Open Tension-free Hernia Repair Research Articles

Comparative Analysis of the Efficacy of Transabdominal Pre-Peritoneal Vs Open Tension-Free Hernia Repair in Treating Inguinal Hernia

Objective: To investigate and analyze the clinical outcomes of inguinal hernia patients treated with transabdominal pre-peritoneal repair (TAPP) versus open tension-free hernia repair. Methods: The study was carried out from January 2021 to August 2023, and a total of 50 inguinal hernia patients were selected for this study. The patients were randomly divided into a study group (n = 25) and a control group (n = 25) by the numerical table method. The patients in the control group were treated with open tension-free hernia repair, whereas the patients in the study group were treated with TAPP. The surgical and postoperative recovery indexes, complication rates, and recurrence rates of the two groups were compared. Results: There was no significant difference in the operative time and intraoperative blood loss between the two groups (P > 0.05), and the postoperative feeding time, time out of bed, and hospitalization time of the study group were shorter than those of the control group (P < 0.05); the incidence rate of postoperative complications in the study group was lower than that in the control group (P < 0.05); and there was no significant difference in the recurrence rate of the two groups after operation (P > 0.05). Conclusion: Compared to open tension-free hernia repair, TAPP offers a shorter postoperative recovery duration and hospitalization time, and reduces the incidence of complications. Therefore, this surgical method should be popularized in the treatment of inguinal hernia.

İnguinal Herni Onarımlarında Kullanılan Polipropilen Meshin Performansı ve Güvenlik Değerlendirmesi

Aim: This study aimed to compare the data of patients who underwent open tension-free hernia repair using polypropylene mesh with the data obtained from the literature, and to evaluate the efficacy and safety of this mesh in the early postoperative period. The results of this study will provide additional data to the literature in terms of comparing different mesh materials. Material and Methods: In this cross-sectional, and observational study, the early postoperative-period data of 96 patients who had undergone standard Lichtenstein tension-free hernia repair using polypropylene mesh in a tertiary-level hospital, using polypropylene mesh were evaluated and compared with the data obtained from the literature. Results: The mean age of patients was 58.59±13.82 (range, 20-83) years. The median length of hospital stay was 1 (range, 1-4) day. The median of visual analogue scale (VAS) scores was 2 (range, 0-4) for the day of surgery, 0 (range, 0-4) for postoperative day-1, and 0 (range, 0-2) for postoperative day-2. A total of 6 complications developed in 5 of the patients, 3 (3.13%) were hematoma, 2 (2.08%) were wound site infections, and 1 (1.04%) was seroma. In one patient, both hematoma and wound infection were determined. No mortality was encountered. Conclusion: Polypropylene mesh could be used effectively and safely in groin hernia operations. Although some complications with the use of synthetic mesh materials have been reported since the introduction of these materials into clinical use, none of these have yet been considered as conditions that will adversely affect the use of polypropylene mesh.

DESARDA'S VS LICHTENSTEIN'S TECHNIQUE IN INGUINAL HERNIA REPAIR : A COMPARATIVE STUDY

Background: About 75% of abdominal wall hernias are inguinal hernias, with a lifetime risk of 27% in men and 3% in women. Lichtenstein's hernia repair was favored and became the gold standard of open tension-free hernia repair. However, the use of synthetic prostheses can result in new clinical problems. In order to reduce the incidence of complications and postoperative dysfunction, the tissue-based groin herniorrhaphies has re-attracted the attentions in recent years. In 2001, Dr. Mohan Desarda proposed a solution which involves use of a strip of external oblique aponeurosis to strengthen the posterior wall of the inguinal canal.(1) To compare the Aim: post-operative complications, short-term outcomes and recurrence rate for one year between Lichtenstein's and Desarda's technique. Materials And Methods: This is a prospective, randomised study (ODD – EVEN basis) in GSVM Medical College, LLR & Associated Hospitals, Kanpur (UP). 100 patients in two groups with 50 patients in each group: Group A (Lichtenstein's repair) and Group B (Desarda's repair). Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); Operating time; Cost of procedure in total; Post operative course (post operative pain, induration, redness of operated site, post operative wound infection rate. discharge time or hospital stay). Out of 100 patients majority of Results: patients were having right sided indirect hernia. The duration of the surgery was statistically less in Desarda group (53.68±20.21) than Lichtenstein (68.4±53.68) (p<0.05). The pain was signicantly lesser in Desarda group than Lichtenstein groups (p<0.05). The duration of hospital stay was signicantly lower in Desarda group (p<0.05). Seroma Formation was major complication in Lichtenstein group followed by Hematoma Formation, Surgical site infection and recurrence whereas in Desarda group seroma formation was found in only 2 patients and recurrence was in only 1 patient (association of complications in both groups was found to be statistically signicant (p<0.05)). The result of the Conclusion: inguinal hernia treatment with Desarda technique are comparable to results of Lichtenstein surgery. Desarda technique do not use mesh, this makes Desarda repair cost effective and easy to learn. Patients after Desarda's procedure get sooner ambulatory than Lichtenstein mesh repair.(2,3). Recurrence rate is more in Lichtenstein's group although the association was insignicant.(3,4). Hence, Desarda's no mesh repair is favorably comparable with Lichtenstein's mesh repair.

Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair.

Testicular flow studies after hernia mesh repair mostly showed different outcomes. The reason of infertility in some men after hernia repair is immunological factors. Aim of the study was to investigate the influence of mesh hernia repair on antisperm antibodies production and testicular blood flow and a connection among these parameters. A prospective interventional longitudinal cohort study was made on 82 male patients without exclusion criteria who had an inguinal hernia. Patients underwent laparoscopic TAPP or open tension-free hernia repair. Vascular ultrasound and antisperm antibodies were measured in the preoperative and postoperative periods. Main outcome measures were resistive index (RI), peak systolic velocity (PSV) cm/s, and end-diastolic velocity (EDV) cm/s in testicular blood flow measurement and the quantitative value of antisperm antibodies (ASA) in serum (IU/ml). ASA significantly increased postoperatively only in patients who underwent open tension-free hernia repair (p < 0.001). ASA stayed in normal range in all patients except the one with postoperative complication. Friedman analysis showed significant change of the RI only on intratesticular (p < 0.001) and capsular artery level (0.02) in patients who underwent laparoscopic technique. PSV significantly changed on intratesticular (p < 0.001) and capsular artery level (p = 0.015) in the laparoscopic hernia repair. PSV showed significant change on intratesticular (p < 0.001) and testicular artery levels (p < 0.001) in the open tension-free hernia repair. EDV showed significant change only on testicular artery level (p = 0.032) in the patients who had open tension-free hernia repair. These blood flow parameters significantly increased in the early postoperative period and returned on basal value in the late postoperative period. Parameters of flow did not show any significant correlation with ASA. Mesh hernia repairs without complication caused only a transitory change in testicular blood flow and no clinical significant autoimmune reaction.

Antibiotic Prophylaxis for the Prevention of Surgical Site Infection after Tension-Free Hernia Repair: A Bayesian and Frequentist Meta-Analysis

Efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after open tension-free hernia repair remains controversial. In light of additional data, the aim of this study was to determine whether antibiotic prophylaxis reduces SSI after hernia repair. We conducted a systematic review and meta-analysis to identify randomized controlled trials comparing antibiotic prophylaxis and the subsequent incidence of SSI after inguinal or femoral hernia repair. The primary outcomes measure was the incidence of SSI. Subgroup analysis was evaluated by stratifying the categories of SSI. The meta-analysis was performed using Bayesian and frequentist methods. Twelve studies were included in this meta-analysis; 1,902 patients received antibiotic prophylaxis and the other 1,936 patients were allocated to the control group. Incidence of SSI was 47 (pooled rate 3.0%) in the antibiotic group and 91 (6.0%) in the control group. The number needed to treat to prevent 1 episode of SSI is 41. The Bayesian meta-analysis yielded a significant reduction of SSI in the antibiotic group (odds ratio = 0.49; 95% credible interval 0.25-0.81). Subgroup analysis showed that an antibiotic prophylaxis was beneficial for the prevention of superficial SSI (odds ratio = 0.40; 95% credible interval 0.12-0.98), but not beneficial for prevention of deep SSI (odds ratio = 0.59; 95% credible interval 0.11-3.20). Also, the results were similar to those with frequentist methods. This meta-analysis suggests that antibiotic prophylaxis is efficacious for the prevention of SSI after open mesh hernia repair.

Influence of inguinal hernia mesh repair on testicular flow and sperm autoimmunity

The incidence of infertility caused by the mesh inguinal hernia repair is not known. The aim of this study was to determine circulation and immunological testicular disorders after inguinal hernia mesh repair which can be related with infertility. From February 2010 to December 2010, 43 male patients who underwent inguinal hernia mesh repair were included in a prospective study. Testicular, capsular and intratesticular arterial flow dynamics were measured by Color Doppler ultrasound before the operation, in early and late postoperative period. The antisperm antibodies were analyzed before hernia repair and 5 months after. The difference between patients who underwent laparoscopic (Group I) and anterior open tension-free hernia repair (Group II) in age, duration of symptoms and hernia characteristics were not significant. Statistically significant differences were found in peak-systolic and end-diastolic velocity in testicular and intratesticular arteries in Group II and in peak-systolic velocity on all levels in Group I. Only Group I had significant differences in resistive index of intratesticular arteries. All the values returned to basal in late postoperative period except testicular peak-systolic velocity in Group I which stayed in normal range. Wilcox matched pair test showed significant difference between preoperative and late postoperative measurements of the antisperm antibodies only in Group II, but it was within normal range in all cases. Inguinal hernia mesh repair do not have clinically significant influence on testicular flow and immunological response.

Lichtenstein repair of inguinal hernia: fibrin glue or suture for mesh fixation?

First of all, we wish to thank Tripoloni and Schierano [1] for the attention they paid to our trial comparing fibrin glue versus suture for open tension-free Lichtenstein hernia repair [2]. We appreciate their interest in the details. We agree that the two groups may have included subgroups that could cause bias, but we have to remember that this was a prospective observational multicenter study. The study was not randomized or blinded and, for this reason, no formal power calculations were undertaken. This is what happens with observational studies (cohort studies) which, for this reason, reach the level of evidence 2B with grade of recommendation B. Nonetheless, they can provide interesting results or suggestions for clinical practice. In our study, fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group at 1 month, and this occurred until the third month, when all differences disappeared, with the exception of numbness, which continued to be more prevalent in the sutures group. Tripoloni and Schierano [1] noted that the difference in pain intensity in favor of fibrin glue is not clinically meaningful. We agree with this, but the fact remains statistically meaningful. Anyway, in the literature, comparisons among different techniques for hernia repair, i.e., open versus laparoscopic repair, are often based on little variation in terms of mild or mild moderate pain. In our study, the mean operating time was reduced by 9% in the fibrin glue group compared to the sutures group. Although this value is statistically meaningful, Tripoloni and Schierano [1] believe that 6 min for each procedure is of little practical importance. We wish to underline that our study included 16 centers with extensive experience in hernia surgery. In less expert hands, i.e., residents and young surgeons, this saving of time is probably greater, with economic advantages. Of greater importance seems to be the remark on the risk of recurrence and that fibrin glue should expose to higher recurrence risk if compared to the sutures group. Actually, the two recurrences in our study occurred in the first group and in patients with direct hernias (type M) (more numerous in the fibrin glue group for the lack of stratification). We revised the files of both patients that were re-operated for recurrence. In both cases, a mesh of inadequate size was used. Both hernias recurred distally to the mesh, close to the pubic tubercle, type M1. The letter by Tripoloni and Schierano [1] provides us the opportunity to stress the importance of using a mesh of sufficient size to overlap the pubic tubercle, as requested also when a tension-free suture Lichtenstein repair for direct hernia is performed. With this solution, the difference in the recurrence rate between the two techniques nullifies. We, together with all the co-workers in our study, continue to believe that, in the future, the use of fibrin or synthetic glue for mesh fixation or self-gripping meshes will probably replace sutures in groin hernia repair.

Open Tension-Free Hernia Repair in Soccer Players: Preservation or Primary Neurectomy of the Ilioinguinal Nerve?

Zieren, Jürgen MD, PhD*; Tsigris, Christos MD, PhD†; Menenakos, Charalambos MD* Author Information

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair.

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.

Hernioplasty and simultaneous laparoscopic cholecystectomy: A prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair

Background. The laparoscopic repair of unilateral primary groin hernia remains controversial. This randomized study evaluates the outcome of the laparoscopic technique in hernia repair in patients undergoing simultaneous laparoscopic cholecystectomy (LC) and compares laparoscopic repair with tension-free open groin hernia repair. Methods. Sixty-four low-risk patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were randomized to undergo either laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC or LC and open tension-free hernia repair. Results. The operating time was longer in the TAPP and LC group (mean ± SD = 121 ± 32 minutes) than in the LC and open group (95 ± 27 minutes) (P <.01). The mean operating costs were higher in the TAPP and LC group ($1235 versus $1080) (P <.03). The intensity of postoperative pain at rest was greater in the LC and open group at 24 hours (P <.01) and 48 hours (P <.05), with a greater consumption of pain medication (P <.01). No differences between the 2 groups were found in terms of postoperative complications, disability period before return to work, or hernia recurrences. Conclusions. The totally laparoscopic procedure does not result in a significant benefit other than improved comfort in the first 2 postoperative days. However, laparoscopic hernia repair is considerably more difficult to perform than open tension-free hernioplasty. Thus, the totally laparoscopic approach should be performed only by experienced laparoscopic surgeons with special expertise in hernia surgery. (Surgery 2001;129:530-6.)

Convalescence and driver reaction time after tension-free inguinal hernia repair

To obtain an objective basis for a policy on the advice to patients on when to drive after anterior tension-free hernia repair. Foot reaction time before operation and on the 2nd postoperative day in 20 skilled male drivers with a right inguinal hernia was measured and compared with that of 30 normal subjects. The tests in a car simulator indicated that an untreated right inguinal hernia had no effect on emergency stop reaction time and that a plug-mesh hernia repair did not impair reaction time on the 2nd postoperative day ( P>0.30). Average visual analogue pain scores on the 2nd and 4th postoperative days were 2.3 and 1.7, respectively. On the 8th postoperative day 18 patients had returned to normal activity and work. There was no recurrences after a mean postoperative time of 18 months. These data suggest that open tension-free hernia repair allows return to normal activities and car driving within a few days of the operation.