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1.
Purpose
About 2–5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim of the study was to describe and classify patients with severe persistent pain after laparoscopic herniorrhaphy. 相似文献2.
Background
Hiatal repair failure is the nemesis of laparoscopic paraesophageal hernia repair as well as the major cause of failure of primary fundoplication and reoperation on the hiatus. Biologic prosthetics offer the promise of reinforcing the repair without risks associated with permanent prosthetics.Design
Retrospective evaluation of safety and relative efficacy of laparoscopic hiatal hernia repair using an allograft (acellular dermal matrix) onlay. Patients with symptomatic failures underwent endoscopic or radiographic assessment of hiatal status.Results
Greater than 6-month follow-up was available for 252 of 450 consecutive patients undergoing laparoscopic allograft-reinforced hiatal hernia repair between January 2007 and March 2011. No erosions, strictures, or persisting dysphagia were encountered. Adhesions were minimal in cases where reoperation was required. Failure of the hiatal repair at median 18 months (6–51 months) was significantly (p < 0.005) different between groups: group A (primary fundoplication with axial hernia ≤ 2 cm), 3.7 %; group B (primary fundoplication with axial hernia 2–5 cm), 7.1 %; group G (giant/paraesophageal), 8.8 %; group R (reoperative), 23.4 %. Additionally, mean time to failure was significantly shorter in group R (247 days) compared with the other groups (462–489 days).Conclusions
Use of allograft reinforcement to the hiatus is safe at 18 months median follow-up. Reoperations had a significantly higher failure rate and shorter time to failure than the other groups despite allograft, suggesting that primary repairs require utmost attention and that additional techniques may be needed in reoperations. Patients with hiatal hernias >2 cm axially had a recurrence rate equal to that of patients undergoing paraesophageal hiatal hernia repair, and should be treated similarly. 相似文献3.
Ada Ng David Yong Eric Hazebroek Hayley Berry Richard Radajewski Steven Leibman Garett S. Smith 《Surgical endoscopy》2009,23(11):2505-2508
Background
The use of an intraesophageal bougie has traditionally been an integral step in the repair of large hiatal hernia and fundoplication. Typically, the bougie is passed by the anesthesiologist or a member of the surgical team into the stomach to enable calibration of the hiatal repair and fundoplication. An inherent risk of esophagogastric perforation is associated with this maneuver. The authors report their experience comparing symptomatic outcomes for patients who have had a large hiatus hernia repaired with and without the use of a calibration bougie.Methods
Data were collected prospectively for 28 consecutive patients undergoing elective laparoscopic repair of a paraesophageal hernia. A bougie was used in the first 14 patients. In the next 14 patients, the use of a bougie was omitted. Symptom and quality-of-life data were collected preoperatively and 6 months postoperatively for all the patients.Results
All the patients were satisfied with their symptomatic outcome, as reflected in their postoperative quality-of-life scores. No patients required dilation for postoperative dysphagia. There was no difference in postoperative dysphagia scores between the two groups.Conclusion
The current series of consecutively performed laparoscopic paraesophageal hernia repairs showed no benefit in terms of symptomatic outcome associated with the use of an intraesophageal bougie. Currently, the authors’ standard practice is to perform laparoscopic repair of the paraesophageal hernia and fundoplication without the aid of a calibration bougie. 相似文献4.
Edgar J.B. Furnée Werner A. Draaisma Rogier K. Simmermacher Gerard Stapper Ivo A.M.J. Broeders 《American journal of surgery》2010,199(5):695-701
Background
The long-term durability of laparoscopic repair of paraesophageal hiatal herniation is uncertain. This study focuses on the long-term symptomatic and radiologic outcome of laparoscopic paraesophageal herniation repair.Methods
Between 2000 and 2007, 70 patients (49 females, mean age ± standard deviation 60.6 ± 10.9 years) undergoing laparoscopic repair of paraesophageal herniation were studied prospectively. After a mean follow-up of 45.6 ± 23.8 months, symptomatic (65 patients, 93%) and radiologic follow-up (60 patients, 86%) was performed by standardized questionnaires and esophagograms.Results
The symptomatic outcome was successful in 58 patients (89%), and gastroesophageal anatomy was intact in 42 patients (70%). The addition of a fundoplication was the only significant predictor of an unfavorable radiologic outcome in the univariate analysis (odds ratio .413; 95% confidence interval, .130 to 1.308; P = .125).Conclusions
The long-term symptomatic outcome of laparoscopic repair of paraesophageal hiatal herniation was favorable in 89% of patients, and 70% had successful anatomic repair. The addition of a fundoplication did not prevent anatomic herniation. 相似文献5.
Background
Laparoscopic ventral hernia repair in comparison to open herniorrhaphy results in reduced length of stay, less post-operative pain, earlier return to work, and reduced complications for the repair of complex ventral hernias. The laparoscopic approach has been the standard of care for complex or large ventral hernias for non-pregnant patients over the past decade. Despite evidence that demonstrates that laparoscopy is safe during pregnancy, there is currently no consensus regarding the indications, contraindications, patient selection and post-operative care of pregnant patients evaluated for laparoscopic ventral herniorrhaphy. 相似文献6.
Background
Large paraesophageal hernias are notoriously difficult to manage via laparoscopy and are associated with a significant recurrence rate. A novel laparoscopic approach was used to close the diaphragmatic defect in four patients diagnosed with large, paraesophageal hernias and gastroesophageal reflux disease symptomatology.Methods
All procedures were performed via laparoscopy. Three patients underwent a reduction of the paraesophageal hernia with a Nissen fundoplication and one with Collis-Nissen fundoplication. Standard crural closure was performed over a #60 Fr Bougie in two patients, and two patients did not undergo a cruroplasty. In all four patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect.Results
Postoperatively, all patients did well without notable, unusual complaints. Average length of stay was 2 days. Although not statistically significant, all patients had no recurrence of symptoms or of their paraesophageal hernia at 8, 9, 11, and 15 months after the procedure.Conclusions
In selected patients, large paraesophageal hernias can safely be managed via a laparoscopic antireflux procedure with the hepatic shoulder technique. Although no long-term follow-up is available, this technique has shown good early postoperative results and may be used as an alternative to a laparoscopic Mesh reinforced fundoplication or difficult crural closure. 相似文献7.
Shigeru Tsunoda Glyn G. Jamieson Peter G. Devitt David I. Watson Sarah K. Thompson 《World journal of surgery》2010,34(1):79-84
Background
The necessity for routine postoperative contrast studies following laparoscopic fundoplication for either gastroesophageal reflux disease or paraesophageal hernia is unclear. 相似文献8.
Julio C. U. Coelho Christiano M. P. Claus João Carlos Michelotto Fabiana Marques Fernandes Christian Lopez Valle Leonardo Dudeque Andriguetto Antonio C. L. Campos 《Surgical endoscopy》2010,24(11):2708-2712
Background
Although laparoscopic inguinal herniorrhaphy is considered safe, several complications may occur. This study aimed to evaluate the complications observed in 780 laparoscopic inguinal herniorrhaphies at the authors’ hospital. 相似文献9.
Purpose
Laparoscopic inguinal hernia repair is associated with reduced post-operative pain and earlier return to work in men. However, the role of laparoscopic hernia repair in women is not well reported. The aim of this study was to review the outcomes of the laparoscopic versus open repair of inguinal hernias in women and to discuss patients’ considerations when choosing the approach.Methods
A retrospective chart review of all consecutive patients undergoing inguinal hernia repair from January 2005 to December 2009 at a single institution was conducted. Presentation characteristics and outcome measures including recurrence rates, post-operative pain and complications were compared in women undergoing laparoscopic versus open hernia repair.Results
A total of 1,133 patients had an inguinal herniorrhaphy. Of these, 101 patients were female (9 %), with a total of 111 hernias. A laparoscopic approach was chosen in 44 % of patients. The majority of women (56 %) presented with groin pain as the primary symptom. Neither the mode of presentation nor the presenting symptoms significantly influenced the surgical approach. There were no statistically significant differences in hernia recurrence, post-operative neuralgia, seroma/hematoma formation or urinary retention between the two approaches (p < 0.05). A greater proportion of patients with bilateral hernias had a laparoscopic approach rather than an open technique (12 vs. 2 %, p = 0.042).Conclusions
Laparoscopic herniorrhaphy is as safe and efficacious as open repair in women, and should be considered when the diagnosis is in question, for management of bilateral hernias or when concomitant abdominal pathology is being addressed. 相似文献10.
Terrence M. Fullum Tolulope A. Oyetunji Gezzer Ortega Daniel D. Tran Ian M. Woods Olusola Obayomi-Davies Orighomisan Pessu Stephanie R. Downing Edward E. Cornwell 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(1):23-29
Background:
The literature reports the efficacy of the laparoscopic approach to paraesophageal hiatal hernia repair. However, its adoption as the preferred surgical approach and the risks associated with paraesophageal hiatal hernia repair have not been reviewed in a large database.Method:
The Nationwide Inpatient Sample dataset was queried from 1998 to 2005 for patients who underwent repair of a complicated (the entire stomach moves into the chest cavity) versus uncomplicated (only the upper part of the stomach protrudes into the chest) paraesophageal hiatal hernia via the laparoscopic, open abdominal, or open thoracic approach. A multivariate analysis was performed controlling for demographics and comorbidities while looking for independent risk factors for mortality.Results:
In total, 23,514 patients met the inclusion criteria. By surgical approach, 55% of patients underwent open abdominal, 35% laparoscopic, and 10% open thoracic repairs. Length of stay was significantly reduced for all patients after laparoscopic repair (P < .001). Age ≥60 years and nonwhite ethnicity were associated with significantly higher odds of death. Laparoscopic repair and obesity were associated with lower odds of death in the uncomplicated group.Conclusion:
Laparoscopic repair of paraesophageal hiatal hernia is associated with a lower mortality in the uncomplicated group. However, older age and Hispanic ethnicity increased the odds of death. 相似文献11.
Background
Dysejaculation and pain from the groin and genitals during sexual activity represent a clinically significant problem in up to 4% of younger males after open inguinal herniorrhaphy. The aim of this questionnaire study is to assess the prevalence of dysejaculation and pain during sexual activity after laparoscopic inguinal herniorrhaphy on a nationwide basis. 相似文献12.
Purpose
Series of conventional inguinal herniorrhaphy from low and middle income countries (LMICs) suggest elevated rates of morbidity, mortality, and recurrence, although the reasons remain incompletely understood. We sought to identify risk factors for adverse outcomes from inguinal herniorrhaphy performed in a resource-limited LMIC setting.Methods
We performed mesh-free modified Bassini inguinal herniorrhaphies on 141 consecutive patients with 156 inguinal hernias over 10 months in rural Haiti. We prospectively followed these patients for complications.Results
No intraoperative or perioperative deaths occurred. Follow-up was poor, with 20 patients (14%) returning after discharge. 14 complications were identified in 11 patients, yielding an identified complication rate per herniorrhaphy of 9%. Five complications required reoperation, for an overall reoperative complication rate per herniorrhaphy of 3%. Reoperative complications included one postoperative hemorrhage, one persistent painful cord mass, and three infected hematomas or seromas. On univariate analysis, trends towards complication and need for reoperation were noted with concurrent repair of an ipsilateral hydrocele (OR 4.5, p = 0.300, for complication; OR 9.0, p = 0.115, for reoperative complication).Conclusions
In rural Haiti, we found that adding ipsilateral hydrocele repair to inguinal herniorrhaphy may elevate the risk of both complications and need for reoperation. This previously unreported association is of high relevance to surgical practice across tropical LMICs, where concurrent inguinal hernia and hydrocele is common.13.
Costas D. Lallas Mark L. Pe Jitesh V. Patel Pranav Sharma Leonard G. Gomella Edouard J. Trabulsi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):142-147
Background and Objectives:
We report our institutional experience performing transperitoneal robotic-assisted laparoscopic prostatectomy (RALP) in patients with prior prosthetic mesh herniorrhaphy to assess the feasibility of this procedure in this patient population.Methods:
From October 2005 to January 2008, transperitoneal robotic-assisted laparoscopic prostatectomies were performed and prospectively recorded. We retrospectively reviewed 309 patients.Results:
Twenty-seven patients (8.7%) were found to have a history of prior hernia repair with prosthetic mesh placement. The mean age was 55.7, estimated blood loss (EBL) was 228 mL, operative (console) time was 197 minutes, and length of hospital stay (LOS) was 1.62 days. In contrast, patients undergoing RALP with no history of mesh herniorrhaphy had a mean age of 59.3, EBL of 302 mL, console time of 193 minutes, and LOS of 2.2 days. These differences were not statistically significant. The mesh herniorrhaphy cohort had a lower percentage of organ-confined disease, but no difference was seen in margin status, continence, or potency rates after one year.Conclusions:
Transperitoneal RALP is a feasible option for previously operated on patients with prosthetic mesh herniorrhaphy. Two areas that we identified as critical were the initial step of gaining access for pneumoperitoneum and port placement, and meticulous dissection to expose the mesh, which can be subsequently avoided and left intact. As RALP continues to gain popularity, urologists will continue to exploit the advantages of robotic surgery to perform increasingly challenging cases. 相似文献14.
Laura Medina Michael Peetz Erick Ratzer Michael Fenoglio 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》1998,2(3):269-272
Background and Objective:
Paraesophageal hernias are uncommon yet potentially lethal conditions. Their repair has now been facilitated by laparoscopic technology. We present a series of 20 patients with paraesophageal hernias repaired laparoscopically.Methods:
Twenty patients with paraesophageal hernias had laparoscopic repairs. Eighteen patients had primary repair of their hiatal defect. Two required mesh reinforcement. Fifteen patients had a fundoplication procedure performed concomitantly.Results:
Long-term follow-up is available on 17 patients. There was no in-hospital morbidity or mortality. Average length of stay was 2.3 days. One patient recurred in the immediate postoperative period. There were no other recurrences. The only death in the series occurred in the oldest patient 18 days postoperatively. He had been discharged from the hospital and died of cardiac failure. No patients have had complications from a paraesophageal hernia postoperatively.Conclusion:
Laparoscopic repair of paraesophageal hernias is possible. Preoperative work-up should include motility evaluation to assess esophageal peristalsis as the majority of these will need a concomitant anti-reflux procedure. This data helps the surgeon to determine whether or not a complete or partial wrap should be done. Repair of the diaphragmatic defect can be accomplished in the majority of patients without the use of prosthetic material with excellent results. 相似文献15.
Background
The last decade has seen the publication of multiple case series investigating the feasibility of performing reoperative fundoplications using laparoscopic techniques. Most of these studies are small and reflect initial experiences with the procedure. To examine the collective experience with laparoscopic redo fundoplications, a systematic review was conducted. 相似文献16.
Fernando Spencer Netto Fayez Quereshy Bruna G. Camilotti Kristen Pitzul Josephine Kwong Timothy Jackson Todd Penner Allan Okrainec 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(4)
Purpose:
The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy.Methods:
A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs.Results:
Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827).Conclusions:
In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy. 相似文献17.
Yves-Marie Dion 《Canadian journal of surgery》1996,39(3):229-232
Objectives
To assess the safety and effectiveness of individualized laparoscopic herniorrhaphy and to compare its intraoperative cost to that of the standard Bassini operation.Design
An analytic cohort study.Setting
A university teaching hospital.Patients
One group of 158 patients underwent 167 laparoscopic herniorrhaphies for symptomatic groin hernias. The approach was transabdominal preperitoneal for the first 124 patients and totally preperitoneal for the last 34 patients. A second group of 50 patients underwent a conventional Bassini operation.Intervention
Individualized laparoscopic inguinal herniorrhaphy or Bassini herniorrhaphy.Main Outcome Measures
Complications and recurrences encountered in the laparoscopic group. Total operative time and intraoperative cost involved in both procedures. Analgesia required in each group during the first 2 postoperative days.Results
Intra- and postoperative complications of the laparoscopic approach were not life threatening. The recurrence rate at a mean follow-up of 16.8 months was 1.2%. Total operative time was significantly (p < 0.001) longer in the laparoscopy group than in the Bassini group. Patients in the Bassini group took more parenteral analgesics than those in the laparoscopy group (p = 0.02), but there was no difference with respect to the number of times enteral analgesics were required (p = 0.32). Use of mesh and staples was more expensive than sutures alone inserted laparoscopically. The Bassini procedure was a less expensive procedure than laparoscopic herniorrhaphy.Conclusions
The laparoscopic treatment of groin hernias is safe. The recurrence rate is low. Primary unilateral inguinal hernias could be adequately treated at a lesser cost by a standard approach. Bilateral, recurrent and femoral hernias could benefit from a laparoscopic approach. 相似文献18.
B. Zendejas E. O. Onkendi R. D. Brahmbhatt S. M. Greenlee C. M. Lohse D. R. Farley 《Hernia》2011,15(4):403-408
Purpose
Contralateral exploration during laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy allows for the repair of incidentally found hernias. Nonetheless, some patients with a negative contralateral exploration subsequently develop a symptomatic hernia on that side. We pondered the incidence of contralateral metachronous hernia development and whether prophylactic “repair” in these circumstances would be beneficial. 相似文献19.
Allan Okrainec Lorenzo E. Ferri Liane S. Feldman Gerald M. Fried 《Surgical endoscopy》2011,25(4):1083-1087
Introduction
There are numerous reports in the literature documenting high recurrence rates after laparoscopic paraesophageal hernia repair. The purpose of this study was to determine the learning curve for this procedure using the Cumulative Summation (CUSUM) technique. 相似文献20.
Oelschlager BK Petersen RP Brunt LM Soper NJ Sheppard BC Mitsumori L Rohrmann C Swanstrom LL Pellegrini CA 《Journal of gastrointestinal surgery》2012,16(3):453-459