Laparoscopic Inguinal Hernia Repair Research Articles

Laparoscopic mesh placement during inguinal hernia repair: a meta-analysis of two methods of repair.

There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. One of these is a slit on the mesh to surround the cord structures which proponents of it suggest that it decreases the recurrence rate due to better anchoring of the mesh and lower risk of displacement. There is only low-level evidence in current literature examining the two methods. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit mesh technique. The reporting of this systematic review was guided by the standards of the preferred reporting items for systematic review and meta-analysis statement and registered with PROSPERO (ID: CRD42022300629). Eligible studies had to compare the two methods of mesh placement slit Vs nonslit in laparoscopic Inguinal hernia repair and also report on at least one outcome. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed a random effects model was used otherwise a fixed effects model was used. Five studies met the criteria for inclusion in quantitative analysis. Overall, there were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group OR 0.62, 95% CI (0.27-1.41). There was no difference in the incidence of post-operative bleeding (OR 1.21, 95%CI 0.4-3.66), seroma formation (OR1.5, 95% CI 0.81-2.76), or post-operative neuralgia (OR 0.98, 95%CI 0.11-8.92) between the two groups. There was no difference between the two methods.

Skipping the cord during laparoscopic percutaneous internal ring suturing in children, is it reasonable?

As a minimally invasive procedure, laparoscopic inguinal hernia repair in children was introduced. Percutaneous internal ring suturing (PIRS)is a popular technique. The main concern is that the spermatic cord will be trapped and/or the vasculature of the testes will be damaged in boys. This can be avoided by performing a careful dissection or by skipping the peritoneum over the cord and/or the vessels. The aim of the study was to compare the incidence of recurrence or complication (e.g. hydrocele) in children with skipped peritoneum on the cord and/or vessels compared to those without skipped peritoneum during laparoscopic PIRS repair. The charts of children who underwent laparoscopic PIRS repair for inguinal hernia between 2017 and 2021 were analyzed. Complications and recurrence were assessed. The video recordings were viewed, and data on skipping (group 1) or not skipping (group 2) the peritoneum on vas deferens was recorded. The rates of recurrence and complications were compared between groups. There were 101 boys with a total of 125 inguinal hernias in the study. There were45 right-sided hernias, 32 had left-sided hernias, and 24 had bilateral hernias. According to the video investigation, there were 63 hernias in group 1 and 62 hernias in group 2. In each group, there were two recurrences (3% for both groups). There were no other postoperative complications. To avoid spermatic cord or vessel damage, skipping the cord appears to be an acceptable path that does not appear to increase recurrence or complication rates while also ensuring the safety of spermatic structures.

Long-Term, Patient-Reported Outcomes of Pediatric Laparoscopic and Open Inguinal Hernia Repair

INTRODUCTION: Long-term outcomes studies of pediatric inguinal hernia repair have been limited and primarily conducted via chart review. We assessed long-term outcomes, including recurrence, through a questionnaire, hypothesizing that laparoscopic repair would not have higher recurrence rate compared with open. METHODS: Families of patients <18 years old undergoing inguinal hernia repair from 2011 to 2018 were administered a questionnaire in 2021 assessing outcomes including recurrence, long-term pain, and cosmetic satisfaction. Chart review was also conducted. Student’s t-tests or Wilcoxon rank sum tests as well as chi-square tests were performed. Time-dependent analysis of laparoscopic vs open recurrence was performed using Kaplan-Meier analysis and log-rank test. RESULTS: Of 506 children, 325 (64%) underwent laparoscopic repair and 181 (36%) open. There was no difference in median (interquartile range) age (20 (4–68) vs 21 (4–66) months, p = 0.69), mean weight (14 ± 12 vs 17 ± 16 kg, p = 0.06), or preoperative incarceration (10% vs 7%, p = 0.22) by approach. The questionnaire was completed by 57% (n = 288) of families for a median follow-up time of 70 (46–93) months. There was no difference in demographics or operative approach between respondents and nonrespondents (all p > 0.05). The recurrence rate among respondents was 3.5% (n = 10) and occurred at a median of 7 (4–14) months after index repair. There was no difference in recurrence after laparoscopic vs open repair (Figure; p = 0.86).FigureCONCLUSION: Patient-reported outcomes were excellent after pediatric inguinal hernia repair in our study with up to 10 years of follow-up. The recurrence rate is equivalently low regardless of laparoscopic or open approach, but it is likely underestimated when assessed by chart review alone.

OC-026 PERFORMING A SLIT ON THE MESH TO ENCIRCLE THE CORD STRUCTURES DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Aim There are several modifications in the technique for the placement of mesh during laparoscopic inguinal hernia repair. The present study aimed to provide stronger evidence in establishing whether the slit mesh technique is superior to the non-slit technique (the most common practice). The primary outcome was recurrence and secondary outcomes were postoperative groin pain, bleeding, seroma formation and duration of surgery. Material &amp; Methods Eligible studies had to compare the two methods of mesh placement slit Vs non slit in laparoscopic TEP or TAPP inguinal hernia repair. Databases searched were Embase, Medline, Cochrane collaboration, NICE guidelines search. The meta-analysis was conducted using Review Manager software 5:4. The outcomes were expressed in odd ratios with their 95% confidence intervals. Where significant heterogeneity existed (I2&amp;gt;75%) a random effects model was used otherwise a fixed effects model was used. Results Five studies included, all were single centre studies, 4 retrospective and one prospective observational studies. 1076 patients included, 633 in the slit group and 434 in the non-slit group. The male to female ration was 9:1. There were 10 (1.5%) recurrences in the slit group compared to 12 (2.5%) in the non-slit group 0.62, 95% CI (0.27–1.41). There was no difference in the incidence of post-operative bleeding (1.21, 95%CI 0.4–3.66), seroma formation (1.5, 95% CI 0.81–2.76), or post-operative neuralgia (0.98, 95%CI 0.11–8.92). Conclusion There is no advantage in performing a slit on the mesh to encircle the cord structures during laparoscopic inguinal hernia repair.

P-155 ROLE OF MDT IN CPIP MANAGEMENT: LITERATURE REVIEW

Abstract Abstract Chronic Post-operative Inguinal Pain (CPIP), is recognised as a long term condition and has a significant effect on patients’ quality of life. CPIP affects 18–30% of patients after an open inguinal hernia repair and 6% of patients after a laparoscopic inguinal hernia repair. CPIP result from several causes such as a pre-operative nerve lesion in other area of the body, an intra-operative nerve injury, or due to the intensity of acute post-operative inflammation and healing. a multidisciplinary clinic would be considered the best approach in order to assess patients’ pain and identify an individual management plan. This review allowed the team to choose which literature could be used to support the implementation of the clinical practice change. Method Literature searches were performed using PubMed and Embase databases were searched using key terms to include all related articles in the last ten years. three independent reviewers to choose included and excluded articles with two steps. Results Out of 25 articles found by the research, 8 articles included in this review including MDT about CPIP, meeting including criteria after the full articles reviewed. it was important to understand the nature and mechanisms of Chronic Post-operative inguinal hernia. several risk factors have been identified, which may be causing CPIP such as young age, recurrent inguinal hernia repair procedure and presence of pain before the procedure. Because of the complexity of CPIP, many authors concluding that a multidisciplinary approach should be considered the more appropriate method to ensure an effective and safe treatment. This include the need of regular follow up after an inguinal hernia repair to identify the chronic pain and establish an appropriate management plan. Conclusions Although the literature review enabled the team to gather useful information about the topic of the clinical practice change; it was evident that more researches and studies need to be completed in order to identify the safest and effective treatment for patients presenting with CPIP.

V-038 INGUINAL TEP WITH ARTICULATED INSTRUMENTS: BEYOND CONVENTIONAL LAPAROSCOPY, CLOSER TO ROBOTIC SURGERY

Abstract Introduction Is known that laparoscopic inguinal hernia repair is well recommended in the guidelines. Despite that, in most cases the surgeon needs to do with the instruments manoeuvres that are not ergonomics. Robotic surgery has eliminated these problems but unfortunately this platform is not within reach of all. Articulated instruments appear as a forward stepwise to avoid these difficulties and allowing a better performance of the technique. We present a video that shows a case of an inguinal total extraperitoneal (TEP) performance with these instruments. Material and methods A 45-year-old man with a bilateral inguinal hernia underwent an inguinal TEP using 2 articulated grasper and Maryland instruments (IMM-Tontarra). An expander balloon was used to open the Retzius space, then a Hasson umbilical trocar and 2 (5mm) infraumbilical and suprapubic trocars were placed. All surgery was performed with these 2 instruments an only straight graspers were used when placing the mesh. Results The patient was discharged the same day of surgery with no complications. Our group made different kind of surgery and we observed that the learning curve to obtain an optimal performance of this instruments is short, lesser than 10 patients. We did eTEP procedure for ventral/incisional hernias, Cholecystectomies and hemicolectomies demonstrating the usefulness of these tools. Conclusions Inguinal TEP technique repair using articulated instruments is a very good option for a better dissection of the tissues, better triangulation of the graspers and more ergonomic for the surgeon.

OC-005 ENDOSCOPIC SURGICAL SKILL QUALIFICATION SYSTEM IN JAPAN: PROVEN PERFORMANCE IN HERNIA SURGERY

Abstract Endoscopic Surgical Skill Qualification System by Japan Society for Endoscopic Surgery is implemented from 2004. Laparoscopic inguinal hernia repair (TAPP, TEP) is positioned as a low difficulty level operation under general surgery field in this system. An application qualification to the system demands the list of a specified operative cases, to participate in education seminars, and training of endoscopic surgery over 2 years after the Board Certified. A specified case quantity is the operative experience of above 5 examples of a high-difficulty level and 45 examples of a low difficulty level operation. Candidates submit 3 no edited videos of the endoscopic surgery performed for indirect hernia with the orifice above 1.5 cm in a male-sex. Which to examine among 3 videos is decided randomly by the society. Two hernia-specified referees examine one candidate. When both results don't agree, an extra referee will examine newly and fixes the result. An evaluation is estimated within 60 points of common standards and 40 points by an hernia. Equal to or more than 70 points in amount become a pass. Acceptance rate in hernia was 16% in 2021. The Nationwide Survey of Endoscopic Surgery reported recurrence rates of after laparoscopic hernia surgery as 5% in TEP in and 4% in TAPP in 2012–2013, 2.0% and 1.3% in 2018∼2019, what is improved beyond the period. It's no exaggeration to say that the Qualification System has played a big part. The Qualification System like no other in the world is to be introduced.

V-040 LAPAROSCOPIC TRANS-ABDOMINAL PREPERITONEAL PROCEDURE (TAPP) FOR RIGHT INGUINAL HERNIA WITH HANDXTM HOOK AND NEEDLE HOLDER

Abstract AIM HandX™ is a handheld, powered laparoscopic device with interchanging single-patient fully articulating instruments. It is electromechanically controlled, and, as the manual interface is handled by the surgeon, beside the patient's bed, the movements of the surgeon's wrist and fingers are translated to the instrument-articulating tip. This report is to show the feasibility and safety of this technology applied in inguinal hernia repair. MATERIALS AND METHODS We report the case of the laparoscopic repair of a right inguinal hernia using HandXTM instruments. RESULTS The index case was a 55-year-old, otherwise healthy male, with an inguinal right hernia. Three trocars were used: one 10 mm umbilical and two of 5 mm, approximately 4 cm laterally from the umbilicus and 1 cm under the level of the horizontal umbilical line. The dissection started with peritoneal cut, from the antero-superior iliac spine to the medial umbilical ligament, into the preperitoneal avascular plane. The anatomical landmarks (epigastric vessels, Cooper and Gimbernat ligaments, the corona mortis and external iliac vessels) were identified and well exposed. A polypropylene mesh was inserted from the optical trocar, placed in the appropriate position and fixed with three separated stiches handled with the articulating needle holder. The peritoneal flap was closed with a readsorbable running suture handled with the HandX instrumentation. No blood loss nor intraoperative or post-operative complications were recorded CONCLUSIONS The report showed how the HandX technology could be safely adopted to obtain both a safe dissection and an ergonomically advantageous suture in laparoscopic TAPP.

OC-042 HIGHER REOPERATION RATES FOR TISSUE PENETRATING FIXATION METHODS IN LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR

Abstract Aim The study compares three types of mesh fixation techniques of laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) in regards to recurrence: non-tissue penetrating (NP), tissue-penetrating (TP) and no fixation (NF). Methods The cohort was established retrospectively by way of the Danish Hernia Database, and all patients operated for inguinal hernia using TAPP from January 2010 to February 2021 in Denmark were identified. Logistic regression analyses were performed, with multivariate analysis correcting for significant confounding variables, yielding adjusted odds ratios for reoperation for the three fixation methods. Results A total of 38,503 primary TAPP repairs were included (penetrating fixation n=25,216, non-penetrating n=10,172, no fixation n=3,115). Overall recurrence rate was 3.57% over the 133 month follow-up period (mean length 59 months) with significant differences between the three methods: recurrence was 1.23% for NP, 2.87% for NF and 4.84% for TP. Using NF as reference, the adjusted odds ratio for reoperation was 1.80 for NF (p=0.007) and 3.51 for TP (p=0.001). Conclusions This comprehensive analysis demonstrated significant superiority of non-penetrative mesh fixation followed by no mesh fixation and lastly penetrative fixation. We corrected for significant confounding variables. With TP being the most widespread method of fixation, these results encourages reconsideration of standard practices for mesh fixation in TAPP.

P-009 OPEN VS LAPAROSCOPIC VS ROBOT-ASSISTED INGUINAL HERNIA REPAIR: A CASE SERIES

Abstract Aim Minimally invasive inguinal hernia repair is thought to be associated with fewer complications. To address this hypothesis, we compared short- and long-term complications in patients undergoing elective open (Lichtenstein), laparoscopic (TAPP) and robot-assisted inguinal hernia repair (rTAPP). Material &amp; Methods Patients undergoing either, Lichtenstein, TAPP or rTAPP at our institution between January 1st 2017 and December 30th 2019 were retrospectively identified. Short (haematoma, seroma, surgical-site infections) and long-term complications (chronic pain, recurrence) were recorded and compared between groups. Results 636 patients were included in the study. 370 were treated with Lichtenstein, 125 TAPP and 141 with rTAPP. There was a significant overweight of men in all groups (p &amp;lt; 0,001). Among the rTAPP group, the overall rate of complications was reduced (open: 10.0%; laparoscopic: 8.8%; robot-assisted 5.7%) while the presence of chronic pain was slightly more prevalent (Lichtenstein: 1.6%; TAPP: 1.6%; rTAPP: 2.1%). The rate of recurrence was lower following rTAPP (Lichtenstein: 3.8%; TAPP: 2.4%; rTAPP: 1.4%). Same day discharged was more likely following the open technique (open: 88.9%; laparoscopic: 78.4%; robot-assisted 78.7%). Nevertheless, these results were not statistically significant (p&amp;gt;0.05). Conclusions The present case series demonstrates a comparable rate of short and long-term complications following open and minimally invasive inguinal hernia repair. The trend towards a lower overall complications rate and recurrence rate, though not statistically significant, implies that minimally invasive surgery might be associated with a lower complication and recurrence rate. However, a larger prospective study design with a longer follow-up is needed to test this hypothesis.

Open and laparoscopic inguinal hernia repair in children: A regional experience

PurposeThe optimal approach for pediatric inguinal hernia repair continues to be debated. We conducted a regional retrospective study to assess rates of recurrence and metachronous hernias after open repair (OPEN) and laparoscopic repair (LAP) MethodsA retrospective cohort study was conducted at two children's hospitals that serve a region of approximately 4 million people. All patients < 14 years old undergoing OPEN or LAP by pediatric surgeons during a 5-year period (2011 – 2015) were analyzed after a minimum follow up of 4 years. Cox proportional regression was used to compare the effect of surgical approach on hernia recurrence and metachronous contralateral hernias. ResultsA total of 1,952 patients, 587 female (30%) and 1365 male (70%), had 2305 hernias repaired. Median post operative follow up time was 6.6 years (range 4–9 years). OPEN and LAP were performed for 1827 (79%) and 478 (21%) hernias, respectively. There were no significant differences in rate of prematurity, age at repair, or frequency of emergent repair. LAP was associated with a lower incidence of metachronous contralateral hernias compared to OPEN (1.4% vs 3.8%, p = 0.047), and a higher incidence of recurrence (9% vs 0.9%, p < 0.001). After adjusting for confounders, LAP had a higher rate of recurrence than OPEN (hazard ratio 10.4, 95% CI 6–18.1).The recurrence rate did not decrease over the study period (p = 0.731). ConclusionLaparoscopic inguinal hernia repair in children resulted in a modest decrease in the incidence of metachronous hernias, at the cost of a significant increase in recurrence. Type of StudyRetrospective Comparative Study. Level of evidenceLevel III.

Comparative Study of Different types of Mesh Fixation during Laparoscopic Repair of Inguinal Hernia

Comparative Study of Different types of Mesh Fixation during Laparoscopic Repair of Inguinal Hernia

Comparing different doses of dexmedetomidine in attenuating extubation response in chronic smokers undergoing total extraperitoneal laparoscopic inguinal hernia repair: a randomized prospective study

BackgroundDuring the process of emergence from general anesthesia, tracheal extubation is a very critical step. Tracheal extubation is not just a reversal of intubation, as during extubation we encounter a change of state from controlled conditions to an uncontrolled environment. We have aimed our study at evaluating the attenuating effect on the extubation response using three different doses of dexmedetomidine on patients who are smokers and undergoing total extraperitoneal laparoscopic inguinal hernia repair under general anesthesia. This randomized, controlled, triple-blinded study included 90 smokers aged between 40 and 60 years. These patients were randomized to receive dexmedetomidine 0.5 μg/kg (group A), 0.75 μg/kg (group B), and 1 μg/kg (group C) prepared as a 10 ml infusion started 10 min before patients were extubated. Extubation quality, hemodynamic changes, oxygen saturation, sedation, and postoperative complications were evaluated.ResultsThe extubation quality became better, sedation and incidence of bradycardia in the post-operative period increased with a higher dose of dexmedetomidine. Attenuation of hemodynamic parameters was observed after 4 min of starting infusion and during extubation in each group and was found to be significant (P < 0.001).ConclusionsIt was concluded that dexmedetomidine when used at a dose of 0.75 μg/kg provided excellent extubation conditions with stable hemodynamic parameters in chronic smokers with minimal sedation and no other adverse effects.

The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

PurposeTo describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospitalMethodsWe describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR.ResultsWe performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009).ConclusionA structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.

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.

Laparoscopic and robotic inguinal hernia repair are safe and effective after prior pelvic or low abdominal surgery

BackgroundThe ideal approach to inguinal hernia repair (IHR) after prior pelvic or low abdominal surgery is not agreed upon. We compared safety and outcomes of IHR between open, laparoscopic, and robotic approaches. MethodsThis retrospective review of a prospective database analyzed demographic, perioperative, and quality of life data for patients who underwent IHR after pelvic or low abdominal surgery. Results286 qualifying patients underwent IHR between 2008 and 2020; 119 open, 147 laparoscopic, and 20 robotic. Laparoscopic repair led to faster cessation of narcotics and return to ADLs than open repair (all p <0.05). Post-operative complications, 30-day readmission, recurrences, and quality of life outcomes were equivalent, except less pain at 3-weeks post-op in the minimally invasive groups, p < 0.01. ConclusionMinimally invasive IHR after prior pelvic or low abdominal surgery is safe compared to an open approach. Laparoscopic repair provides faster recovery, yet patient satisfaction is equivalent regardless of surgical approach.

Curative effect of different drainage methods on laparoscopic inguinal hernia repair: A meta-analysis.

Background:Laparoscopic inguinal hernia repair has developed rapidly as an important surgical method for inguinal hernia repair; however, postoperative complications, especially postoperative seroma, are becoming an important factor hindering its development. Many studies have shown that placing a negative-pressure drainage tube in the preperitoneal space can effectively reduce postoperative seromas. Accordingly, this study aimed to compare differences in postoperative seroma between surgical procedures with drainage tubes (DRG) and those without drainage tubes (nonDRG).Methods:PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from the establishment of the database to May 1, 2021. Odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were selected as the effect scale indices for the evaluation of the difference in seroma, operation time, hospital stay time, blood loss, and recovery time. All of these were compared using RevMan 5.3 Software.Results:Sixteen studies involving 4369 patients, 2856 in the DRG group and 1513 in the nonDRG group, were included. The incidence of seroma in the DRG group was lower than that in the nonDRG group (OR = 0.16, 95% CI: 0.07–0.35, P < .001). Additionally, the operation time (min) in the DRG group was longer than that in the nonDRG group (MD = 3.67, 95% CI: 2.18–5.17, P < .001). Nevertheless, no significant differences were found in hospital stay (days) (SMD = 0.22, 95% CI: −0.10–0.54, P = .17), blood loss (mL) (MD = 0.28, 95% CI: −0.14–0.69, P = .19), and recovery time (h) (SMD = 0.54, 95% CI: −0.60–1.69, P = .35) between the 2 groups.Conclusion:Despite the slightly prolonged operation time, negative pressure drainage in the preperitoneal space during laparoscopic inguinal hernia repair can significantly reduce the occurrence of postoperative seroma without increasing blood loss, recovery, and hospital stay.

Laparoscopic Assisted Percutaneous Anterior Gastropexy for the Management of Acute and Chronic Gastric Volvulus in Infants

Acute and chronic gastric volvulus (ACGV) is a rare event in infants and children. Its prompt treatment is needed to avoid gastric ischemia and perforation. A laparotomy or a laparoscopic/endoscopic reduction with or without the gastrostomy formation has been described to treat this condition. We wanted to report our experience and describe the surgical technique used to perform the percutaneous laparoscopic assisted anterior gastropexy in neonates presenting with this condition. We perform a retrospective review of a single institution’s experience with laparoscopic assisted percutaneous anterior gastropexy over a seven-year period (2015–2022). Procedures were performed under general anesthesia and the anterior gastropexy was performed using a modified extracorporeal knotting technique as described for the laparoscopic assisted repair of inguinal hernias via percutaneous internal ring suturing. Thirteen patients underwent surgery for ACGV at our institution over a seven-year period. The median age at diagnosis was 57 days, 7/13 patients presented with acute vomiting and regurgitation (54%), 1/13 (8%) presented with mainly feeding difficulties and 1/13 (8%) presented with acute abdominal distension. Data were not available for 4/13 patients. All of the patients underwent laparoscopic assisted anterior gastropexy using extracorporeal knotting technique; no gastrostomy insertion was needed. The median operative time was 50 min (40–95 min). No intraoperative complications were reported. Post-operatively patients were started on feeds on day 3 (2–5 days). Only one patient (8%) developed a postoperative complication: subcutaneous granuloma at the extracorporeal knot site. Although rare, acute GV is an important cause of gastric outlet obstruction with a detrimental outcome if not promptly recognized and treated. Laparoscopic assisted percutaneous anterior gastropexy is an attractive and safe alternative for the management of this condition in both infants and older children. This technique does not require gastrostomy placement and it has a very low morbidity rate with no mortality reported.

Same-Day Surgery Clinic: A model for improving access to care at academic medical centers

BackgroundBest-practice models delivering surgical care in the preoperative setting are unknown. In April 2018, we established a Same-Day Clinic (SDC) to increase the access and efficiency of general surgical care delivery. MethodsThis is a single-institution retrospective cohort study. We included patients who underwent elective laparoscopic cholecystectomy, inguinal or umbilical hernia repair. 112 patients were seen in the year prior to clinic creation; 84 were seen in the year following clinic creation. ResultsAfter clinic creation, the percentage of patients referred following an emergency department encounter decreased from 33.4 to 17.9%. Patients referred from primary care encounters increased from 28.6 to 44%. Patients who underwent pre-referral imaging decreased from 58.9% to 44%. The SDC cohort was seen 11 days sooner (40 vs. 29d). ConclusionThe SDC increases access and decreases wait times to surgical treatment. It strengthens referral networks for traditionally underserved populations and reduces the burden of non-necessary preoperative imaging.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist