Elective Laparoscopic Inguinal Hernia Repair Research Articles

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair.

Objective:To observe the effect of Ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative sedation in patients undergoing laparoscopic hernia repair.Methods:100 male patients aged 60 to 80 years old, a line to elective laparoscopic inguinal hernia repair, were randomly divided into four groups: control group (Group A) and dezocine group (Group B), ketorolac tromethamine group (Group C), ketorolac tromethamine combined with dezocine group (Group D). Patients were administrated with 0.1 mg/kg dezocine in Group B, 0.5 mg/kg ketorolac in Group C, 0.1 mg/kg dezocine, and 0.5 mg/kg ketorolac in Group D, and with an equal dose of normal saline in group A. The heart rate (HR) and mean arterial pressure (MAP) of patients in 4 groups were recorded at each time point as follows, T0 (enter the operating room), T1 (before skin resection), 10 min after pneumoperitoneum (T2), mesh placement (T3), and laryngeal mask extraction (T4). Operation time, awakening time (time from drug withdrawal to consciousness recovery), the dosage of propofol, sufentanil, remifentanil, and intraoperative vasoactive drug dosage were recorded to compare. Visual analog scale score and sedation Ramsay score were evaluated 1, 6, 12, and 24 hours after extubation.Results:There was no significant difference in operation time, anesthesia recovery time, sufentanil dosage, and vasoactive drugs among all groups. The amount of propofol in Group B and D was less than that in Group A and C (P < .05), and there was no difference between Group B and D, A and C (P > .05). The amount of remifentanil in Group B, C, and D was less than that in Group A (P < .05), and Group D was less than B and C (P < .05). After extubation, HR and MAP were significantly higher than before (P < .05). Compared with T0, HR and MAP increased in each group at T4, but MAP and HR in Group D increased the least (P < .05). There were significant differences between Group B, C, D, and A, MAP and HR fluctuated little during extubation (P < .05), but there was a significant difference between Group D and B, C (P < .05). Visual analog scale scores of Group B, C, and D were lower than those of A at 1, 6, and 12 hours after surgery (P < .05), and there was a significant difference between Group D, and B, C (P < .05). Ramsay scores in Group B and D were higher than those in A and C at 1 and 6 hours after the operation (P < .05). There was no difference in the incidence of adverse reactions among groups.Conclusion:The prophylactic use of ketorolac tromethamine and dezocine before laparoscopic inguinal hernia repair can reduce hemodynamic disorder during anesthesia recovery, increase postoperative sedative and analgesic effects.

English

BACKGROUND After surgery, 1 / 4th of patients develop urinary retention. POUR (Post-Operative Urinary Retention) is clinically identifiable urinary bladder post-operatively. POUR occurs more frequently after hernia surgeries (both open and laparoscopic methods), lower urinary tract, perineal, gynaecologic, and anorectal surgeries. tamsulosin, being an alpha-1 receptor blocker, decreases the bladder neck tone and hence increases the efficiency of micturition. We wanted to evaluate tamsulosin in preventing POUR in patients who underwent laparoscopic groin hernioplasty. METHODS From January 2017 through January 2018, a total of 150 males more than 40 years of age who underwent laparoscopic inguinal hernia repair in Government T.D. Medical College were included in this study. In group 1, patients were given 0.4 mg Tamsulosin orally, 2 weeks before surgery and continued postoperatively and group 2 patients were selected from other units in surgery where tamsulosin was not used. CONCLUSIONS Tamsulosin, before and after surgery, is useful in reducing the incidence of POUR in patients undergoing elective laparoscopic inguinal hernia repair. KEYWORDS Laparoscopic Hernioplasty, Tamsulosin, Urinary Retention, Alpha Adrenergic Antagonist, Post-Operative Urinary Retention (POUR), Post-Voiding Residual Urine Volume (PRV) RESULTS There are 75 patients in group 1 (tamsulosin) and 75 patients in group 2 (control group). All the patients were male and the mean age in both the groups was almost similar. In tamsulosin group 5 patients (6.7 %), and in control group 14 patients (18.7 %) developed Post-Operative Urinary Retention (POUR). The type and side of hernia, duration of surgery, and post-voiding residual urine volume (PRV) were not effective in causing POUR. There was significantly lower incidence of post-operative urinary retention in Tamsulosin group compared to control group. The age, severity of seven pre-operative urinary symptoms and the prostate volume was statistically significant in patients who developed postoperative urinary retention in both groups.

Comparison of the Effect of Laryngeal Mask Airway Versus Endotracheal Tube on Airway Management in Pediatric Patients with Tonsillar Hypertrophy

PurposeThe laryngeal mask airway (LMA) has become an important choice in both routine and difficult airway management. We aimed to evaluate the safety and effectiveness of LMA use in pediatric patients with tonsillar hypertrophy. DesignThis study was a randomized controlled trial. MethodsThe study included 100 pediatric patients who had first or second degree tonsillar hypertrophy. Pediatric patients undergoing elective laparoscopic inguinal hernia repair were randomly divided into two groups (n = 50): LMA group and the endotracheal tube (ETT) group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (PETco2). Data for primary outcomes were collected before and 5-, 15-, and 25-minute after opening pneumoperitoneum, and on closing the pneumoperitoneum. Complications such as laryngospasm, bronchospasm, desaturation, severe coughing, blood on the device after removal, and sore throat were recorded. FindingsA total of 100 pediatric patients were assessed and 97 eligible patients were randomly assigned to receive an LMA (n = 49) or an ETT (n = 48). There was no statistically significant difference in ventilation leak volume and PETco2 between the LMA and ETT groups (P > .05). Compared with T1-4, peak airway pressure was significantly lower in T0 (LMA group 12.6 ± 0.9, 95% confidence interval 12.2 to 13.0; ETT group 12.8 ± 1.2, 95% confidence interval 12.2 to 13.3; P < .05). The incidences of laryngospasm 11 (22.9%), desaturation 18 (37.5%), and severe coughing 13 (27%) were higher in the ETT group (11 [22.9%] vs 3 [6.1%], 18 [37.5%] vs 6 [12.2%], 13 [27%] vs 3 [6.1%]; P < .05). ConclusionsThe application of LMA has a lower incidence of complications. LMA as an airway device is effective and perhaps superior in appropriate patients.

Laparoscopic Inguinal Hernia Repair by Transabdominal Preperitoneal Mesh Hernioplasty (TAPP), A Prospective Study

Background: Hernia is not a disease of modern society; its occurrence was found during early 16th century and it was recognized as a surgical disease by Praxagoras of Kos because of its demand for some sort of life-saving treatment. In general, hernia is described as a protrusion of contents of abdominal cavity through a weakness or opening in the abdominal muscle wall. Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. It has several significant advantages over the tension-free open repair now in use. In this report we summarize our laparoscopic hernia repair results and Recommendations. Method: The study was conducted in the Department of General Surgery, Geetanjali Medical College, Udaipur, from November 2017 to November 2019. It was a prospective, observational study on the patients of uncomplicated inguinal hernias who underwent an elective laparoscopic inguinal hernia repair. The following data was collected prospectively: age, sex, duration of surgery, intra-operative complications, postoperative pain, postoperative complications, hospital stay and recurrence. Results: A total 30 patients were operated during study period and total number of hernia repair were 36, with their ages renged from 22 to 80 year with mean age of 52.6year. All patents were male.The average duration of operation was 55.33 ± 17.02minutes. The average length of hospital stay was 3.06day. The main complication in our study were postoperative seroma formation. One patient required conversion to open with zero recurrence till date. Conclusion: Laparoscopic TAPP hernia repair has proven to be an efficient method for the treatment of groin hernias at our institution.

Inguinal hernia repair in patients with liver cirrhosis: Lichtenstein repair versus laparoscopic total extra-peritoneal approach

Background: The optimal surgical approach of inguinal hernia in patients with liver cirrhosis; laparoscopic or open; is still undefined. Whether laparoscopic inguinal hernia repair is safe and potentially affords superior outcomes in patients with liver disease is unknown. Aim of this study is to assess the outcomes of laparoscopic inguinal hernia repair compared to open procedures regarding postoperative complications and recurrence rate in patients with liver cirrhosis.Methods: This study involves data of ninety patients with primary unilateral inguinal hernia and liver cirrhosis. 48 of them had Lichtenstein repair and 42 patients had laparoscopic inguinal hernia repair with the total extra-peritoneal (TEP) approach.Results: The mean operation time was greater for the patients operated by TEP than that by Lichtenstein repair with a statistically significant difference (p=0.02). Wound infection, scrotal edema and hospital stay were greater for the patients operated by Lichtenstein repair (p=0.0001 for all). At a mean follow-up of 16.9 months (range: 2 –32 months); recurrence of hernia developed in 3 (3.1 %) with Lichtenstein repair but no recurrence of hernia occurred in the patients operated with TEP.Conclusions: Elective Laparoscopic inguinal hernia repair is feasible option in liver cirrhosis patients. However; despite of some better outcomes with TEP; there is insufficient evidence to conclude its greater effectiveness than Lichtenstein repair.

Laparoscopic-assisted transversus abdominis plane block as an effective analgesic in total extraperitoneal inguinal hernia repair: a double-blind, randomized controlled trial

PurposeLaparoscopic inguinal hernia repair has facilitated early mobilization. Management of post-operative pain is paramount in these day case procedures. The aim of this study was to compare laparoscopic-assisted transversus abdominis plane (TAP) block with periportal local anaesthetic infiltration in managing post-operative pain.MethodsA double-blind, randomized controlled trial was conducted with patients undergoing elective laparoscopic inguinal hernia repair (January 2016–October 2017). The intervention group received laparoscopic-assisted TAP block with 30 ml 0.25% Bupivacaine. The control group received 15ml of 0.5% Bupivacaine at the periportal sites. Primary outcome measure was assessment of post-operative pain scores using numerical rating on visual analogue scale (VAS) at rest and on coughing at 3 h. Efficacy of TAP block was assessed as reduction in mean pain scores in the order of 2 points using the VAS.Results60 (57 males and 3 females) were enrolled; 30 patients were randomized to each group. Patient demographics, anaesthetic and surgical times were similar in both groups. Mean pain scores were significantly reduced in the intervention group at 3 (3.1 vs 1.1 p < 0.001) and 6 h (4.1 vs 1.7 p < 0.001) at rest and on coughing at 3 (4.8 vs 2.1 p < 0.001) and 6 h (5.4 vs 3.0 p < 0.001). Patient satisfaction was higher (8.0 vs 6.8 p < 0.001) and rescue analgesic requirements (169.4vs 71.3 p < 0.001) lower in the intervention group.ConclusionsThis analysis has demonstrated the therapeutic benefit of laparoscopic-assisted TAP block in initial post-operative pain management for patients undergoing elective laparoscopic inguinal hernia repair.

Computed tomography in the investigation and management of obturator hernia.

Obturator hernias are a rare groin hernia. They are most commonly found incidentally during laparoscopic inguinal hernia repair. We investigated our experience with obturator hernias in the elective and emergency setting. Cases of obturator hernia were identified from a hospital database and reviewed retrospectively over the last 10 years. There were no exclusions. There were a number of surgeons involved with an interest in groin hernia surgery. Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery. Computed tomography would be recommended in cases of diagnostic uncertainty. It may avoid unnecessary surgery in the elective setting and allow a focused procedure in the emergency setting. Laparoscopic repair is feasible in the emergency and elective setting with excellent results.