Laparoscopic Inguinal Repair Research Articles

BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK REDUCES POSTOPERATIVE NSAIDS USE AFTER LAPAROSCOPIC HERNIA REPAIR

INTRODUCTION: Bilateral peripheral block (TAP - block) is usually performed under ultrasonography (US) guidance in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle, and it aims to block the thoracoabdominal nerves from Th6 to L1 by infiltrating local anesthetic. TAP block is effective tool of managing pain control, especially in the first twenty-four hours after surgery. It improves recovery pathway following minimally invasive surgery and reduces narcotic and non-steroidal anti-inflammatory drugs (NSAIDs) use for postoperative pain management in various different abdominal surgery. AIM: The purpose of this research was to assess the analgesic efficacy of TAP block in regard to used NSAIDs concentrations during the first 24 hours following laparoscopic inguinal hernioplasty. METHODS: The study was conducted with 60 patients, who were randomized into two groups. Control group – were patients who received general anesthesia (GA), and experimental group, were patients who have received GA and a bilateral TAP block. All patients received NSAIDs in the postoperative period. RESULTS: From the acquired data, during the first postoperative hour (POH) only 20% of the experimental group required Paracetamol in a dosage of 1000 mg. Control patients used three times more NSAIDs (60%). Compared to the control group, 63.3% of TAP-block patients did not require analgesia from the 6th to the 12th POH. In the control group average amount of paracetamol was 5167 mg, while in experimental group it was twice lower. Similar finding was established in regard to Ketonal consumption. The control group (without TAP-block) consumes around twice as many NSAIDs as the experimental group at all post-operative time intervals. CONCLUSION: The findings of our research demonstrate that patients undergoing bilateral laparoscopic inguinal repair, administering ropivacaine as part of an US-guided bilateral TAP-block decreases the requirement of NSAIDs in the first twenty-four hours after surgery. TAP-block is a component of multimodal anesthesia and an adjuvant for intraoperative and postoperative analgesia.

Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention. For decades, the preferred approach was the open repair. As laparoscopy became more popular and available and more surgeons became familiarized with this modality, laparoscopic inguinal hernia repair became an alternative. The aim of this study is to assess the effectiveness of laparoscopic inguinal repair, with a focus on bilateral inguinal hernias. Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias. However, there are only a few studies concerning laparoscopic repair of bilateral hernias. It is yet to be proven that laparoscopy is the “gold standard” in the treatment of bilateral inguinal hernias. So far, the choice of an inguinal hernia repair technique has been up to each surgeon, depending on their expertise and available resources after taking into consideration each patient’s needs.

An Overview on Laparoscopic Inguinal Hernia Repair

One of the most frequent surgical operations in the globe is the repair of inguinal hernia, with over 20 million individuals undergoing it each year. A small percentage of individuals are asymptomatic; nonetheless with imminent surgery in 70% of the cases in this group even with a watchful surgery. In the vast majority of instances, surgical therapy is highly effective. Laparoscopic inguinal repair, which was initially reported in the 1990s, still faces opposition from surgeons today due to seve

Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review.

Seroma formation is the most common postoperative complication after laparoscopic inguinal hernia repair. Recurrence and seroma formation may be difficult to distinguish. Many adjunctive techniques with which to reduce the incidence of seroma formation after laparoscopic inguinal repair have been described in the literature; however, the evidence for using intraoperative adjunctive techniques is limited. Therefore, the present systematic review was performed to evaluate the effects and limitations of adjunctive techniques used during laparoscopic inguinal hernia repair. Major databases (PubMed, Embase, Springer, and Cochrane Library) were searched using the terms "seroma," "laparoscopic inguinal hernia", "TAPP", "TEP", "inguinal hernia", "tack", "barbed suture", "drainage", "Endoloop technique", and "fibrin sealant". All studies involving adults undergoing laparoscopic/endoscopic inguinal hernioplasty with at least one intervention designed to reduce seroma formation were included. Of the 965 studies identified, 8 met the inclusion criteria. Six adjunctive techniques were described in the literature. Transversalis fascia (TF) inversion with tacking: one prospective non-randomized controlled study revealed a lower incidence of postoperative seroma after TF inversion with tacking for direct inguinal hernias (4.17% vs. 14.29%, P < 0.05). Endoloop technique: one prospective study of 76 cases involving this technique revealed a low incidence of seroma formation (3.9% at 2weeks) in direct hernias. Barbed suture closure of TF: one prospective study of 36 direct hernias reported only one clinical palpable seroma that resolved 1month later. Surgical drains: three trials reported the results of drains, and the pooling results demonstrated significantly less seroma formation in patients with surgical drains (2.1 vs. 23.8%; odds ratio 0.12; 95% confidence interval 0.08-0.19; P < 0.0001). Fibrin sealant: one prospective clinical study of 40 patients with indirect inguinal hernias reported a lower volume (P < 0.001) and lower incidence (5% vs. 15%) of seroma formation in the fibrin group. Distal sac fixation technique: in one prospective study of six patients with large inguinoscrotal hernias, one patient developed a seroma on postoperative day 8. Seroma formation is a natural process that cannot be completely prevented following laparoscopic inguinal hernioplasty, especially in patients with direct and large indirect inguinal hernias. Some intraoperative adjunctive techniques are effective in reducing clinically palpable seroma formation in select patients. More randomized controlled trials are needed for further evaluation.

Contemporary Factors Associated with the Use of Laparoscopy for Inguinal Hernia Repair Among Department of Defense Beneficiaries.

The factors that contribute to variation in utilization of laparoscopic inguinal hernia repair are unknown. We sought to determine the current usage patterns of laparoscopic and open surgery in the elective repair of uncomplicated unilateral inguinal hernia in a large population with universal health care coverage comprised of Department of Defense (DoD) beneficiaries. The DoD Military Health System Data Repository (MDR) tracks health care delivered to a universally insured population of active/reserve/retired members of the U.S. Armed Services and their dependents. The MDR was queried for elective unilateral inguinal hernia repair among adult patients between 2008 and 2014. The primary outcome was laparoscopic (vs. open) approach to hernia repair. We conducted univariable and multivariable analyses of patient- and systems-level factors associated with approach to inguinal hernia repair. This research was approved by our institutional review board prior to commencement of the study and need for informed consent was waived given the design of this study. Among 37,742 elective uncomplicated unilateral inguinal hernia repairs, 35% (n = 13,114) were performed laparoscopically. In 2014, 40% of inguinal hernia repairs were performed laparoscopically, compared with 27% of repairs in 2008 (P < 0.01). In multivariable analysis, laparoscopic hernia repair was more likely for male patients (OR = 1.38, 95% CI = 1.23-1.54, P < 0.01), military (vs. civilian) institutions (OR = 1.34, 95% CI = 1.28-1.41, P < 0.01), active-duty officers (vs. active-duty enlisted; OR = 1.21, 95% CI = 1.12-1.30, P < 0.01), and more recent year of surgery (P < 0.01). Laparoscopic repair was significantly less likely among patients with greater than one comorbidity (vs. none; OR = 0.68, 95% CI = 0.61-0.76, P < 0.01). In a large, universally insured population of military service members and their dependents, laparoscopic inguinal repair is increasingly used and was preferred over open repair for younger, healthier, active-duty patients and those treated within the military (vs. non-military) care system.

Hernioplastias inguinales por vía laparoscópica. Experiencia inicial en 324 casos

IntroductionInguinal hernias are the most frequent pathologies a surgeon must know how to treat. Lately, their management with techniques using surgical mesh has become increasingly relevant, especially when repaired is done via laparoscopy. The purpose of this study is to show our initial experience in the laparoscopic treatment of inguinal hernias. Material and methodsA prospective descriptive study was carried out with all the patients submitted to laparoscopic inguinal repair at Gestion Salud Clinic in Cartagena, between June 2010 and May 2014. Special interest was drawn upon the impact of learning curve on the ocurrence of complication and the relationship between the number of tackers used with level of pain, analgesia requirement and time to return to habitual activities. ResultsA total of 412 inguinal repairs were performed in 324 patients. The average visual analog score (VAS) score at the seventh postoperative day was 5.8 (2-9) and 2 (0-8) at the thirtieth. The most painful postoperative score with more analgesic requirement and latest return to habitual activities was associated with the number of spiral staples used, the occurrence of complications, bigger body mass index, history of hernia recurrence, male sex and the younger the patient was. Hernia recurrence percentage of this series was 1.5%, with an average follow up of 26 months (14-61). ConclusionsLaparoscopic inguinal repair has a short learning curve in surgeons accustomed to laparoscopic techniques, it offers low index of complications and recurrence that never disappears, even above 100 cases. The possibility of visceral damage is always present, becoming more frequent in TAPP approach. In our experience, postoperative pain, analgesia requirement and the return to normal activities were related to fixation intensity (number of staples used).

Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh.

Repair of inguinal hernia is one of the most common elective operations performed in general surgery practice. Mesh hernia repair became the gold standard because of its low recurrence rate in comparison with non-tension-free repair. Laparoscopic approach seems to have potential advantages over open techniques, including faster recovery and reduced acute and chronic pain rate. Laparoscopic mesh fixation is usually performed using staples, which is associated with higher cost and risk for chronic pain. Recently, the role of mesh fixation has been questioned by several surgeons. To evaluate mesh displacement in patients undergoing laparoscopic inguinal hernia repair comparing mesh fixation with no fixation. From January 2012 to May 2014, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups: control group--10 patients underwent totally extraperitoneal (TEP) repair with mesh fixation; NO FIX group-50 patients underwent TEP repair with no mesh fixation. Mesh was marked with three 3-mm surgical clips at its medial inferior, medial superior and lateral inferior corners. Mesh displacement was measured by comparing an initial X-ray, performed in the immediate postoperative period, with a second X-ray obtained 30 days later. The mean displacement of all three clips in control group was 0.1-0.35 cm (range 0-1.2 cm), while in NO FIX group was 0.1-0.3 cm (range 0-1.3 cm). The overall displacement of control and NO FIX group did not show any difference (p = 0.50). Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.

Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis

Reinforcement of inguinal hernia repair with prosthetic mesh is standard practice but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in lighter-weight mesh. Minimally invasive approaches have also significantly reduced postoperative recovery from inguinal hernia repair. The aim of this systematic review was to compare the outcomes after laparoscopic inguinal repair using new lightweight or traditional heavyweight mesh in published randomised controlled trials. Medline, Embase, trial registries, conference proceedings, and reference lists were searched for controlled trials of heavyweight versus lightweight mesh for laparoscopic repair of inguinal hernias. The primary outcomes were recurrence and chronic pain. Secondary outcomes were visual analogue pain score at 7 days postoperatively, seroma formation, and time to return to work. Risk differences were calculated for categorical outcomes and standardised mean differences for continuous outcomes. Eight trials were included in the analysis of 1,667 hernias in 1,592 patients. Mean study follow-up was between 2 and 60 months. There was no effect on recurrence [pooled analysis risk difference 0.00 (95% CI -0.01 to 0.01), p = 0.86] or chronic pain [pooled analysis risk difference -0.02 (95% CI -0.04 to 0.00); p = 0.1]. Lightweight and heavyweight mesh repair had similar outcomes with regard to postoperative pain, seroma development, and time to return to work. Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.

Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair

About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim of the study was to describe and classify patients with severe persistent pain after laparoscopic herniorrhaphy. Eleven patients with severe persistent pain following laparoscopic inguinal herniorrhaphy were assessed in detail by their medical history, questionnaires (impairments of daily activities, pain description, psychological parameters, socio-economic status), physical examination, sensory mapping, and quantitative sensory testing. The median time since operation was 2years (range 1-14years). Ten patients experienced pain in the inguinal region and five patients had pain outside the inguinal region. Based upon the clinical pain pattern and the detailed quantitative sensory testing, the patients could be separated into three different entities, suggesting different pathogenic mechanisms leading to the persistent pain state. Four patients experienced dysejaculation. Six patients were unemployed or retired due to the postherniorrhaphy pain. These results suggest that patients with severe persistent pain after laparoscopic inguinal herniorrhaphy belong to distinctive subgroups with indicators of either neuropathic, inflammatory, or mechanical irritation from the mesh, or a combination of these symptoms. The findings of a number of pain localizations outside the inguinal region demarcate it from persistent pain following open groin hernia repair. A classification based on a larger study group is required in order to define mechanism-based treatment strategies.

Inguinal Hernia Repair in a Community Hospital Setting—Have Attitudes Changed Because of Laparoscopy?

The laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair is well documented in numerous studies as an excellent choice when performed by an experienced surgeon. In this report we wish to evaluate our experience of TAPP laparoscopic inguinal repair performed in a Community Hospital over the last 5 years, focusing on the feasibility of the technique and the incidence of complications when performed by general surgeons in this setting. We also wish to report and discuss how our attitudes concerning inguinal hernia repair have changed since we adopted the laparoscopic approach. Between January 2003 and January 2008 a total of 193 patients, at "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic inguinal hernia repair. The total hernias repaired were 362. The overall mean operative time was 45.58 min. (+/-15.2 min). All the procedures were performed in day surgery. There were no conversions to open repair or deaths in our series. We had 2 cases of small bowel occlusion and 5 relapsing hernias (1.3%), which we preferred to treat with an anterior approach. The mean follow-up was 30.4 (+/-5.6; range: 1 to 60 mo) months. No patients reported severe pain at 10 days, 7.2% (14 cases) reported mild pain at 3 months. There were no reports of night pain at 30 days. Approximately 90% of the patients had a return to physical-work capacity within 7 days, the remainder within 14 days. All patients were completely satisfied at 3 months. The analysis of the short-term postoperative outcomes of our experience enabled us to conclude that in the proper setting TAPP is feasible, effective, safe, and beneficial for patients and should be a routine part of any surgical practice providing adequate training has been undertaken and proper preparation observed.

Laparoscopic inguinal herniorrhaphy in children: A three-center experience with 933 repairs

Background/Purpose: Laparoscopic inguinal herniorrhaphy has been introduced recently as an alternative to conventional open repair in children. This study was undertaken to evaluate the safety, efficacy, and reproducibility of this minimally invasive approach. Methods: A total of 933 laparoscopic inguinal herniorrhaphies were performed on 666 children (597 boys and 69 girls), ranging in age from 3 weeks to 14 years (median, 3.2 years). A 5-mm laparoscope was placed through an umbilical incision, and two 2-mm or 3-mm needle drivers were inserted through the lateral abdominal wall. The neck of the sac was closed with a 4-0 monofilament suture. The needle was inserted directly through the abdominal wall, and removed together with the trocar. Only the umbilical fascia was closed with an absorbable suture. No skin sutures were applied. Results: A total of 911 indirect inguinal hernia sacs were closed (337 right, 172 left, 402 bilateral) and 22 direct inguinal hernias were repaired (14 boys, 3 girls; 11 right, 3 left, 4 bilateral). The median operating time was 22 minutes (range, unilateral, 7 to 45 min; bilateral, 9 to 51 min). With experience, this time gradually decreased. There were no intraoperative complications. The contralateral asymptomatic processus was unexpectedly open on the left side in 137 of the boys (23%) and 10 of the girls (15%), and on the right side in 131 of the boys (22%) and 21 of the girls (32%). In 16% of the children, the final procedure was modified on the basis of the anatomic findings. No hernia was found in 13 children (1.9%). The recurrence rate was 3.4% (follow-up time ranged from 2 months to 7 years). Hydroceles were observed in 4 children, and a subtle change in testicular position and size was noted in one boy. Conclusions: Laparoscopic inguinal repair in children proved safe and reproducible, although the recurrence rate was slightly higher than with the open approach. However, laparoscopy allows easy and precise identification of the type of defect and its correction. In this series, the incidence of direct inguinal hernias was higher, and the incidence of a patent contralateral processus vaginalis was lower than previously reported.