Identification and management of the ilio-inguinal and ilio-hypogastric nerves in open inguinal hernia repair: benefits of self-gripping mesh

Purpose

A large randomized, multicenter European study recently reported a reduction in early pain after open inguinal surgery when self-gripping mesh was used compared with sutured Lichtenstein repair. This secondary exploratory study is focused on the influence of nerve identification and handling on post-operative pain.

Methods

Post-operative VAS pain data and Surgical Pain Scores (SPS) from 507 patients included in this study were analyzed according to whether inguinal nerves were preserved or resected during surgery to investigate whether identification and peri-operative nerve handling impact post-operative pain.

Results

Preservation of the ilio-hypogastric nerve during Lichtenstein mesh repair with suture fixation was associated with significantly more post-operative pain compared with resection at each follow-up (p ≤ 0.003). This difference was not significant with self-gripping mesh repair. The decrease from baseline in post-operative VAS and SPS scores were significantly greater after self-gripping mesh repair compared to Lichtenstein repair at 1 year, but only when the ilio-hypogastric nerve was preserved (VAS scores, p = 0.009; SPS scores, p = 0.015). No such difference was observed with the ilio-inguinal nerve. When self-gripping mesh was used, preservation of the ilio-hypogastric nerve was associated with significantly greater decreases in post-operative pain (change in VAS score from baseline) compared with Lichtenstein repair at each follow-up (p ≤ 0.018).

Conclusions

The ilio-hypogastric nerve is in danger of being traumatized during Lichtenstein mesh repair with suture fixation. The use of self-gripping mesh was shown to reduce the level of post-operative pain when the ilio-hypogastric nerve was preserved. Resection of the ilio-hypogastric nerve during Lichtenstein repair eliminates this difference.

     

Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study

Background The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. Methods For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. Results There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Conclusion Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.     

Predicting chronic post-operative pain following laparoscopic inguinal hernia repair

Background  Chronic post-operative pain (CPP) following laparoscopic inguinal hernia repair (LIHR) may cause significant morbidity and be more problematic than recurrence. Determining pre-operative risk may reduce morbidity. Our aim was to determine prevalence of CPP following LIHR and identify risk factors for its development. Methods  Data from patients undergoing LIHR (1996–2004) at one District General Hospital were collected, including demographics, body mass index, pre-operative pain, LIHR type (TEP or TAPP, primary/recurrent, unilateral/bilateral) and post-operative complications including CPP (pain lasting ≥1 year). Results  A total of 881 patients underwent LIHR (1,029 hernias). Of these, 523 (60%) patients completed the questionnaire, and 72/523 (13.8%) patients experienced CPP. Presence of pre-operative pain (P < 0.001), recurrent LIHR (P = 0.021) and age <50 years (P < 0.001) were significantly correlated with CPP. Conclusion  Chronic post-operative pain following LIHR is more prevalent than recurrence. Pre-operative pain, surgery for recurrent inguinal hernias (following anterior repair) and younger age at surgery predict development of CPP. Identification of ‘high-risk’ patients may improve management, reducing morbidity and cost.     

Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia

Background: Laparoscopic hernia repair excites controversy because its benefits are debatable and critics claim it is attended by serious complications. The one group of patients in whom benefits may outweigh the perceived disadvantages are those with bilateral or recurrent inguinal hernias. Method: One hundred twenty patients with bilateral or recurrent hernias were randomized to either laparoscopic transabdominal preperitoneal (TAPP) or open mesh repair. Patients completed a well-being questionnaire prior to and following surgery together with a visual analog pain score. Patients were followed up clinically at 1 and 3 months and thereafter by their general practitioner. Results: Age and sex distribution was similar in the two groups. Laparoscopic TAPP hernia was quicker (40 vs 55 min; p < 0.001), less painful (visual analog pain score, 2.8 vs 4.3; p = 0.003) and allowed earlier return to work (11 vs 42 days; p < 0.001) compared to open mesh repair. Conclusion: This trial demonstrates that laparoscopic hernia repair via the TAPP route offers significant benefit to patients undergoing bilateral or recurrent inguinal hernia repair.     

Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair

Background The optimal treatment for recurrent inguinal hernia is of concern due to the high frequency of recurrence. Methods This randomized multicenter study compared the short- and long-term results for recurrent inguinal hernia repair by either the laparoscopic transabdominal preperitoneal patch (TAPP) procedure or the Lichtenstein technique. Results A total of 147 patients underwent surgery (73 TAPP and 74 Lichtenstein). The operating time was 65 min (range, 23–165 min) for the TAPP group and 64 min (range, 25–135 min) for the Lichtenstein group. Patients who underwent TAPP reported significantly less postoperative pain and shorter sick leave (8 vs 16 days). The recurrence rate 5 years after surgery was 19% for the TAPP group and 18% for the Lichtenstein group. Conclusion The short-term advantage for patients who undergo the laparoscopic technique is less postoperative pain and shorter sick leave. In the long term, no differences were observed in the chronic pain or recurrence rate.     

Patient satisfaction after laparoscopic and conventional day case inguinal hernia repair

Comparison of patient satisfaction after laparoscopic and conventional day case inguinal hernia repair. The post-operative course of 60 patients subjected to laparoscopic hernia repair (TAPP) and conventional anterior hernia repair (Griffith) under general anaesthesia as day case procedures was analysed. Both groups (TAPP, n=30; Griffith, n=30) were comparable for age and gender. The operating time, success rate of ambulatory surgery, readmissions and complications were assessed. After 6 months (range 3–10) post-operative pain and nausea, consumption of analgesics/anti-emetics, convalescence and adequacy of the patient information were recorded by a telephonic questionnaire. The patients were asked also if they would choose again a day case procedure for hernia repair. In the TAPP group, 28 out of 30 operations succeeded in ambulatory surgery; one patient was admitted because of nausea and another because of the late time of operation. In the Griffith group all operations succeeded as a day case procedure. In the TAPP group patients experienced less pain (P=0.05), but more nausea (P<0.05), they also needed fewer days bedrest (P<0.05) and felt fully recovered sooner. A total of 90% of both groups would choose a day case procedure again. In conclusion, laparoscopic inguinal hernia repair under general anaesthesia can very well be performed as a day case procedure. After laparoscopic hernia repair patients experienced less pain (statistically non significant) and had an earlier recovery, but they had more nausea than after conventional repair.     

Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP,TEP and Lichtenstein (SETTLE)

Background

This pilot trial investigates whether the trans rectus sheath extra-peritoneal (TREPP) mesh repair is a safe and effective procedure compared to the currently most performed inguinal hernia repair techniques TEP and Lichtenstein.

Methods

Three hundred patients older than 18 years with unilateral inguinal hernia were included in this retrospective cohort study, of which 58 (19.3%) underwent TREPP, 190 (63.3%) TEP and 52 (17.3%) Lichtenstein. The primary outcome of this study was inguinal hernia recurrence rate within 1 year after surgery. Secondary objectives were chronic post-operative inguinal pain (CPIP) lasting more than 6 months, (major) complication rates and operating time.

Results

Recurrence rate within 1-year post-operative was low overall in the study population and did not differ significantly between TREPP, TEP and Lichtenstein, respectively 1.7, 2.1, 0.0% (P?=?0.591). The rate of CPIP for which the patient contacted the hospital was similar in the study groups: TREPP: 1.7%; TEP: 1.6%; Lichtenstein: 1.9%; (P?=?0.591). The mean operating time in minutes (SD) was significantly shorter in the TREPP group compared with the two other patient groups (TREPP: 22.2 (±?5.7); TEP: 38.7 (±?14.8); Lichtenstein: 49.3 (±?17.1), P?<?0.001). No major complications occurred in any patient of the study groups.

Conclusion

TREPP seems to be an effective and safe technique for unilateral primary inguinal hernia repair. It is found to be comparable to TEP and Lichtenstein in terms of recurrence rates, chronic post-operative inguinal pain, and clinically significant adverse events. This pilot study proves the need for future research into the TREPP technique.

     

The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded,prospective, randomized trial

For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair ($1,200 less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair ($125 more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics. Presented at the 2003 Society of the American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting March 12–15, Los Angeles, CA     

Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial

Background

Laparoscopic hernia repair accounts for 10% of all hernia surgery. Potential benefits include reduction in postoperative pain, rapid recovery, lower recurrence rate, and fewer complications. The outcomes of health-related quality of life and patient perspective after hernia repair are our aim.

Methods

Consecutive patients treated for unilateral uncomplicated groin hernia were enrolled after evaluation for inclusion. Participants were randomly distributed to receive either laparoscopic transabdominal preperitoneal repair (TAPP) (group I) or Lichtenstein repair (group II). Operative and postoperative complications, operative time, hospital stay, and late complications were assessed early postoperatively, at 4?weeks, and every 6?months thereafter. Quality of life was assessed using Short Form-36 questionnaire in the first visit (after 4?weeks).

Results

One hundred and eighty-five patients of unilateral uncomplicated groin hernia were included; 88 patients (group I) were treated by TAPP, and 97 patients were treated by Lichtenstein repair (group II) with median follow-up of 17.9?months. Mean hospital stay, mean operative time, operative and postoperative complications were similar in the two groups. Quality of life showed better and significant outcomes in group I for physical function (p?≤?0.001), role physical (p?≤?0.011), bodily pain (p?≤?0.017), general health (p?≤?0.047), and total physical health (p?≤?0.008). However, mental health showed no statistical significance in its four scales, but with better outcomes in group I. Total quality outcomes showed significantly better outcomes in group I (p?≤?0.031).

Conclusions

TAPP hernia repair technique is a safe technique with low complication rate, less postoperative body pain, and better quality-of-life outcomes compared with open technique, being well accepted from the patient’s perspective for quality of life.     

Lichtenstein术后复发性腹股沟疝的腔镜治疗

目的：评价腹腔镜下经腹腹膜前入路（TAPP）治疗Lichtenstein术后复发性腹股沟疝的临床效果。 方法：回顾性分析2009年5月—2014年3月间中南大学湘雅医院行腹腔镜下TAPP治疗的12例Lichtenstein术后复发疝患者临床资料。 结果：全组均顺利完成腹腔镜手术,无1例中转开放手术。平均手术时间为（110±25）min,术后2例发生血清肿,经穿刺抽液治愈。术后均于48 h内痊愈出院,随访至目前无1例再复发。 结论：腹腔镜下TAPP是治疗Lichtenstein术后复发性腹股沟疝安全有效的方法。

     

Lichtenstein和腹腔镜经腹腹膜前疝修补术在腹股沟阴囊疝患者中的临床应用

目的比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放Lichtenstein手术,在腹股沟阴囊疝治疗中的疗效,并探讨其可行性及术后并发症的发生率。 方法选择2016年1月至2018年12月,南京市高淳人民医院阴囊疝患者48例。按照术式不同分为TAPP组（20例）和Lichtenstein组（28例）。比较2组术中及术后并发症,包括手术时间、术中出血、术后疼痛、伤口及网片感染和术后复发等。 结果本组患者均顺利完成手术。Lichtenstein组手术时间（59±12）min,TAPP组手术时间（56±9）min,差异无统计学意义（P>0.05）;Lichtenstein组术中出血量（30.0±10.5）ml,TAPP组为（10.0±5.1）ml,差异有统计学意义（P<0.05）。Lichtenstein组住院时间（9.0±5.2）d,TAPP组（3.0±2.4）d,差异有统计学意义（P<0.05）。Lichtenstein组术后疼痛VAS评分（术后1周）为（4.0±1.4）分,TAPP组（2.0±1.2）分,差异有统计学意义（P<0.05）。2组患者在随访期间均无补片感染、复发及慢性疼痛发生。Lichtenstein组切口并发症（浅表感染及血肿,渗血,渗液）6例,阴囊积液6例;TAPP组切口并发症0例,阴囊积液7例。均经过换药或者保守治疗,均治愈出院。 结论TAPP可以进行腹股沟阴囊疝修补术,其疗效与腹股沟疝开放修补术相当,TAPP具有术后疼痛轻、伤口并发症少,住院时间较短的优点。     

Sexual Dysfunction after Elective Endovascular or Hand-Assisted Laparoscopic Abdominal Aneurysm Repair

ObjectiveTo evaluate the incidence of sexual dysfunction and retrograde ejaculation after elective endovascular aneurysm repair (EVAR) and hand-assisted laparoscopic surgery (HALS) for abdominal aortic aneurysm (AAA).MethodsA total of 100 patients eligible for elective repair of infrarenal AAAs were randomised in two groups: EVAR and HALS. The quality of sexual function was evaluated using the International Index of Erectile Function (IIEF), a 15-item questionnaire. Patients completed the IIEF preoperatively and at 12 months. The incidence of retrograde ejaculation was also evaluated.ResultsOne- and 12-month mortality rates were zero. Three patients in the EVAR group (6%) and two patients in the HALS group (4%) reported an erectile dysfunction (p = NS). The quality of sexual function at 1 year was similar in both groups: total score of 66 in the EVAR group versus 68 in the HALS group (p = 0.66). Retrograde ejaculation was detected in three cases in the HALS group versus no case in the EVAR group.ConclusionsThe HALS technique could be a minimally invasive alternative for sexually active males unsuitable for EVAR repair.     

Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair

Despite growing popularity and potential advantages of robotics in general surgery, there is very little published data regarding robotic inguinal hernia repair. This study examines a single surgeon’s early experience with robotic TAPP inguinal hernia repair compared with laparoscopic TAPP repair in terms of feasibility and cost. We performed a retrospective review of 63 consecutive patients (24 laparoscopic and 39 robotic) who underwent inguinal hernia repair between December 2012–December 2014 at a single institution by a single surgeon. Data examined included gender, age, BMI, operative times, recovery room times, pain scale ratings, and cost. Patient groups were the same in terms of age and BMI. The mean operative time (77.5 vs 60.7 min, p = 0.001) and room time (109.3 vs 93.0 min, p = 0.001) were significantly longer for the robotic vs the laparoscopic patients. Recovery room time (109.1 vs 133.5 min, p = 0.026) and average pain scores in recovery (2.5 vs 3.8, p = 0.02) were significantly less for the robotic group. The average direct cost of the laparoscopic group was $3216 compared with $3479 for the robotic group. The average contribution margin for the laparoscopic group was $2396 compared with $2489 for the robotic group. Robotic TAPP inguinal hernia repair had longer operative times, but patients spent less time in recovery and noted less pain than patients who underwent laparoscopic TAPP inguinal hernia repair. The direct cost and contribution margin are nearly equivalent. These results should allow the continued investigation of this technique without concern over excess cost.     

Comparison of Lichtenstein and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias

The aim of our study was the comparative analysis of the results of two surgical methods: tension-free repair by the Lichtenstein technique and laparoscopic transabdominal preperitoneal (TAPP) repair. In total 52 patients with recurrent inguinal hernia were randomly assigned to the two groups: Lichtenstein (28 patients) and TAPP (24 patients). Comparisons between these groups were done by several preoperative, intraoperative, and postoperative factors. For postoperative factors both short-term and long-term results were considered. Average operation time for Lichtenstein group was 59.6 +/- 9.9 minutes, compared with 64.4 +/- 8.4 minutes for TAPP patients (P = 0.068). In TAPP patients there was less pain in the postoperative period (P = 0.002) and fewer sick-leave days (13.4 +/- 1.7 versus 17.5 +/- 2.6 days; P < 0.001) and, correspondingly, faster recovery. In the Lichtenstein group a total of 4 postoperative complications (infection, hematoma, seroma, urinary retention) were observed, compared with 8 in the TAPP group (P = 0.19). Statistically significant difference was only by urinary retention (0 for Lichtenstein, 4 for TAPP; P = 0.039). There were no cases of hernia recurrence observed during the followup. Chronic pain developed in 5 patients from the Lichtenstein group (17.9%) and 2 patients from the TAPP group (8.3%; P = 0.28) more than 1 year after the operation; 4 Lichtenstein patients (14.3%) and 1 TAPP patient (4.2%; P = 0.23) more than 2 years after the operation; and 3 Lichtenstein patients (10.7%) and 1 TAPP patient (4.2%; P = 0.36) more than 3 years after the operation. For the treatment of recurrent inguinal hernias, which are developed after use of conventional (nonmesh) methods, the first choice should be given to the laparoscopic method, especially for young, physically active, nonobese patients, and if there are any contraindications for the laparoscopy, the Lichtenstein approach should be recommended.     

Sexual function in women after rectocele repair with acellular porcine dermis graft vs site-specific rectovaginal fascia repair

The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage 2 or greater. Fifty women underwent rectocele repair utilizing porcine dermis graft (group 1) and 50 women underwent a site-specific repair of the rectovaginal fascia (group 2). The same questionnaire was administered to all subjects 6 months after surgery. The two groups were similar in age, race, parity, prior hysterectomy, and postmenopausal hormone use. Preoperative sexual function scores were similar in the two groups (group 1 81.4 ± 7.3 and group 2: 83.6 ± 8.2, p = 1.0). Six months after surgery, PISQ scores in group 1 significantly increased (score increase 19.9 ± 2.2, p = 0.01). The mean increase in PISQ scores for group 2 was 6.9 ± 3.1 (p = 0.08). When compared with group 2, subjects undergoing rectocele repair with porcine dermis graft scored significantly higher on the PISQ 6 months after surgery (group 1 101.3 ± 6.4 and group 2 89.7 ± 7.1, p = 0.01). We conclude that rectocele repair using porcine dermis graft is associated with improved sexual functioning when compared with site-specific rectovaginal fascia repair.     

Comparison of open and laparoscopic preperitoneal repair of groin hernia

Background

Compared with laparoscopic groin herniorrhaphy, the open procedure used in most former studies was Lichtenstein repair. However, unlike the totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) laparoscopic techniques, Lichtenstein procedure is a premuscular but not preperitoneal repair. This retrospective study compared the outcomes between laparoscopic preperitoneal and open preperitoneal procedure—modified Kugel (MK) herniorrhaphy.

Methods

Groin hernia patients older than 18 years who underwent open MK or laparoscopic preperitoneal herniorrhaphy in our hospitals between January 2008 and December 2010 were enrolled. Baseline characteristics, recurrence, and intraoperative, short-term, and long-term postoperative complications were recorded.

Results

Among the 1,760 included patients (530 open and 1,230 laparoscopic), 96.08 % completed the follow-up (24–60 months). The patients in the open group were older than laparoscopic group (p < 0.001). More bilateral (91.45 %) and recurrent (82.12 %) hernia patients underwent laparoscopic procedures (p < 0.001 and p = 0.004, respectively). The overall recurrence rate was 0.71 %, with no significant difference between the two approaches (p = 0.227). The overall complication rate was lower for the laparoscopic than the open approach (14.47 vs. 19.25 %, p = 0.012), whereas the rates of life-threatening complications were similar (1.51 vs. 0.98 %, p = 0.332). The laparoscopic group had significantly lower incidence rates of wound infection and chronic pain (p = 0.016 and p < 0.001, respectively), shorter operative time, lower visual analogue scale scores, and faster recovery than the open group (p < 0.001).

Conclusions

As preperitoneal herniorrhaphy, both MK and laparoscopic (TEP/TAPP) procedures are safe and effective, with low incidence rates of life-threatening complications and recurrence. The laparoscopic approach is superior in terms of lower incidence rates of infection and chronic pain, shorter operative time, and faster recovery; however, careful surgical procedure selection and implementation of technical details are required.     

Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP

Introduction Chronic pain after hernia repair is common, and it is unclear to what extent the different operation techniques influence its incidence. The aim of the present study was to compare the three major standardized techniques of hernia repair with regard to postoperative pain.Patients and methods Two hundred and eighty male patients with primary hernias were prospectively, randomly selected to undergo Shouldice, tension-free Lichtenstein or laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty repairs. Patients were examined after 52 months with emphasis on chronic pain and its limitations to their quality of life.Results Chronic pain was present in 36% of patients after Shouldice repair, in 31% after Lichtenstein repair and in 15% after TAPP repair. Pain correlated with physical strain in 25% of patients after Shouldice, in 20% after Lichtenstein and in 11% after TAPP repair. Limitations to daily life, leisure activities and sports occurred in 14% of patients after Shouldice, 13% after Lichtenstein and 2.4% after TAPP repair.Conclusion Chronic pain after hernia surgery is significantly more common with the open approach to the groin by Shouldice and Lichtenstein methods. The presence of the prosthetic mesh was not associated with significant postoperative complaints. The TAPP repair represents the most effective approach of the three techniques in the hands of an experienced surgeon.     

Buried penis in adults as a complication of circumcision: Surgical management and long-term outcomes

We aimed to evaluate the feasibility and long-term functional outcomes of surgical correction of adult buried penis patients due to complications of childhood circumcision. A retrospective analysis was performed for patients who underwent treatment for buried penis between 1997 and 2019. An autologous split-thickness skin graft (STSG) was used. Surgical management steps included circumcision, resection of the bands between the corpora and other tissues, harvesting of STSG from femoral region and graft application. Surgical and functional outcomes were the primary end points. Thirteen patients were included with a mean age of 22.4 years and median body mass index 27. Patients had similar symptoms, including sexual dysfunction, inadequate penile length, impossible penetration and decreased quality of life. No early post-operative complication was seen. During a median of 44-month follow-up, post-operative long-term complications were seen in 4 (30%) patients: decreased graft sensation (n = 2); graft contracture five months after surgery (n = 1); and retarded ejaculation (n = 1). Patients’ post-operative three-month International Index of Erectile Function (IIEF) score and sexual satisfaction score (SSS) significantly increased compared with patients’ pre-operative scores (IIEF; 22.8 vs. 14.1, p = .03, SSS; 8.7 vs. 3.2, p < .01). Buried penis is a rare but challenging condition. Patients had excellent graft acceptance with successful functional outcomes.     

Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias

Purpose

The aim of this study was to compare the transinguinal preperitoneal technique (TIPP) using a memory ring patch versus the Lichtenstein technique in relation to acute and chronic pain, post-operative complications and recurrence rates.

Methods

During an 18-month period, all adult patients that needed treatment for a unilateral inguinal or femoral hernia were treated by the TIPP repair using the Polysoft? mesh. This group was retrospectively compared with a historical cohort of patients treated by the Lichtenstein technique. Our policy concerning type of anaesthesia, post-operative pain management and visual analogue scale measurements did not change over the study period. For post-operative pain evaluation, the visual analogue scale was used (0–10) and scores were measured after 6 h, 24 h, 1 week, 1 month, 1 year and yearly thereafter. Recurrence rates were evaluated at time of clinical examinations.

Results

In total, 142 patients have been analysed with the TIPP technique (group I) versus 136 patients operated in the previous 2 years with a Lichtenstein repair (group II). In group I, 112 patients (78.9%) received a medium size patch of 14?×?7.5 cm and 30 patients (21.1%) had a large patch (16?×?9 cm). The mean operative time for a TIPP procedure was statistically shorter than for a Lichtenstein repair, 33 versus 44 min, respectively (p?=?0.04). After 24 h, 1 week and 1 month post-surgery, there was significantly less post-operative pain observed in the TIPP group than in the Lichtenstein group. In total, four recurrences were observed in the TIPP group (2.8%), of which one laterally and three medially. In group II, seven recurrences were observed in total (5.1%), of which five were detected within 2 years of follow-up (3.7%).

Conclusion

For surgeons performing the Lichtenstein repair but looking for modifications concerning pain relief and a quicker procedure, the TIPP approach is a feasible alternative that seems to be associated with less post-operative pain.