogenic reduction of this type of hernia may lead to disastrous consequences such as obstruction, gangrene, or peritonitis. According to the reports so far, surgical management is the only choice for this condition. Presentation of case In this paper, we report a 48-year-old man who presented with vague abdominal pain and a history of inguinal hernia for years and had reduced his hernia five days earlier. Computed tomography (CT) and ultrasonography confirmed the diagnosis, and the patient was taken to the operating room to relieve the bowel loop utilizing laparoscopy. Conclusion Laparoscopic relief could be an effective tool in diagnosis and surgery of reduction en-masse. Transabdominal preperitoneal repair is the best choice due to its capability to explore the intraabdominal organs and its low risk of recurrence. Reduction en-masse of inguinal hernia is a rare entity in which has been reported about 200 cases so far. We reported a 48-year-old case of reduction en-masse hernia who operated by laparoscopy. Laparoscopy can be a strong diagnostic and therapeutic tool in the management of reduction en-masse hernia Transabdominal preperitoneal repair is the best choice due to its capability to explore the abdominal cavity.
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Affiliation(s)
- Bahador Oshidari
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Manoochehr Ebrahimian
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mobin Nakhaei
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Ghayebi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marmolejo A, Farell J, Ruiz Funes AP, Ayala S, Sánchez A, Navarro CA, Ramírez NA, García L, Daes J. Critical view of the myopectineal orifice: a scoring system to objectively evaluate transabdominal preperitoneal inguinal hernia repair. Surg Endosc 2021; 36:5094-5103. [PMID: 34846592 DOI: 10.1007/s00464-021-08874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. METHODS The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. RESULTS Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p < 0.001). The Finn coefficient for inter-rater agreement was 0.97 for the s-CVMPO score and 0.99 for the e-CVMPO score (p < 0.001 for both). Both the s-CVMPO and e-CVMPO scores showed internal consistency with Cronbach's α of 0.89 and 0.87, respectively. The correlation coefficient between the two scores for the average score of each procedure was ρ = 0.96 (p < 0.001). CONCLUSION The CVMPO score is a reliable tool for expert evaluation of TAPP repair. Implementing the CVMPO score facilitates objective assessment of the safety and quality of the procedure.
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Affiliation(s)
- Antonio Marmolejo
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico.
| | - Jorge Farell
- Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Ana Paula Ruiz Funes
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Sergio Ayala
- Department of Clinical Pathology, Hospital Universitario "Dr. José E. González", 1st Floor, Av. Francisco I. Madero Pte. Mitras Centro, 64460, Monterrey, Nuevo Leon, Mexico
| | - Alain Sánchez
- Department of Internal Medicine, ABC Medical Center, Sur 136 No. 116, Las Américas, Álvaro Obregón, 01120, Ciudad de México, CDMX, Mexico
| | - Carlos Armando Navarro
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Nubia Andrea Ramírez
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Luis García
- Department of Surgery, Hospital Central Sur de Alta Especialidad, PEMEX, 7th Floor, Periférico Sur 4091 Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Jorge Daes
- Department of Minimally Invasive Surgery, Clinica Portoazul, 30 Carrera, Corredor Universitario #1-850, Consultorio 411, Barranquilla, Colombia
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Lade C, Lewis S, Venincasa K, Harmon A, Choi P, Lee B, Raines A. Feasibility of robotic-assisted minimally invasive inguinal hernia repair in patients with urologic considerations including artificial urinary sphincters and bladder herniation. J Robot Surg 2021; 15:695-9. [PMID: 33107011 DOI: 10.1007/s11701-020-01163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Robotic surgical technology has the potential to broaden the applicability of minimally invasive approaches into more complex, technically challenging inguinal hernia repairs. A unique patient population requiring inguinal hernia repair are those patients who either have artificial urinary sphincters (AUS) or inguinal bladder herniation (IBH). Traditionally, these patients have not been considered candidates for minimally invasive inguinal hernia repairs. Through this retrospective series, we aim to contribute to the growing body of literature on robotic-assisted inguinal hernia repair (RIHR) by describing our experience with RIHR in this patient subset. We performed a retrospective chart review of RIHR cases performed from June 2017 to April 2019 by a single surgeon at our university-affiliated community hospital. Charts were reviewed for preoperative considerations, operative complications, and postoperative outcomes. A total of three patients with an AUS and six patients with IBH were included, all of whom were male. All the patients received transabdominal preperitoneal (TAPP) approaches, and all received placement of mesh. There were no intraoperative complications and no conversions to open surgery. Postoperatively, one patient with IBH had persistent surgical site pain that resolved after 3 weeks and one patient, also with IBH, had a surgical site seroma that resolved without further intervention. Mean follow-up time was 10.71 and 12.13 months for patients with AUS and IBH, respectively. No patients reported hernia recurrence during this time. This review suggests that the use of robotic assistance for laparoscopic inguinal hernia repair is safe and effective and may provide additional benefits for patients with concurrent urological considerations such as AUS and IBH.
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12
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Kudsi OY, Gokcal F, Bou-Ayash N, Crawford AS, Chung SK, Chang K, Litwin D. Learning curve in robotic transabdominal preperitoneal (rTAPP) ventral hernia repair: a cumulative sum (CUSUM) analysis. Hernia 2020; 25:755-764. [PMID: 32495055 PMCID: PMC7268975 DOI: 10.1007/s10029-020-02228-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Purpose rTAPP-VHR is a novel technique which may be added to a surgeon’s armamentarium. We aim to evaluate the robotic transabdominal preperitoneal ventral hernia repair (rTAPP-VHR) learning curve based on operative times while accounting for peritoneal flap integrity. Methods We performed a retrospective analysis of a database collected over a 7-year period. Patients with primary ventral hernias were included and a cumulative sum analysis(CUSUM) was used to create learning curves for three subsets of operative times. A risk-adjusted CUSUM (RA-CUSUM) accounted for repair quality based on peritoneal flap completeness. The flap was considered as incomplete when peritoneal gaps were unable to be closed. Results 105 patients undergoing rTAPP-VHR were included. Learning curves were created for skin-to-skin, console, and off-console times. Patients were divided into three phases. In terms of skin-to-skin times, both phase 2&3 had a mean 11 min shorter than that of phase 1 (p = 0.0498, p = 0.0245, respectively), with a steady decrease after forty-six cases. An incomplete peritoneal flap was noted in 25/36 patients in phase 1, as compared to 5/24 and 5/45 patients in phase 2&3, respectively. When risk-adjusted for peritoneal flap completeness, gradually decreasing skin-to-skin times were observed after sixty-one cases. In terms of off-console times, the mean across three phases was 14 min, with marked improvement after forty-three cases. Conclusions Forty-six cases were needed to achieve steadily decreasing operative times. We can assume that ensuring good-quality repairs, through maintenance of peritoneal flap integrity, was gradually improved after sixty-one cases. Moreover, familiarization with port placements and robotic docking was accomplished after forty-three cases.
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Affiliation(s)
- O Y Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.
| | - F Gokcal
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - N Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - A S Crawford
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - S K Chung
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - K Chang
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - D Litwin
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
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Min L, Yong P, Yun L, Balde AI, Chang Z, Qian G, He L, Fang P. Propensity score analysis of outcomes between the transabdominal preperitoneal and open Lichtenstein repair techniques for inguinal hernia repair: a single-center experience. Surg Endosc 2020; 34:5338-5345. [PMID: 32157406 DOI: 10.1007/s00464-019-07324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The mechanism of persistent chronic pain after TAPP and OLR remains controversial. Therefore, more prospective and well-designed studies are needed to determine the predictive risk factors that will lead to better pain prevention and possibly elimination. The aim of the present study was to investigate the risk factors of chronic pain after TAPP repair and OLR in a single institution. METHODS A single-center, retrospective study of propensity score-matched patients who underwent TAPP or OLR surgery between 2008 and 2018 was conducted. To overcome selection bias, we performed 1:1 matching using 6 covariates to generate the propensity score. RESULTS A total of 400 patients treated with TAPP and 424 patients treated with OLR were balanced to 400 pairs of matched patients. The patients' age (P < 0.001), BMI (P < 0.001), foreign body sensation within 3 months after surgery (P < 0.001), and persistent sensation loss (P = 0.002) were different between the two groups. The OLR group had a shorter operative time than did the TAPP group (P < 0.001). The univariate analysis of factors predicting a difference in VAS between the preoperative assessment and the assessment 3 months after surgery showed that the type of surgery (P = 0.004), hernia grade (P = 0.001), type of mesh (P < 0.001), presence of scrotal invasion (P = 0.024), and foreign body sensation within 3 months (P = 0.047) were risk factors. The multivariate analysis revealed that only hernia grade III (CI - 8.524, - 2.783; P < 0.001), OLR operation type (CI 1.069, 4.987; P = 0.002), and the use of polypropylene mesh (CI - 5.400, - 1.489; P = 0.001) were independently associated with chronic pain. CONCLUSION These results suggest that compared to OLR, TAPP leads to less postoperative pain and a better long-term quality of life.
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Affiliation(s)
- Liuwei Min
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Pengzhi Yong
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liuying Yun
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Alpha I Balde
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China.
| | - Zhanghuan Chang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Gao Qian
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Liangzheng He
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
| | - Panyan Fang
- Department of General Surgery, Qingxin District People's Hospital, BP: 511800, Qingyuan City, Guandong Province, People's Republic of China
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Zheng W, Zhu Z, Zhang C, Zhang H. Application of the novel enhanced transabdominal preperitoneal (ETAP) technique for laparoscopic suprapubic incisional hernia repair. Surg Today 2019; 50:525-530. [PMID: 31538257 DOI: 10.1007/s00595-019-01879-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
Suprapubic incisional hernia is a special type of incisional hernia, the optimal choice of surgery for which remains controversial. Inspired by advantages of laparoscopic incisional hernia repair and inguinal hernia repair, we developed a novel laparoscopic surgery procedure for suprapubic incisional hernia repair: the enhanced transabdominal preperitoneal (ETAP) technique. To create a peritoneal flap, the peritoneum was dissected from 2 cm above the abdominal wall defect to 2 cm below the pubic arch, then the hernia defect was closed with a full-thickness transabdominal suture. Following the position of mesh to cover the defect with an 5-cm overlap on all sides, the peritoneal flap was closed with continuous suture. In this study, a total of 57 patients with suprapubic incisional hernia underwent laparoscopic ETAP. The mean hernia size was 61.5 cm2, the average mesh size was 173.6 cm2, the mean operating time was 90 min, the mean blood loss was 34 cc, and the average hospital stay was 2.6 days. In the follow-up period, which ranged from 12 to 45 months, the overall incidence of complications was 17.86%. Six patients developed seroma without herniation, six patients suffered from obvious postoperative pain, and four patients experienced urinary retention. All complications resolved without treatment. No recurrence was observed. In conclusion, the laparoscopic ETAP technique contributes to reduced rates of suprapubic incisional hernia repair and mesh-induced complications.
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Affiliation(s)
- Wei Zheng
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Zhonglin Zhu
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China
| | - Hui Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, 450003, People's Republic of China.
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15
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Gokcal F, Morrison S, Kudsi OY. Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia 2019; 23:957-967. [PMID: 30968286 DOI: 10.1007/s10029-019-01946-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to compare perioperative results of robotic IPOM (r-IPOM) and robotic TAPP (r-TAPP) in ventral hernia repair, and to identify risk factors associated with postoperative complications. METHODS After obtaining balanced groups with propensity score matching, the comparative analysis was performed in terms of perioperative and early outcomes. All variables were also examined in a subset analysis in patients with and without complications. Multivariable regression analysis was used to identify independent risk factors associated with the development of complications. RESULTS Of 305 r-IPOM and r-TAPP procedures, 104 patients were assigned to each group after propensity score matching. There was no difference in operative times between two groups. Although postoperative complications were largely minor (Clavien-Dindo grade-I and II), the rate of complications was higher in the r-IPOM group within the first 3-weeks (33.3% in r-IPOM vs. 20% in r-TAPP, p = 0.039). At the 3-month visit, outcomes between groups were not different (p = 0.413). Emergency department re-visits within 30-days and surgical site events were also higher in the IPOM group (p = 0.028, p = 0.042, respectively). In regression analysis, the development of complications was associated with incisional hernias (p = 0.040), intraperitoneal mesh position (p = 0.046) and longer procedure duration (p = 0.049). CONCLUSION Our data suggest r-IPOM may be associated with increased complication rates in the immediate postoperative period when compared to r-TAPP. However, at 3 months, outcomes are comparable. More investigation is needed in this area, specifically with regards to long-term follow-up and multicenter data, to determine the true value of extra-peritoneal mesh placement.
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Affiliation(s)
- F Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA
| | - S Morrison
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA
| | - O Y Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pear Street, Brockton, MA, 02301, USA.
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16
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Huang DY, Pan L, Chen MY, Fang J. Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature. World J Clin Cases 2018; 6:398-405. [PMID: 30283803 PMCID: PMC6163131 DOI: 10.12998/wjcc.v6.i10.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 02/05/2023] Open
Abstract
A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.
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Affiliation(s)
- Di-Yu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ming-Yu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jing Fang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Narang K, Krishan A, Pisavadia B, Wadood A, Budhoo M, Zaman S. Laparoscopic inguinal hernia repair: a rare case of colonic mesh migration. Ann R Coll Surg Engl 2018; 100:e1-e4. [PMID: 30112945 PMCID: PMC6204502 DOI: 10.1308/rcsann.2018.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/22/2023] Open
Abstract
Inguinal hernia repair can be performed via either an open or laparoscopic technique. Use of a mesh to repair the abdominal wall defect is now common practice, leading to a reduction in hernia recurrence but also associated with a number of complications. We report a rare case of a 49-year old man who presented 3 years after laparoscopic hernia repair with right-sided abdominal pain and loose stools. Colonoscopy and computed tomography revealed a mesh and fixation devices within the lumen of the caecum and ascending colon. The mesh was successfully excised with primary closure of the bowel defect. This case highlights the importance of recognising mesh migration as a complication of hernia repair, a phenomenon which can lead to serious morbidity. We suggest that patients should be informed of this risk during the consent process, while further research is needed to investigate how this occurrence can be prevented.
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Affiliation(s)
- K Narang
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - A Krishan
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - B Pisavadia
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - A Wadood
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - M Budhoo
- Sandwell General Hospital, Lyndon, West Bromwich, UK
| | - S Zaman
- Sandwell General Hospital, Lyndon, West Bromwich, UK
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Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ. Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc 2018; 33:418-428. [PMID: 29987564 DOI: 10.1007/s00464-018-6314-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/29/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Compared with open herniorrhaphy, laparoscopic herniorrhaphy can yield more favorable clinical outcomes. However, previous studies failed to give definite answer for comparison between laparoscopic inguinal hernia repair approaches. This study aimed to systematically determine the differences in recurrence rate, duration of return to work, pain, surgery duration, and duration of hospital stay between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approach for inguinal hernia. METHODS PubMed, Embase, and Cochrane Library (including the Cochrane Central Register of Controlled Trials) abstracts up to September 2017 were searched for randomized controlled trials (RCTs) comparing TAPP or TEP hernia repairing. The hernia recurrence rate, time to return to work, analgesic consumption, surgery duration, hospital stay, and the pain score were recorded with subgroup analysis of the hernia type. RESULTS Sixteen RCTs that randomized 1519 patients with hernia into TEP and TAPP repair groups were analyzed in this study. The results revealed that TEP repair resulted in shorter hospital stay of primary cases (MD - 0.87, 95% CI - 1.67 to - 0.07) but was associated with a longer operative duration in recurrent hernia group (MD 3.35, 95% CI 0.16 - 6.54). CONCLUSIONS TEP and TAPP have their own advantages. TEP repair reduces short-term postoperative pain more effectively than TAPP repair and results in shorter hospital stay of primary cases. In contrast, TAPP repair is correlated with shorter surgery duration. These findings show that shared decision-making regarding both approaches of laparoscopic hernia repair may be needed.
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Affiliation(s)
- Li-Siou Chen
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chieh Chen
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan. .,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chien-Chih Wu
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Long-Wen Tsai
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan
| | - Min-Zhe Liu
- Department of Urology, Taipei Medical University Hospital, No. 252, Wu-Xing Street, Taipei, 110, Taiwan.
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Antoniou SA, Antoniou GA, Bartsch DK, Fendrich V, Koch OO, Pointner R, Granderath FA. Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies. Am J Surg. 2013;206:245-252.e1. [PMID: 23768695 DOI: 10.1016/j.amjsurg.2012.10.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/20/2012] [Accepted: 10/04/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aim of the present study was to comparatively evaluate the outcomes of laparoscopic transabdominal preperitoneal inguinal hernia repair and totally extraperitoneal repair. METHODS The electronic databases of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a meta-analysis of randomized clinical trials was undertaken. RESULTS Seven studies comprising 516 patients with 538 inguinal hernia defects were identified. A shorter recovery time (P = .02) was found for totally extraperitoneal repair in comparison with transabdominal preperitoneal inguinal hernia repair (weighted mean difference = -.29; 95% confidence interval [CI], -.71 to .07) although the length of hospitalization (P = .89) was similar in the 2 treatment arms (weighted mean difference = .01; 95% CI, -.13 to .15). Operative morbidity (P = .004) was higher for the preperitoneal approach (odds ratio = 2.15; 95% CI, 1.29 to 3.61). No differences were found with regard to the incidence of recurrence, long-term neuralgia, and operative time. CONCLUSIONS Current evidence suggests similar operative results for endoscopic and laparoscopic inguinal hernia repair, with a trend toward higher morbidity for the preperitoneal approach. Randomized trials with a longer-term follow-up are needed in order to assess the effect of each approach on the prevention of recurrence.
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