Comparing perichondrial M-TAPA and subcostal OSTAP blocks in laparoscopic hernia repair: A randomized, non-inferiority trial.

Laparoscopic inguinal hernia repair has become a frequently performed procedure. It is thus inevitable that some candidates for radical prostatectomy for prostatic carcinoma will have undergone such previous intervention. Mesh placement in the space of Retzius as performed in laparoscopic hernia repair may cause obliteration of the preperitoneal space, complicating radical prostatectomy. The objective of this review was to assess the literature regarding outcomes of radical prostatectomy (open, laparoscopic, robot-assisted) after laparoscopic inguinal hernia repair with mesh placement and to investigate whether key outcomes are compromised. A literature search was conducted in the PUBMED database using the search terms "prostatectomy" and either "hernia repair" or "herniorrhaphy." A further evaluation of the references cited in the articles that were found was performed. Only publications related to radical prostatectomy after laparoscopic hernia repair were included. A total of 15 articles referring to radical prostatectomy after laparoscopic hernia repair were found. These publications included a total of 436 patients. We evaluated operative and long-term outcome parameters such as completion of radical prostatectomy, completion of lymph node dissection, operative complications, and long-term, functional, and oncologic outcome. Radical prostatectomy (open, laparoscopic, robot-assisted) is feasible and safe after laparoscopic inguinal hernia repair. The procedure is technically demanding, although perioperative, oncologic, and functional outcomes do not differ from those after radical prostatectomy without previous laparoscopic inguinal hernia repair. Pelvic lymph node dissection may not be safe in some patients and may compromise accurate staging. A potential future need for radical prostactectomy in a male patient with inguinal hernia should not be a determining factor against a laparoscopic approach to inguinal hernia repair.

BackgroundLaparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC.MethodThe present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome.ResultsThe mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results.ConclusionsAfter the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block.Clinical trial registrationThe study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).

I appreciate the comments of Sabuncuoglu et al. [1] about my article [2]. They raised several important issues regarding indications for laparoscopic hernia repair, primary end points of hernia surgery, and the difficulties of urologic surgery after laparoscopic and endoscopic hernia repair. The historical studies on laparoscopic and open hernia repair techniques presented by Sabuncuoglu et al. do not analyze the different hernia types (e.g., medial and lateral inguinal hernias, scrotal hernias, incarcerated hernias, hernias after radical prostatectomy and recurrences following TAPP and TEP). Therefore, the statements of the Hernia Trialists Collaboration study are restricted [3]. Nevertheless, the data suggested less persistent postoperative pain and numbness following laparoscopic repair and the patients were able to return to their usual activities more quickly. According to the study, there was no apparent difference in recurrence rate between laparoscopic and open mesh methods of hernia repair. However, the transferability of the results is limited. The European Hernia Society (EHS) has recommended TAPP and TEP as standard procedures for repairing bilateral and recurrent hernias after anterior repair, and inguinal hernias in females [4]. In addition, the International Endohernia Society (IEHS) recommended TAPP and TEP as treatment options for complicated hernias (scrotal hernias, incarcerated hernias, hernias after radical prostatectomy, and recurrent hernias after TAPP and TEP procedures), if the repair is performed by a surgeon experienced in laparoscopic and endoscopic hernia repair [5]. Besides the recurrence rate, a high level of patient satisfaction with the outcome of their repair is an important primary end point in hernia surgery. According to my retrospective study, 96.9 % of all patients were satisfied with the result of their modified TAPP. Only 1.5 % was dissatisfied due to hernia recurrence, persistent pain, or postoperative complications. A radical prostatectomy after a bilateral laparoscopic or endoscopic hernia repair and a TAPP or TEP after a radical prostatectomy are challenging and time-consuming interventions. A modification of the surgical repair technique is necessary. There is necessarily a steep learning curve for these procedures. The repair should be done only by surgeons who have extensive experience in laparoscopic and endoscopic hernia repair [5]. According to single-case reports [6, 7], the fibrotic reaction of the implanted mesh after endoscopic and laparoscopic hernia repair makes urologic cancer surgery complicated. According to these reports, the preparation of the preperitoneal space should be nearly impossible [1]. In contrast, Stolzenburg et al. [8] presented a large series of 2,000 endoscopic extraperitoneal radical prostatectomy (EERPE) procedures, including 50 patients who had had a prior endoscopic/laparoscopic hernioplasty, with no conversions to an open procedure and the rates of intraand postoperative complications were not increased. We agree with these authors that EERPE after TAPP and TEP is a safe and effective procedure when port placement and the preparation of the retropubic space are modified. For this procedure, a surgeon experienced not only in laparoscopic hernia repair but also in laparoscopic radical prostatectomy is needed. Replying to the question of how to manage hernia repair in patients with risk factors for pelvic surgery, to our W. K. J. Peitsch (&) Klinik fur Allgemeinund Viszeralchirurgie, Katholisches Krankenhaus St. Josef, Kliniken Essen Sud, Propsteistr. 2, 45239 Essen, Germany e-mail: wkjpeitsch@t-online.de

Patient satisfaction after laparoscopic and conventional day case inguinal hernia repair

Inguinal hernia is a common disease, and laparoscopic tension-free inguinal hernia repair has become the standard procedure for treating inguinal hernia. During surgery, carbon dioxide gas is injected into the patient's abdominal cavity to maintain a specific pneumoperitoneum pressure. Under standard pneumoperitoneum pressure (SPP), we occasionally observe that some patients are prone to subcutaneous emphysema and hypercarbia, especially elderly patients with inguinal hernias, where the occurrence is relatively high. The aim of this study was to analyse whether using lower pneumoperitoneum pressure (LPP) in laparoscopic hernia repair is safer while maintaining surgical success. This was a prospective, double-blind, randomized controlled study in which patients were randomly assigned to either the LPP group or the SPP group. The primary outcome measures were the results of patients' arterial blood gas analysis, including partial pressure of carbon dioxide (PaCO2), arterial oxygen partial pressure (PaO2), pH value, arterial oxygen saturation (SaO2), whole blood base excess (ABE), and standard base excess (SBE). The secondary outcome measures included heart rate, blood pressure, cardiac output (CO), stroke volume (SV), end-tidal carbon dioxide pressure (PetCO2), airway pressure (Paw), intraoperative complications, surgical duration, anesthesia recovery time, Length of hospital stay, postoperative pain, and quality of life. The aim of this study was to analyse the differences in these indicators between the two groups of patients. Compared with laparoscopic inguinal hernia repair performed under SPP, the use of LPP in laparoscopic inguinal hernia repair is advantageous for improving patients' blood gas analysis and systemic circulatory indicators. This study demonstrated that LPP for inguinal hernia repair is safe and effective, providing evidence-based support for the selection of pneumoperitoneum pressure values. Chinese Clinical Trial Registry, ChiCTR2400091218, Registered on October 23, 2024.

With advances in clinical medicine, many premature babies nowadays can have excellent survival outcomes. As the incidence of inguinal hernias in this group is high and there is scarce data in the literature regarding the optimal timing for repair, this study aims to review our experience in laparoscopic repair in premature infants. In our centre, premature neonates with inguinal hernia noted during hospitalization were offered laparoscopic repair when the body weights reached 2.5kg unless there is contraindication for laparoscopy. A retrospective review was carried out for all premature neonates who underwent laparoscopic inguinal hernia repair from 2001 to 2011. The operative results, complications, incarceration risk and postoperative apnea risk were recorded. A total of 79 premature neonates received laparoscopic inguinal hernia repair during this period. The mean gestational age at birth was 31.9weeks (27-36weeks) and the mean gestational age at operation was 46.5weeks (33-92weeks). One patient had incarceration and required emergency operation while waiting for the elective repair. The mean operative time was 44.9min (25-93min). One patient (1.3%) had recurrence. No postoperative apnea was noted in any patient. Laparoscopic hernia repair is safe and feasible in premature neonates when they attain reasonable body size, as long as there is excellent anaesthesia support. Low risk of incarceration was noted in this study and it is worth waiting for the body weight to build up and hence facilitate laparoscopic repair.

Laparoscopic inguinal hernia repair in women: Trends, disparities, and postoperative outcomes

Background:We aimed to assess whether an ultrasound (US)-guided oblique subcostal transversus abdominis plane (OSTAP) block would improve the postoperative pain scores and decrease the tramadol consumption after a laparoscopic hysterectomy.Methods:Sixty-six female patients with American Society of Anesthesiologists I, II, or III, aged 18 to 65 years who were scheduled for laparoscopic hysterectomy for benign gynecologic pathologies were recruited in this randomized, controlled, observer-blinded trial. Sixty patients completed the study. Patients were randomized into 2 groups. In the OSTAP group, the patients received a bilateral OSTAP block with 40 mL of 0.375% bupivacaine and in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. All patients received tramadol patient-controlled analgesia for the first 24th hour. Patients in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. The primary outcome was the 24th hour tramadol consumption. The secondary outcomes included visual analog scale (VAS) scores during movement, the tramadol consumption at the 1st, 4th, and 12th postoperative hours, and nausea scores at the 24th hour postoperatively.Results:At all time points, tramadol consumption of the OSTAP group remained significantly lower when compared with Sham group. The OSTAP group showed a statistically significant reduction at the postoperative 24th hour tramadol consumption (mean difference 22 mg, 95% confidence interval −38.4 to −5.6 mL; P = .009). Compared with the Sham group, OSTAP block reduced the VAS scores at all time points during movement. Nausea scores at the 24th postoperative hour were significantly lower in the OSTAP group compared with the Sham groupConclusion:We concluded that bilateral US-guided OSTAP blocks reduced 24th hour tramadol requirements and VAS scores after laparoscopic hysterectomy. The OSTAP block is a promising technique for producing effective and prolonged postoperative analgesia in patients undergoing laparoscopic hysterectomy surgeries.

Sexual dysfunction after inguinal hernia complication is considered rare. However, its consequences impact on quality of life inevitably. Laparoscopic and open inguinal hernia repair may be comparable in terms of recurrent rate, overall complications, and chronic pain. Therefore, its complication is still questionable between these approaches. In this study, we compared sexual dysfunction and related complications between laparoscopic and open inguinal hernia repair. Systematic review and meta-analysis of randomized controlled trials (RCTs) studies were performed to compare laparoscopic and open inguinal hernia repair. Risk ratio (RR) and 95% confidence intervals (95% CI) were used as pooled effect size measures. Thirty RCTs (12,022 patients) were included. Overall, 6014 (50.02%) underwent laparoscopic hernia repair, and 6008 (49.98%) underwent open hernia repair. Laparoscopic approach provided non-significance benefit on pain during sexual activity (RR 0.57; 95% CI 0.18, 1.76), Vas deferens injury (RR 0.46; 95% CI 0.13, 1.63), orchitis (RR 0.84; CI 0.61,1.17), scrotal hematoma (RR 0.99; CI 0.62,1.60), and testicular atrophy (RR 0.46; CI 0.17,1.20). Meanwhile, the open inguinal hernia approach seems to perform better for cord seroma complications and testicular pain. There is no advantage of laparoscopic inguinal hernia repair over an open approach concerning sexual dysfunction. On the contrary, there is an increasing risk of cord seroma after laparoscopic inguinal hernia repair with statistical significance.

Background: Hernias of the abdominal wall constitute an important public health problem. Laparoscopic inguinal hernia repair (TEP) is a minimal access surgical procedure as compared to open hernia repair. The objective of the study was to compare open and laparoscopic hernia repair in terms of safety, complications, morbidity, recurrence, post-op pain and hospital stay.Methods: This was a prospective observational comparative study. Total 50 patients were taken in this study; out of them 25 patients subjected to group A (open repair of inguinal hernia) and 25 patients subjected to group B (laparoscopic repair of inguinal hernia). Postoperatively patients were observed for any complications and followed up one year.Results: Present study shows high incidence of inguinal hernia in males. Mean operative time for open hernia repair group was less than laparoscopic hernia repair group. Time to return to normal work, duration of hospital stay and postoperative pain were less in laparoscopic hernia repair group than open hernia repair group. Out of 25 patients in laparoscopic hernia repair (TEP) 1 patient had recurrence but in open hernia repair group there was no recurrence.Conclusions: Laparoscopic hernia repair is quite safe; it has definite advantages in bilateral and recurrent cases, postoperative pain, early return to normal activities, less postoperative hospital stay and better cosmetic results although it has its own disadvantages in terms of recurrence rate, operative time and cost effectiveness.

To compare postoperative pain after laparoscopic hernia repair and conventional open hernia repair. Prospective, randomized study. Veterans Affairs Medical Center. Sixty-two patients scheduled for elective inguinal hernia repair. Patients were randomized in the operating room to have a laparoscopic hernia repair (30 patients) or a conventional open hernia repair (32 patients). All operations were performed while the patient was under general anesthesia to avoid anesthesia as a confounding variable. Postoperative pain following laparoscopic hernia repair and open hernia repair were compared using the McGill Pain Score, the McGill Visual Analogue Pain Scale score, and the number of acetaminophen with 30-mg codeine sulfate (Tylenol 3) tablets needed for pain during the first and second 24-hour periods postoperatively. All of the patients were interviewed and the postoperative pain was evaluated by a special study nurse (P.M.L.) who was blinded to the repair technique. At 24 hours, the patients with laparoscopic hernia repair had 26% less pain by the McGill Pain Score (P = .02) and 31% less pain by the McGill Visual Analogue Scale (P = .006) than those who underwent an open hernia repair. At 48 hours the patients who underwent laparoscopic hernia repair had 28% less pain by the McGill Pain Score (P = .03), 42% less pain by the McGill Visual Analogue Scale (P = .002), and used 42% fewer analgesic tablets (P = .004). Patients with a laparoscopic hernia repair had significantly less pain postoperatively than those with standard open hernia repairs.

This study aimed to evaluate the outcomes of laparoscopic inguinal hernia (LIH) repair in pediatric patients in our clinic. LIH repairs that are between January 2008 and April 2013 were evaluated retrospectively. LIH repair was performed between in 133 patients with a mean age of 5.57 years (range 1 month-17 years). For the repairs, either the Schier’s, Montupet’s, or percutaneous internal ring suturing (PIRS) techniques were used. Of the cases, 67 were on the right side (50.4%), 33 on the left (24.8%), and 33 were bilateral (24.8%). Of the patients who underwent laparoscopic surgery for inguinal hernia (133) 70 were male. Schier’s method was used in 23 patients, 8 with bilateral hernias. Montupet’s was used in 28 patients (4 with bilateral hernias). The PIRS method can be very well considered as the first choice because of it is relatively easy to apply, can be completed in less operative time, and is more cost effective than the other methods. In 7 cases, concomitant umbilical hernias were used as camera ports and repaired at the end of the operation. One femoral hernia was diagnosed and repaired. No complications or recurrences occurred during the mean 48-month (16-76 months) follow up. LIH repair is a safe method in children, it is affordable compared to other laparoscopic operations, and it is advantageous, especially in recurrent hernias, in cases concomitant with umbilical hernias, and in bilateral hernias. The PIRS method may be the first choice because of its lesser operative time, expense, and need for surgical experience.

Background: Inguinal hernias are a common medical problem that can significantly decrease the quality of life.Repair of inguinal hernia is one of the commonest surgical procedures worldwide irrespective of the country, race, or socioeconomic state. The inguinal hernia repair has been a controversial area in surgical practice from the time it has been conceived. Laparoscopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition.Objectives: To compare the outcome of laparoscopic versus open inguinal hernia mesh repair in terms of operative time , analgesics requirement , postoperative complication , hospital stay and return to daily activities and work.Patients and methods: A prospective study of 80 patients with inguinal hernia repair, carried out during the period from January 2010 till January 2013, Baghdad Teaching Hospital\Medical City, Iraq, to compare the effectiveness and safety of laparoscopic and conventional open mesh techniques. Those patients were divided into 2 groups (each group of 40 patients); 1st group treated by laparoscopic (TAPP) repair and the 2nd one by open technique (mesh repair).Results: The mean operating time in laparoscopic repair was 55 minutes (45-120) while in open repair it was 38 minutes (30-110) .The laparoscopic repair was superior to open repair in regard to ; less analgesic requirement post operatively , short hospital stay , and faster return to daily activities and workThere was no statistically significant difference between the two groups regarding complications.Conclusion: Laparoscopic hernia repair is equally safe and can provide less postoperative morbidity in experienced hands Therefore laparoscopic hernia repair can be safely recommended for most cases of inguinal hernia unless laparoscopy itself is contraindicated.

Polypropylene mesh is the most commonly used mesh for open and laparoscopic hernia repair in the United States. A variety of newly developed polyester mesh products have recently become available. This is the first U.S. multiinstitutional study evaluating the initial experience of polyester mesh use for total extraperitoneal (TEP) laparoscopic inguinal hernia repair. Between January 2000 and June 2001, 337 patients underwent 495 TEP laparoscopic inguinal hernia repairs using polyester mesh. There were 309 men and 28 women in the study, whose average age was 45 years (range, 17-80 years). The average operative time for all cases was 54.3 min (range, 18-157 min). There were no conversions to open repair and no mortality. Complications included 12 seromas/hematomas (six aspirated), chronic pain in three patients, urinary retention in two patients, and one incidence each of the following: epididimitis, prostatitis, hydrocele, and port-site cellulitis. Additionally, one patient had carbon dioxide (CO2) in the Foley bag at the end of the surgery, but a normal cystogram showed no identified bladder injury. There has been one recurrence (0.2%), occurring 4 months after surgery, which was repaired using a transabdominal laparoscopic approach. The mean follow-up period was 11 months (range, 2-22 months). There have been no documented infections of the mesh, and no mesh has been removed. This study documents a favorable initial experience with polyester mesh for TEP laparoscopic inguinal hernia repair. There were no complications related to the mesh. There may be technical and long-term advantages with the use of polyester mesh for laparoscopic inguinal hernia repair. Longer follow-up evaluation and additional studies are warranted to evaluate these potential advantages.

Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.