Comparison of biomaterials: three meshes and TAPP for inguinal hernia

Background In laparoscopic hernia repair the use of biocompatible materials is necessary. A prospective, double-blind study was projected to compare three different meshes. Methods Ninety male patients with primary inguinal hernia undergoing transabdominal preperitoneal (TAPP) implant procedures were included. Three different types of mesh were tested: a monofile, heavy-weight, rigid mesh (group A), a smooth, heavy-weight variant of polypropylene (group B), and a polyglactin/polypropylene compound mesh (group C). Complications, pain development, inability to work, physical conditions, testicular volume, and blood circulation were documented. Results Convalescence in group A was slower than in groups B and C: Postoperative values of visual scales for pain development were higher, inability to work was 7.3 days longer, urologic effects were more severe, activities of everyday life were more reduced, and data of the German SF-36 Health Survey Test showed a significant reduction of physical condition (p < 0.05). Conclusion The compound mesh did not create more comfort for the patients than the smooth variant of the heavy-weight polypropylene mesh.     

Incidence and risk factors for urinary retention after endoscopic hernia repair

BACKGROUND: Postoperative urinary retention (PO-UR) frequently complicates the repair of inguinal hernias. The purpose of this study was to determine the incidence of and risk factors for developing PO-UR in patients undergoing endoscopic inguinal hernia repair. METHODS: The incidence of PO-UR was determined by a retrospective review of a prospective patient database for all patients undergoing inguinal hernia repair by 1 surgeon from 2001 to 2003 at a tertiary referral center. A case-control study was used to identify risk factors for the development of PO-UR. RESULTS: Thirty-four (22.2%) out of 153 patients undergoing endoscopic inguinal hernia repair developed PO-UR. The use of narcotic analgesia and the volume of intravenous postoperative fluid administered were significant risk factors (P < .05) for the development of PO-UR. CONCLUSIONS: Postoperative urinary retention is common after totally extraperitoneal and transabdominal preperitoneal inguinal hernia repairs and is associated directly with increased narcotic and postoperative intravenous fluid administration.     

TAPP和TEP两种疝修补术治疗腹股沟疝的对照研究

目的总结腹腔镜腹股沟疝修补术（LIHR）治疗腹股沟疝手术经验,探讨LIHR手术的安全性、有效性、手术技巧及术式选择。方法回顾分析我院2008年2月～2010年2月的84例LIHR手术病例,35例行经腹腔腹膜前修补术（TAPP）,49例实施完全腹膜外疝修补法（TEP）手术。结果两者术后住院天数,术后下床时间,住院费用差异无统计学意义（均P〉0.05）,手术时间TAPP长于TEP（P〈0.05）,两组共发生血肿4例,腹股沟区暂时性神经感觉异常2例,尿潴留1例,无其他明显并发症发生。随访6～30个月,1例TAPP术后复发,为开展手术早期病例。结论 LIHR中,TAPP和TEP均是安全、有效的腹股沟疝修补方法,两者手术疗效相当。     

Laparoskopische Leistenhernientherapie (TAPP) als Ausbildungsoperation

Zusammenfassung. Einleitung: Aufgrund der steigenden Anwendungsfrequenz der endoskopischen Hernienoperation stellt sich die Frage nach der Standardisierbarkeit und Erlernbarkeit der Methode als Grundlage für eine ad?quate Qualit?tssicherung der Ergebnisse. Material und Methode: Zur Analyse dieser Fragestellung erfolgte eine Bewertung prospektiv dokumentierter Daten zur TAPP-Technik, die seit 1993 an unserer Klinik etabliert ist. Gegenübergestellt wurden dabei den Ergebnissen der Ausbildungsoperationen die Resultate einer Expertengruppe nach überwinden deren Lern- sowie der Methodenentwicklungskurve. Ergebnisse: Insgesamt wurden 778 Ausbildungsoperationen von 10 Operateuren durchgeführt mit einer Individualerfahrung von im Median 30,5 Eingriffen. Vorausgegangen waren dabei 89 Kameraassistenzen der Auszubildenden. Die postoperative Morbidit?t der Ausbildungsoperationen betrug dabei 1,9 % verglichen mit 1,4 % der Expertengruppe. Bei einer medianen Nachbeobachtungszeit von 23 Monaten wurden in der Expertengruppe 2 Rezidive (0,23 %) diagnostiziert, w?hrend nach Ausbildungsoperationen (16 Monate Nachbeobachtungszeit) bislang keines gefunden wurde. Schlu?folgerung: Die TAPP-Technik ist als standardisierbare Operation auch in der Ausbildungssituation mit gleich guten Ergebnissen anwendbar und erfüllt somit die Voraussetzung für eine Anwendung im Routinebetrieb.

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Introduction: Because of an increasing number of endoscopic hernia procedures, it is important to look into the possibility of standardizing these techniques helping surgeons to acquire the operative skills necessary. Material and Methods: To discuss these aspects, the documented data on TAPP operations that have been carried out in this department since 1993 were analyzed. The results of teaching procedures were compared with those of experts after they had gotten past the learning and development curve. Results: A total of 778 teaching procedures were performed by 10 surgeons with an individual experience of 30.5 operations (median). Before starting the first procedure, 89 were done by assistants operating the camera. The morbidity of teaching operations was 1.9 % compared to 1.4 % for those performed by experts. After a median follow-up of 23 months there were two recurrences (0.23 %) in the expert group and none in the teaching group (follow-up 16 months). Conclusion: Because of the potentials of standardization of the TAPP technique, the results of teaching were equal to expert operations. Therefore, TAPP is suitable for application in a routine setting.

     

经腹腔腹膜前疝修补术治疗复发性腹股沟疝19例临床分析

目的探讨经腹腔腹膜前腹股沟疝修补手术在复发性腹股沟疝修补的临床治疗效果。方法通过随访、回顾分析2009年3月～2012年3月笔者所在医院采用腹腹膜前疝修补术治疗复发性腹股沟疝的临床资料共19例,从手术时间、住院天数、术后并发症等方面分析TAPP在修复复发性腹股沟疝治疗中的临床效果。结果手术均获成功,无中转手术。手术时间(75.4±15.6)min,住院时间(5.2±1.8)d,发生手术并发症4例,经对症治疗均在1周内消失,最长随访3年,无一例复发。结论腹腔镜经腹膜腹股沟斜疝无张力修补手术对于复发性腹股沟疝的治疗具有明显优势,避免了在手术瘢痕处的再手术,减少并发症的出现几率,同时减少了复发性腹股沟疝的再复发率,腹腔镜经腹膜腹股沟斜疝无张力修补手术在修复复发性腹股沟疝的治疗中值得推广。     

Laparoscopic transperitoneal inguinal hernia repair (TAPP) after radical prostatectomy: is it safe? Results of prospectively collected data of more than 200 cases

Background

Feasibility of laparoscopic transperitoneal inguinal hernia repair (TAPP) in primary hernias has been well established, but can the TAPP also be recommended after radical prostatectomy?

Methods

Our prospectively collected patient database was reviewed from March 1996 until December 2006 in order to compare operative data and postoperative outcomes in 264 TAPPs after prostatectomy with 10,962 TAPPs because of primary hernias. Patients operated after prostatectomy were divided into two subgroups (year of surgery March 1996–July 2002 and August 2002–December 2006, with 132 TAPPs per group) to check for a possible learning curve.

Results

In the group operated after prostatectomy patients were older (70 vs. 59 years), duration of operation was longer (59 vs. 40 min) and morbidity was higher (5.7 vs. 2.8%), but recurrence rate was similar (0.8 vs. 0.7%) as was body mass index (BMI) (25 kg/m²). Subgroup analysis showed a clear learning curve with a decrease of morbidity (9.8–1.5%) and recurrence rate (1.5–0%) but similar results in operation time (60 and 58 min).

Conclusions

Even if TAPP after radical prostatectomy is a difficult operation it can be performed efficiently and safely. However, for a definite decision regarding recurrence rate long-term results have to be waited for.     

Sixty-month follow-up after endoscopic inguinal hernia repair with three types of mesh: a prospective randomized trial

Background  This prospective, clinical, randomized, double-blind study was intended to investigate the impact of the structure and the amount of polypropylene (PP) mesh used in laparoscopic transabdominal preperitoneal hernioplastic (TAPP) on physical function and life quality. Methods  180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m²), double-filament PP mesh (Prolene, 10 × 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m²) of PP mesh (Serapren, 10 × 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 × 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate) and life quality (pain development, physical function). The development of life quality was documented according to the SF-36 Health Survey. The follow-up period was 60 months. Results  The recurrence rate (2.2% overall) during 60-month follow-up was not significantly different between the groups. Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p < 0.05) higher, incapacity for work was 8.2 days longer, and urological adverse effects were stronger. The mean-term development of life quality was significantly lower in group A up to 12th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th postinterventional week the differences diminished. Conclusions  The composite mesh does not provide an advantage concerning physical function or pain development in comparison to the multifilament, heavyweight, pure polypropylene mesh. Independently of which mesh was implanted 5% of patients are still suffering from discomfort after 5 years.     

Usefulness of a novel,slim long syringe‐like device for applying surgical mesh through a 5‐mm trocar

We developed a device for introducing surgical mesh through a 5‐mm trocar during transabdominal preperitoneal hernia repair. This device is like a slim long syringe; it has a polypropylene outer sheath (outer diameter, 5.8 mm; inner diameter, 5.6 mm; length, 2500 mm) and inner rod, and is made in a similar manner to a drinking straw. Therefore, the manufacturing costs are low. To use the device, folded mesh is placed inside it with a grasper before surgery. The device is then inserted through the trocar, and the mesh is pushed out by the inner rod and applied. The folded mesh extrudes smoothly pubis side to lateral side along the inguinal curve. It reinforces the area without any contamination and expands in a manner that makes it easy for the surgeon to place and fix the mesh. Our device allows mesh to be applied smoothly, comfortably, and economically, and it may reduce the risk of infection.     

Inguinal Hernia-The Practicalities of TAPP Repair

In a previous paper in this Journal, the case for laparoscopic inguinal hernia repair by the transabdominal preperitoneal (TAPP) approach was made, in terms of superiority of outcomes in both recurrence rate and long-term symptoms. This approach has been used by many people, but not always with such good outcomes. This may be due to inattention to detail. The technique used by the author is described, as if following the patient through his surgical pathway. Instrumentation, materials (including composition, configuration and placement) are delineated, suggesting that tailoring the mesh to the individual patient and his hernia are justified, after looking at the outcomes for different mesh sizes.