Laparoscopic Inguinal Hernia Surgery Research Articles

Comparison between anatomical polyester (Parietex) mesh and polypropylene (Prolene) mesh with fixation in total extraperitoneal repair for inguinal hernia

AbstractIntroduction: Laparoscopic inguinal hernia surgery has been gaining in worldwide popularity, with the total extraperitoneal (TEP) repair gaining greater acceptance than the transabdominal pre‐peritoneal repair. Most techniques using TEP advocate some form of fixation of the prosthesis, but newer meshes avoid the use of fixation.Methods: We compared the use of the polyester mesh (Parietex; Tyco, Princeton, USA) without fixation and polypropylene (Prolene; Ethicon, USA) mesh with fixation using either ProTack (Tyco, USA) or EndoAnchor (Ethicon, Cincinnati, USA) in a consecutive series of patients who underwent total TEP endoscopic inguinal hernia repair.Results: Of 127 patients who underwent TEP repairs, 60 had Parietex mesh while 67 had Prolene mesh with fixation. The mean age was 50 years old and 97% were men. There was no difference in patient demographics or complication rate. The most common complication was small seroma or hematoma formation in 14% of patients and none required re‐operation. There was no hernia recurrence in either group with a mean follow‐up period of 13 months.Conclusion: This study shows that in laparoscopic TEP inguinal hernia repair, early results indicate comparable results between the use of polyester (Parietex) mesh without fixation and polypropylene (Prolene) mesh with fixation.

Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia?

Background Theoretically, a lighter and softer mesh may decrease nerve entrapment and chronic pain by creating less fibrosis and mesh contracture in laparoscopic inguinal hernia repair. Methods We performed a telephone survey of patients who underwent laparoscopic inguinal hernia surgery between 2001 and 2007. We recorded patient responses for chronic pain, foreign body sensation, recurrence, satisfaction, and return to work, and then studied the effect of type of mesh (polypropylene vs polyester) on these factors. Results Of 109 consecutive patients surveyed (mean age, 54.5 y), 67 eligible patients underwent 84 transabdominal extraperitoneal procedures and 2 transabdominal preperitoneal procedures. Patients with polypropylene mesh had a 3 times higher rate of chronic pain ( P = .05), feeling of lump ( P = .02), and foreign body perception ( P = .05) than the polyester mesh group. Our overall 1-year recurrence rate was 5.9%. The recurrence rate was 9.3% for the polypropylene group and 2.9% for the polyester group ( P = .26). Conclusions A lightweight polyester mesh has better long-term outcomes for chronic pain and foreign body sensation compared with a heavy polypropylene mesh in laparoscopic inguinal hernia repair. We also saw a trend toward higher recurrence in the polypropylene group.

Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs

In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.

A survey of inguinal hernia repair in Wales with special emphasis on laparoscopic repair

The National Institute of Clinical Excellence (NICE) recently published its guidance on the use of laparoscopic repair for inguinal hernias. This study aimed to assess the likely uptake of laparoscopic surgery for inguinal hernias in Wales. In addition the current practice with regards to day case surgery, use of local anaesthesia, antibiotic prophylaxis, thromboembolic prophylaxis and advice regarding convalescence was assessed. A postal questionnaire survey of all consultant surgeons (n = 91) in Wales was performed. There was a 70% (n = 67) response to the questionnaire. Fifteen percent of surgeons (n = 9) perform laparoscopic inguinal hernia repair in Wales; 10% of surgeons in Wales agreed with the NICE guidance. Lichtenstein hernia repair was the most commonly used the technique to repair primary inguinal hernias in Wales (82%). No surgeon currently is using a laparoscopic repair as the technique of choice for repair of primary inguinal hernias. Eighteen percent of surgeons perform all the procedures as day cases; 15% of surgeons perform more than 90% of the procedures under local anaesthesia; 44% of surgeons do not use any form of thromboprophylaxis for elective inguinal hernia repair, while 78% of the surgeons used routine antibiotic prophylaxis. Post-operative advice regarding return to sedentary work and driving was highly variable (1-4 weeks), as was advice regarding heavy work and sport (2-12 weeks). The uptake of laparoscopic surgery for inguinal hernia repair in Wales is low. Only a minority of surgeons agree with the NICE guidance. Similarly the uptake of day case repair and the use of local anaesthesia are minimal. The use of antibiotic and thromboembolic prophylaxis is empirical and inconsistent. There is a need for evidence-based guidelines to standardise the antibiotic prophylaxis, TE prophylaxis and advice regarding post-operative advice.

Is testicular perfusion influenced during laparoscopic inguınal hernia surgery?

The influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion. In this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow. No statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups. Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.

Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up

Laparoscopy enables hernial orifices to be observed and tension-free mesh repair to be carried out effectively. In the first randomised controlled trial on hernia repair, which compared laparoscopic transabdominal pre-peritoneal...

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived.1 In contrast to...