Laparoscopic Groin Hernia Repair Research Articles

Transabdominal preperitoneal (TAPP) repair for emergency groin hernia: a systematic review.

Laparoscopic groin hernia repair has evolved and gained popularity and laparoscopic transabdominal preperitoneal (TAPP) procedure provides an opportunity to evaluate the peritoneal cavity and both inguinal areas without the need for additional dissection. There is still a paucity of evidence to support TAPP repair in the emergency setting. In this systematic review, we aim to evaluate the feasibility and safety of TAPP repair for incarcerated and strangulated groin hernias. PRISMA guidelines were followed for literature search and established inclusion and exclusion criteria were applied. Data were extracted and analyzed for the outcomes of interest. Overall, 8 studies were included in the review, comprising 316 patients. Patients characteristics and outcomes were limitedly reported. Only 3 cases of conversion to open approach were reported and 2 recurrences were diagnosed. Postoperative complications are inconsistently reported but mostly refer to minor complications. There were no mortality cases. Visceral resections were performed in 25 cases due to ischemia, mostly extracorporeally. Laparoscopy is a game changer and TAPP approach is a feasible, safe, and effective technique for the emergent repair of groin hernias. Further studies and prospective randomized data are needed to establish its role in the emergent groin hernia management.

Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Mesh Fixation Versus Nonfixation in Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6months. A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24hours and 6months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4cm in size. The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24hours and at 6months; however, the rate of recurrence was comparable to that of the fixation method.

Ergonomic Laparoscopic Surgical Repair of three large external herniae through just three optimally placed working ports – A Case report with Review of Literature

Currently, hernia repair is the most frequent procedure performed by general surgeons. Like many other abdominal operations, the laparoscopy revolution has influenced the surgical repair of external herniae as well. Laparoscopic repair of groin and ventral hernia have become more and more popular over the years. Ventral herniae are mostly repaired trans-peritoneally while groin herniae can be repaired both trans- as well as extra-peritoneally. Herein, we describe the case of a 60-year old man who presented to us with large umbilical and large bilateral inguinal herniae. All the three large external herniae were repaired laparoscopically, through just 3 carefully selected trocar sites. The purpose of this paper is to highlight the importance of ergonomics in optimum laparoscopic trocar placement, so as to achieve maximum results with minimum number of port sites.

Varying convalescence recommendations for sport and heavy lifting after groin hernia repair: a nationwide survey among leading hernia surgeons.

Recent international hernia guidelines state that work and leisure activities after inguinal hernia repair can be resumed after a convalescence of three to five days for most patients. There is no specific recommendation for convalescence duration before resuming sport and heavy lifting. This nationwide survey aimed to assess leading hernia surgeons' recommendations for convalescence after groin hernia repair and to explore their general opinions regarding convalescence. A validated questionnaire was sent to 32 leading groin hernia surgeons covering all Danish private and public hospitals. The primary outcome was convalescence recommendations following Lichtenstein and laparoscopic groin hernia repair for activities of daily living, light work, sport, and heavy lifting. A total of 29 surgeons (91%) responded to the questionnaire. The surgeons generally agreed on resuming daily activities and light work as soon as possible according to the level of pain. For resumption of sport, the surgeons recommended a median convalescence of 14days (IQR 10-23, range 7-30) after Lichtenstein repair and 14days (IQR 10-21, range 7-30) after laparoscopic repair. Most of the surgeons instructed patients with a defined number of days before resuming heavy lifting, which after Lichtenstein repair was median 14days (IQR 8-28, range 2-30) and after laparoscopic repair was median 21days (IQR 14-30, range 7-30). None of the surgeons routinely prescribed sick leave. Seventeen surgeons (61%) thought that recommending a too short convalescence could cause complications, primarily recurrence, hematoma, and pain. This study revealed that surgeons agreed on the resumption of daily activities and light work as soon as possible according to the level of pain. However, a broad spectrum of convalescence recommendations was revealed for sport and heavy lifting.

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

Surgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum. To assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists. This nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority's Online Register via surgeons' unique authorization ID. The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral. Hernia repairs performed by supervised residents vs specialists. Reoperation for recurrence, analyzed separately for all 4 groups. A total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048). The findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

A comparative analysis of trans-abdominal pre-peritoneal repair in uncomplicated vs complicated inguinal hernia repair.

Trans-abdominal pre-peritoneal (TAPP) repair is one of the standard techniques for laparoscopic repair of groin hernias. Literature has shown that both total extraperitoneal (TEP) and TAPP are equally effective with similar outcomes but TAPP has an advantage over TEP as there is more working space, and it provides access to the opposite side for repair of occult hernias. We reviewed our experience of TAPP repair in complicated groin hernias and compared the outcomes with uncomplicated groin hernia. Patients undergoing TAPP repair from January 2004 to December 2019 were analyzed, and divided into two groups-I uncomplicated and II complicated groin hernia. TAPP repair was performed in 820 patients, of which 70.3% had uncomplicated and 29.7% patients had complicated hernias. Occult hernia was detected in 61 patients. The intra-operative complications (16.8% vs 1.3%) and conversions (2.4%) were higher in complicated hernias. Laparoscopic assisted repair was used in 16.8% patients with complicated hernias. The incidence of post-operative complications (62.1% vs 17.3%; P value <.01) were significantly higher in complicated groin hernia patients. The median follow-up was 15 months; only three patients in the uncomplicated hernia group developed recurrence, and chronic groin pain was higher in the complicated hernia repair patients (P > .05) at 6months. Although operative time, incidence of intra-operative and post-operative complications (albeit minor in nature), and conversions to open are higher after TAPP repair for complicated groin hernias, the short-term outcomes (hematoma, mesh infection) as well as long-term outcomes (chronic groin pain, port site hernia and recurrence) are not different when compared with uncomplicated hernias. TAPP repair can be used in both complicated and uncomplicated groin hernias with similar short-term and long-term outcomes, albeit with a slightly higher incidence of minor complications in complicated hernias. This can be taken into consideration while operating on patients with complicated hernias and taking informed consent.

Occult hernia: role of laparoscopy in detecting the unseen

Background: OH (occult hernias) refer to those hernias which are not evident on clinical examination, but which are noted either on surgical exploration or on good quality pre-operative imaging. Identifying them in day-to-day practice is of immense importance in view of unexplained and undiagnosed symptomatology, post-operative recurrences and cost effectiveness. The main objective of this paper is to study the incidence of occult hernias diagnosed intra-operatively during laparoscopic groin hernia surgery.Methods: In this retrospective study, we identified 723 patients who underwent laparoscopic repair of groin hernia in our institute by a single surgeon, from 2008 to 2021. OH were found in 120 patients, all during totally extraperitoneal approach (TEPA) and none during transabdominal pre-peritoneal approach (TAPP). The age range of these 120 patients was 22 to 83 years (mean: 60.7 years with SD: ±12.5 years). The patients were also analysed for sex, type of OH, side of OH and post-operative outcomes.Results: Incidence of OH in our study was 16.59% (120 out of 723 patients). OH were found in both male as well as female patients. These comprised of unilateral and bilateral OH. Patients with unilateral OH heavily outnumbered those with bilateral OH (n=117 vs. 3). There were 3 different types of OH in our study-inguinal, femoral and spigelian. The maximum number of cases were of inguinal OH (n=115). Among inguinal OH, patients with direct OH outnumbered those with indirect OH (n=73 vs. 40).Conclusions: Awareness about OH as an entity is important, as their identification and concurrent repair possibly spares the patient another surgical intervention at a later date.

OC-015 PATIENT REPORTED OUTCOMES FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN A DISTRICT GENERAL HOSPITAL USING TWO DIFFERENT METHODS OF MESH FIXATION

Abstract Aim Post-operative pain is recognised as an important outcome following mesh repair of groin hernias. We investigated patient reported outcomes using the Carolinas Comfort Scale (CCS) in patients who underwent laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair in a district general hospital (DGH). Methods The CCS questionnaire was sent to 162 randomly selected patients who underwent groin hernia repair (TAPP), performed using absorbable tacks or tissue glue to fix the mesh, by a single surgeon between 2011–2021. The questionnaire is used to assess 23 patient reported parameters including sensation of mesh, pain &amp; movement limitations in different positions e.g. laying, standing etc. The follow-up ranged between 3 months to 10 years. The median and range values for each criterion were used to determine the outcome. Results Seventy-six responses were received (response rate 46.91%). Our data showed excellent outcomes in all parameters measured by the CCS, with a median score of 0 out of 5. There were no hospital readmissions within 30 days or major complications. Out of 1748 measured parameters across 76 patients, only 71 scores were ≥3 (4.06%) – there was no observable correlation between these higher scores and mesh fixation device used. Conclusions In this study we found that it is possible to achieve excellent outcomes in a DGH following laparoscopic groin hernia repair. Initial assessment has not shown any significant difference in outcome between methods of mesh fixation but we wish to study this further with inclusion of more patient reported outcomes.

Implementation of robot-assisted groin hernia repair diminishes the prospects of young surgeons' training: a nationwide register-based cohort study.

Robot-assisted groin hernia repair is becoming more popular in recent years but may remove operations from surgical trainees. We aimed to investigate the educational level of the surgeons who performed robot-assisted groin hernia repair and the rate of supervision and compare this to open and laparoscopic groin hernia repair. This register-based study was reported according to the RECORD statement and used linked data from the Danish Hernia Database and the Danish Patient Safety Authority's Online Register. We included surgeons that performed robot-assisted, laparoscopic, and/or open groin hernia repairs performed between January 1, 2015, and June 15, 2021 in Denmark. A total of 916 surgeons performing 43,856 groin hernia repairs were included in this study. Surgical specialists performed 98% of the robot-assisted groin hernia repairs, 89% of the laparoscopic repairs (p < 0.0001), and 54% of the Lichtenstein repairs (p < 0.0001). Only 5% of the robot-assisted groin hernia repairs were supervised compared with 11% of the laparoscopic repairs (p < 0.0001) and 28% of the open repairs (p < 0.0001). Almost all groin hernia repairs performed with the robot-assisted technique were performed by surgeons specialized in general surgery. The proportions of surgeons specialized in surgery were higher for robot-assisted operations compared with laparoscopic or open groin hernia surgery. Thus, our data suggest a lack of involvement of surgeons in training, and this diminishes the educational potential in the pool of groin hernia operations by the use of robot-assisted repairs.

Laparoscopic versus open groin hernia repair in older adults: a systematic review and meta-analysis.

Groin hernia repair is a common surgical procedure and includes both open and laparoscopic techniques. Studies comparing outcomes of laparoscopic versus open groin hernia repair specifically in the geriatric population are lacking. This study compares the outcomes of laparoscopic versus open groin hernia repair techniques in older adults. A literature search was conducted in each of the five selected databases up till June 2021: PubMed (MEDLINE), EMBASE, CINAHL, Cochrane and PsychInfo (OVID). Outcomes measured included but were not limited to total length of hospital stay, mean total operative time, intraoperative complications, post-operative complications such as wound infection, seroma formation, chronic pain, mesh infection and recurrence of inguinal hernia. A total of five articles were included in the final analysis. The length of postoperative hospitalization stay was shorter in patients who underwent laparoscopic hernia repair (95% CI: -1.50 to -0.72; P < 0.01, I2 = 79%). The laparoscopic repair group had a significantly smaller number of patients who sustained postoperative wound infections (95% CI: 0.02 to 0.47; P=0.003, I2 = 0%), and lower incidence of chronic pain (95% CI: 0.14 to 0.37, P < 0.01, I2 = 46%). Analysis of the remaining outcomes did not reveal any statistically significant differences between open and laparoscopic hernia repair. The results of this analysis showed a shorter length of stay, lower wound infection rates and lower chronic pain with laparoscopic groin hernia repair as compared to open repair in older adults. Future prospective studies examining the impact of age on the relationship between surgical approach (open versus laparoscopic) and surgical outcomes are needed.

Nationwide analysis of laparoscopic groin hernia repair in Italy from 2015 to 2020

Since its introduction, the minimally invasive treatment of groin hernias has become widely accepted as a viable alternative to open surgery. Still, the rates and reasons for its adoption vary highly among countries and the regions within a country. After almost thirty years since its introduction, its spread is still limited. The present study, conducted under the auspices of AGENAS (Italian National Agency for Regional Services), aims at giving a snapshot of the spreading of minimally invasive and robotic techniques for the treatment of groin hernia in Italy. This study is retrospective, with data covering the period from 1st January 2015 to 31st December 2020. AGENAS provided data using the operation and diagnosis codes used at discharge and reported in the International Classification of Diseases 9th revision (ICD9 2002 version). Admissions performed on an outpatient basis, i.e., without an overnight stay of at least one night in hospital, were excluded. A total of 33,925 laparoscopic hernia repairs were performed during the considered period. Overall, a slight increase in the number of procedures performed was observed from 2015 to 2019, with a mean annual change of 8.60% (CI: 6.46–10.74; p < 0.0001). The number of laparoscopic procedures dropped in 2020, and when considering the whole period, the mean annual change was − 0.98% (CI: − 7.41–5.45; p < 0.0001). Urgent procedures ranged from 335 in 2015 to 508 in 2020 referring to absolute frequencies, and from 0.87% to 9.8% in relative frequencies of overall procedures in 2017 and 2020, respectively (mean = 4.51%; CI = 3.02%–6%; p < 0.001). The most relevant observation that could be made according to our analysis was that the adoption of the laparoscopic approach knew a slow but steady increase from 2015 onward.

Impact of malnutrition on outcomes following groin hernia repair: Insights from the ACS NSQIP

BackgroundThe present study examined the association of nutrition status, as defined by preoperative serum albumin, with postoperative outcomes and resource use after groin hernia repair. MethodsThe 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database was queried for adults (≥18 years) undergoing open or laparoscopic repair of inguinal or femoral hernia. Patients were stratified based on the following preoperative serum albumin levels: <2.5 g/dL (severe hypoalbuminemia), 2.5 to <3.0 (moderate hypoalbuminemia), 3.0 to <3.5 (mild), and ≥3.5 (normal albumin). Multivariable regression models were developed to assess the association of hypoalbuminemia with outcomes of interest, including 30-day mortality, postoperative complications, length of stay, and 30-day readmission. ResultsOf the 261,052 patients meeting inclusion criteria, 0.3% had severe, 1.1% had moderate, and 7.4% had mild hypoalbuminemia, with 91.2% classified as normal albumin. After risk adjustment, mortality risk was greater for severe (5.8%, 95% confidence interval: 4.1–7.6), moderate (4.4%, 95% confidence interval: 3.4–5.3), and mild hypoalbuminemia (1.5%, 95% confidence interval: 1.2-1.8) relative to normal albumin (0.3%, 95% confidence interval: 0.2–0.3). Decreasing serum albumin levels were associated with a stepwise increase in risk of complications, length of stay, and 30-day readmission. ConclusionDecreased preoperative serum albumin is associated with increased mortality and morbidity after open and laparoscopic groin hernia repair. Serum albumin remains a relevant predictor of postsurgical outcomes and can thus be used in shared decision-making and optimization of malnourished patients in need of groin hernia repair.

A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus

Regardless of the advances in surgical techniques, parastomal hernia is still an inevitable complication for many patients with low rectal cancer undergoing abdominal perineal resection (APR). Extraperitoneal colostomy (EPC) seems to be a effective method to reduce the risk of parastomal hernia. We propose a new approach to simplify and standardize laparoscopic EPC to make this operation easy to perform. We used the technique of laparoscopic TEP groin hernia repair to produce an extraperitoneal tunnel, which can not only facilitate precise visualization of the extraperitoneal tunnel but also utilize the intact posterior rectus abdominis sheath as biologic materials to maintain soft-tissue augmentation, with a satisfactory result. With laparoscopy, we can create adequate space without insufficient dissection of the extraperitoneal tunnel while avoiding damage to the retrorectus sheath. At the time of writing, we had performed this method in four patients, without any complications. This technique is effective at preventing parastomal hernia without extra costs.

The Effect of Intraoperative Transversus Abdominis Plane Blocking on Postoperative Pain After Laparoscopic Transabdominal Pre-peritoneal (TAPP) Groin Hernia Repair.

BackgroundManaging postoperative pain even after laparoscopic groin hernia repair still remains an interesting challenge for clinicians especially for patients of high risk. Plenty of operative techniques and analgesic methods have been proposed in order to minimize postoperative pain after laparoscopic groin hernia repair. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain.MethodsPatients that underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) groin hernia repair in a high-volume university hospital were included. Patients were divided in two groups depending on the analgesic method used. Pain was assessed using Visual Numerical Scale (VNS) score.ResultsThirty patients were included. Intraoperative TAP-block seemed to be superior in terms of decreasing pain at the hernia area and at the trocar insertion site (p < 0.05) compared to local analgesic infiltration at the trocar insertion site at 6, 12 and 24 h after surgery (p < 0.05). In addition, pain reduction was more effective in rest rather than in motion for both analgesic methods.ConclusionIntraoperative TAP-block under direct vision seems to be an effective, fast and easy technique in order to reduce postoperative pain after laparoscopic groin hernia repair, but more studies are required to validate these results in a prospective and randomized context.

Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital.

Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited. A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates. Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min±17.2 vs. 71.9 min±19.9, P<0.001) and lower total costs (€ 974.51±266.67 vs. € 1165.32±285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8±13.4 min vs. 34.5±16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9±16.6 min vs. 41.7±18.7 min, P<0.001) and higher total costs in the unilateral open procedure (€ 1007.47±238.58 vs. € 909.35±305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons. Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.

Lower reoperation rates after open and laparoscopic groin hernia repair when performed by high-volume surgeons: a nationwide register-based study.

Previous studies have shown a correlation between surgeons with high annual volume and better outcomes after various surgical procedures. However, the preexisting literature regarding groin hernia repair and annual surgeon volume is limited. The aim was to investigate how annual surgeon volume affected the reoperation rates for recurrence after primary groin hernia repair. This nationwide cohort study was based on data from the Danish Hernia Database and the Danish Patient Safety Authority's Online Register. Patients ≥ 18years undergoing laparoscopic or Lichtenstein primary groin hernia repair between November 2011 and January 2020 were included. Annual surgeon volume was divided into five categories: ≤ 10, 11-25, 26-50, 51-100, and > 100 cases/year. We included 25,262 groin hernia repairs performed in 23,088 patients. The risk of reoperation for recurrence after Lichtenstein repair was significantly higher for the volume categories of ≤ 10 (HR 4.02), 11-25 (HR 3.64), 26-50 (HR 3.93), or 51-100 (HR 4.30), compared with the > 100 category. The risk of reoperation for recurrence after laparoscopic repair was significantly increased for the volume categories of ≤ 10 (HR 1.89), 11-25 (HR 2.08), 26-50 (HR 1.80), and 51-100 (HR 1.58) compared with the > 100 category. The risk of reoperation for recurrence was significantly higher after Lichtenstein and laparoscopic repairs performed by surgeons with < 100 cases/year compared with > 100 cases/year. This indicates that higher surgeon volume minimizes the risk of reoperation for recurrence after groin hernia repair.

Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique.

The aim of this study is to evaluate the cost-effectiveness of different modifications of the trans-abdominal pre-peritoneal (TAPP) repair of groin hernia. Data were collected prospectively for all consecutive patients who underwent TAPP unilateral inguinal hernia repair between November 2017 and March 2019, and who completed a minimum of 1 year of follow-up. Costs and quality adjusted life year (QALY) gained were collected. Three TAPP variations were assessed: mesh fixation and peritoneal closure with staples (group 1); mesh fixation with fibrin glue and peritoneal closure with sutures (group 2); and mesh fixation and peritoneal closure with fibrin glue (group 3). A matched group of open repairs was established. The incremental cost-effectiveness ratio (ICER) and main intra-operative and post-operative outcomes were assessed. Overall 120 patients were included (group 1 n = 31; group 2 n = 27; group 3 n = 33; open group: 29). Operative time was shorter for groups 2 and 3, and the main post-operative outcomes were similar. The overall mean total cost of the open group (1185.95€) was lower compared with the laparoscopic group (group 1: 1682.39; group 2: 1538.54€; group 3: 1510.1€) (p = 0.026). However, the mean ICERs of groups 2 and 3 were significantly higher compared with group 1 (p = 0.021) and the open group (p = 0.032). At simulations analysis, the probability of cost-effectiveness was 33.32%, 36.26%, and 36.7% in TAPP groups 1, 2, and 3. In the long term, laparoscopic repair of groin hernia is cost-effective compared with open surgery. The use of fibrin glue for mesh fixation and/or for closing the peritoneum is the most cost-effective option and shortens operative times.

Lower recurrence rate after groin and primary ventral hernia repair performed by high-volume surgeons: a systematic review.

Hernia repair is a common procedure; however, an overview is lacking regarding the impact of annual surgeon volume and total surgical experience on the outcome of hernia repair. We aimed to explore the impact of annual surgeon volume and total surgical experience on outcomes of groin and primary ventral hernia repair. This systematic review followed the Prefered Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A protocol was registered at PROSPERO (CRD42020176140). PubMed, EMBASE, and Cochrane CENTRAL were searched. We investigated recurrence rates after groin and primary ventral hernia repair reported according to annual surgeon volume or total surgical experience with at least 6months follow-up. Surgeons were pooled in three overlapping categories: high-volume (> 50 cases/year), medium-volume (11-50 cases/year) and low-volume (≤ 25 cases/year). Ten records for groin hernia and one for primary ventral hernia were included. The median (range) recurrence rates after laparoscopic groin hernia repair for high, medium, and low-volume surgeons were 2.6% (2.3-3.0), 2.4% (0.7-4.6), and 4.2% (1.0-6.8), respectively. The median (range) recurrence rate after open groin hernia repair for high, medium, and low-volume surgeons were 2.1% (2.0-2.2), 1.7% (1.6-2.3), and 2.4% (2.2-5.0). The groin hernia recurrence rate seemed to increase when annual surgeon volume decreased below 25 cases/year. For primary ventral hernia, increased annual surgeon volume was associated with decreased reoperation rate. High-volume surgeons seemed to have lower rates of hernia recurrence after groin as well as primary ventral hernia repair and our data supports the need for centralization of groin hernia repair on individual surgeons.

Open Versus Laparoscopic Incarcerated or Strangulated Inguinal Hernia Repair – A Review

Minimal access surgery or laparoscopic surgery has revolutionized the surgical world since its introduction in the 1980s. The evidence for elective laparoscopic groin hernia repair is well established. However, there are only handfuls of literatures on the evidence of emergency laparoscopic groin hernia repairs. In this review article we delineated details on how laparoscopy in emergency incarcerated or strangulated inguinal hernia repair benefits patients, and surgical technique and special precaution required during the operation. During open surgery surgeon to idle for 10–20 min trying to make a return on the bowel condition to prepare for bowel resection, and since its emergency condition and time essence for the surgeon so most of the time, surgeon would just proceed for bowel resection. Whereas, laparoscopic surgery allows ample time for the strangulated bowel to recover, and this in fact will avoid unnecessary laparotomy and bowel resection since most of the time the strangulated bowel can recovered if it allowed enough time for them to revascularize. In conclusion, laparoscopic approach for incarcerated or strangulated inguinal emergency hernias repair has its benefits in several areas over minimal access surgery which contribute to the improvement in clinical outcomes. However, careful selection of patients and a sufficient knowledge of anatomy and expertise in the reduction of the strangulated organs are required.