Open mesh removal combined with laparoscopic totally extraperitoneal inguinal hernia repair: A case report of a novel surgical technique for chronic postoperative inguinal pain

A 74-year-old man presented for surgical treatment to alleviate chronic post-herniorrhaphy inguinal pain. Physical and imaging examinations suggested that his pain was due to his ilioinguinal nerve being entrapped by a meshoma composed of bilayer mesh and plug mesh. The patient strongly desired mesh removal, although it appeared challenging because of adhesion of the meshes from the previous herniorrhaphies. Anticipating technical difficulty, we performed laparoscopic totally extraperitoneal repair followed by open mesh removal. Thus, the risk of damaging the peritoneum and visceral organs during open mesh removal was eliminated because the peritoneum had already been separated from the pathogenic mesh during the laparoscopic repair. The patient's chronic pain was drastically relieved. Combination surgery may therefore be a safe and useful technique in select patients with chronic postoperative inguinal pain. This approach could also prevent hernia recurrence.     

Prospective randomized controlled trial comparing partially absorbable lightweight mesh and multifilament polyester anatomical mesh in laparoscopic inguinal hernia repair

Introduction

Tension‐free mesh repair is currently the gold standard treatment for inguinal hernia. Recent evidence has shown that both open and laparoscopic approaches to inguinal hernia repair can achieve good results. Lots of meshes with different properties are available on the market, but direct comparisons between them are scare. We conducted a prospective randomized controlled trial comparing a partially absorbable lightweight mesh (ULTRAPRO?) and a multifilament polyester anatomical mesh (Parietex?) in laparoscopic total extraperitoneal inguinal hernia repair.

Methods

This study was a single‐center, prospective randomized controlled trial to compare the surgical handling and clinical outcomes between two different types of meshes. All operations were performed using a standardized operative protocol. This study was approved by the Institutional Review Board of the Hong Kong East Cluster Health Service in 2009 (reference number: 2009‐087). The study was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12610000031066).

Results

From October 2009 to August 2011, 85 laparoscopic total extraperitoneal inguinal hernia repairs were performed. The mean mesh handling time was 152 s for the ULTRAPRO group and 206 s for the Parietex group (P = 0.001). There were three cases of seroma formation in the ULTRAPRO group and nine in the Parietex group (P = 0.02). The overall recurrence rate was 2.5%.

Conclusion

It took less time to manipulate the flat mesh (ULTRAPRO) than the anatomical mesh (Parietex) in laparoscopic total extraperitoneal inguinal hernia repair, but the time difference was small. Lightweight mesh and heavyweight mesh offered similar clinical outcomes in terms of discomfort sensation and foreign body sensation during long‐term follow‐up.

     

A review of chronic pain after inguinal herniorrhaphy

BACKGROUND: Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Evidence suggests that patients with chronic pain place a considerable burden on health services. However, few scientific data on chronic pain after this common elective operation are available. OBJECTIVES: To review the frequency of chronic pain and to discuss etiological theories and current treatment options for patients with chronic post herniorrhaphy pain. MATERIALS AND METHODS: All studies of postoperative pain after inguinal hernia repair with a minimum follow-up period of 3 months, published between 1987 and 2000, were critically reviewed. RESULTS AND DISCUSSION: The frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.     

传统疝修补术与疝环充填式无张力疝修补术在腹股沟疝治疗中的应用体会

目的比较传统疝修补术与疝环充填式无张力疝修补术在腹股沟疝治疗中临床疗效。方法选取2006年2月至2010年12月期间住院的120例腹股沟疝患者,随机分为两组,对照组40例:采用传统修补术,治疗组80例:使用疝环充填式无张力修补术。对比分析两组手术时间、下床时间、住院时间、术后并发症和复发等情况。结果治疗组在下床活动时间、住院时间、术后并发症和复发率方面均优于对照组,差异具有统计学意义(P<0.01),在手术时间上无明显统计学差异(P>0.05)。结论疝环充填式无张力疝修补术具有住院时间短、创伤小、痛苦小、术后恢复快、伤口无感染、成功率较高、复发率低等优点,符合腹股沟解剖和生理结构,为目前腹股沟疝手术治疗的首选术式。     

平片式无张力疝修补术治疗腹股沟疝58例临床分析

目的探讨单用平片修补腹股沟疝的疗效与优点。方法采用美国巴德平片修补58例腹股沟疝并对其临床效果进行回顾性分析。结果手术时间30～90min，平均50min，术后无切口感染、硬结、阴囊血肿等并发症，术后短暂尿潴留5例。住院费用2200-4500，平均2950元。术后随访1～5年，无复发。结论单用平片修补腹股沟疝是一种安全、简单、痛苦小、恢复快、费用低的疝修补方法。     

Asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal inguinal hernia repair: A rare case report

This report aims to discuss a case of asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair and to reveal that the risk of mesh infection may occur after a long period of this surgery. This report is also intended to suggest surgeons pay more attention to the follow‐up of such patients and to be aware of the possibility of mesh infection to assist in early diagnosis and treatment. A 63‐year‐old male patient, who underwent TEP inguinal hernia repair 6 years ago for right inguinal hernia, fell down accidentally 2 weeks ago. Enhanced computed tomography(CT) showed right lower abdomen cystic lesions, so he underwent laparoscopic surgery during which abscess caused by delayed mesh infection was found. After removing the mesh and abscess, he was discharged. The risk of mesh infection after TEP inguinal hernia repair is low, but it can last for more than 6 years and can even be asymptomatic as long as the mesh remains in the body.     

Lichtenstein平片无张力疝修补手术228例临床体会

目的：总结Lichtenstein平片无张力疝修补手术治疗成人腹股沟疝的经验。方法：应用聚丙烯网片对228例成人腹股沟疝行Lichtenstein平片无张力疝修补手术。结果：手术平均时间52.5 min,术后住院平均时间5.3 d,全组患者伤口一期愈合,随访期间无复发。结论：Lichtenstein平片无张力疝修补手术治疗成人腹股沟疝安全有效,具有复发率低、并发症少和恢复快等优点。     

Reoperation with laparoscopic mesh repair for recurrent lumbar hernia due to iliac crest bone harvest

Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again.     

Case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent girl with inguinal hernia in which open repair was effective

Chronic pain after laparoscopic percutaneous extraperitoneal closure is very rare. Here, we report a case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent patient with inguinal hernia who underwent open repair. A 15‐year‐old girl was diagnosed with a left indirect inguinal hernia, and laparoscopic percutaneous extraperitoneal closure was performed. However, 6 months later, after strenuous exercise, she developed localized pain around the hernia site. Her pain was well controlled by internal treatment but failed to completely resolve. The pain type was somatic, Tinel's sign was negative, and there was no recurrence of the inguinal hernia. Because she strongly wished to undergo surgery, the Potts procedure with removal of the ligature and excision of the round ligament was performed. Her pain improved after surgery, and further medical treatment was not required. The Potts procedure may be an effective treatment for chronic pain such as in this case.     

Lichtenstein无张力疝修补术的临床应用

目的探讨用聚丙烯网片,采用Lichtenstein术式在成年人腹股沟无张力疝修补术中的优点、并总结经验教训。方法采用德国蛇牌集团公司的聚丙烯网片对312例腹股沟疝病人施行Lichtenstein无张力疝修补术,观察手术时间,伤口疼痛,术后自主能力恢复,并发症及复发率。结果手术时间平均为50min;术后3—4h病人能下床活动;伤口疼痛时间2～3d。术后切口血肿3例,无一例切13＇感染。腹股沟异物感10例。术后随访238例6个月至4年。无一例复发。结论Lichtenstein无张力疝修补术操作简单,术后恢复迅速,并发症极少,复发率低,疗效肯定,手术指征可适当放宽,是近年较先进的一种无张力疝修补术式。     

疝环充填式无张力疝修补术治疗腹股沟疝569例

目的：总结疝环充填式无张力疝修补术治疗腹股沟疝的临床疗效。方法：对我院1999年4月至2008年8月采用疝环充填式无张力疝修补术治疗569例腹股沟疝患者的临床资料进行回顾性分析,对手术时间、伤口疼痛、术后自主能力的恢复、住院时间、并发症及复发率等进行观察。结果：与传统疝修补手术相比,具有方法简便,术后疼痛轻,恢复快,住院时间短,并发症少,复发率低和更宽的手术指征等优点。结论：疝环充填式无张力疝修补术是一种治疗腹股沟疝的理想手术方法。     

Abdominal wall hernia mesh repair: sonography of mesh and common complications.

OBJECTIVE: The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS: We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS: A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS: Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.     

双层普理灵网片修补腹股沟疝41例

【目的】探讨双层普理灵（prolene mesh）网片在腹股沟疝无张力修补术中的·临床应用价值。【方法】对2004年1月至2009年1月41例行双层普理灵网片修补的腹股沟疝病例的手术时间，术后并发症，住院时间，手术时间，复发情况进行回顾性分析。【结果】41例中，原发性腹股沟疝34例（82．9％）；复发性腹股沟疝7例（17．1％）；其中巨大疝环12例（29．3％）；并发症发生率为12．2％（5／41）；平均手术时间60min；平均住院日5d；随访3个月至5年，无术后复发。【结论】应用双层普理灵网片进行腹股沟疝无张力修补术，符合腹股沟疝的解剖特点和“个体化”要求，尤其适合于巨大疝环者或复发性疝，且操作简便、安全和经济，易于推广应用。     

两种无张力腹股沟疝修补术的比较分析

目的研究平片无张力疝修补术、疝环充填式疝修补术对成人腹股沟疝的手术效果。方法随机将1999年3月至2003年12月的358例腹股沟疝病人，分为平片式组和疝环充填式组，分析比较两组的临床资料。结果两者在术后复发，住院天数上差异无显著，但在术后切口异物感和治疗费用上差异有显著性。结论两种术式均有较好的治疗效果。但平片式无张力疝修补术在降低患者治疗费用，减轻切口异物感上更有优势。     

疝环充填式无张力疝修补手术切口疼痛的原因分析及防治

目的探讨疝环充填式无张力疝修补手术切口疼痛的原因及防治方法。方法回顾分析了2010年10月~2011年12月本院68例行疝环充填式无张力修补腹股沟疝患者,采用材料为美国Bard公司锥形充填物和成型补片。结果 68例患者近期内均无复发,无切口感染,无皮下血肿。术后切口慢性疼痛和切口异物感各2例。结论疝环充填式无张力疝修补术具有损伤小、复发率低、术后恢复快等特点,但仍然存在着一定的切口并发症。     

脱细胞真皮基质修补腹股沟疝

背景：当前应用聚丙烯补片行腹股沟疝无张力修补已成为腹股沟疝修补的标准手段,但这些材料可能对患者生殖功能产生影响。目的：总结应用脱细胞真皮基质修补腹股沟疝的经验。方法：回顾性分析19例应用异体脱细胞真皮基质修补腹股沟疝患者的临床资料,男15例,女4例,年龄5~38岁。术后观察切口愈合情况,并定期随访。结果与结论：19例患者伤口均Ⅰ期愈合,无切口感染、皮下积液等并发症。18例患者获得随访,随访3~30个月,无局部疼痛、牵拉等不适感,无复发病例。提示脱细胞真皮基质材料为未成年人、尚未婚育及有生育要求的男性腹股沟疝患者的治疗提供一种新的选择。     

Primary inguinal hernia: The open repair today pros and cons

Open anterior repair for inguinal hernia offers several distinct advantages over endoscopic repair, especially when real‐world effectiveness is taken into account. The learning curve for endoscopic techniques is long, whereas the Lichtenstein and other open tension‐free techniques are easier to teach and replicate at all levels. The outcomes of Lichtenstein repairs for primary inguinal hernia as performed by non‐experts and supervised residents are comparable to those of experts. Moreover, open tension‐free repair does not require expensive instruments or dedicated equipment, other than the prosthetic mesh. As such, it is feasible in any operating room anywhere in the world with limited costs. In our opinion, the most important advantage offered by open tension‐free repair is that it can be performed under local anesthesia. Nevertheless, local anesthesia has some disadvantages: it requires training, excellent knowledge of the anatomy and the necessary technique, patience, and gentle handling of the tissues. Open inguinal hernia repair is a procedure that every surgeon should know and be able to perform because it is necessary to treat two conditions, groin hernia recurrence after a posterior approach (both laparoscopic and open) and pubic inguinal pain syndrome.     

Two cases of early recurrence after transabdominal preperitoneal inguinal hernia repair

We performed transabdominal preperitoneal inguinal hernia repair in 46 patients (58 diseases), two of whom experienced early recurrence after mesh repair. Case 1 was a 76‐year‐old man with a bilateral inguinal hernia (recurrence site, left indirect hernia) after appendectomy. The recurrence occurred 1 month after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using the direct Kugel ® patch with an anterior technique. Case 2 was a 79‐year‐old man with a bilateral inguinal hernia (recurrence site, right direct hernia with an orifice >3 cm) after appendectomy. The recurrence occurred 3 months after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using an ULTRAPRO ® Plug with an anterior technique under laparoscopic observation. We believe the recurrences resulted from insufficient internal exfoliation and fixation affected by complicated exfoliation of the preperitoneal space with omental adhesion after intraperitoneal surgery.     

腹腔镜腹股沟疝修补术与应用UHS无张力疝修补术的对比研究

目的研究比较腹腔镜腹股沟疝修补术与应用轻量型超普疝装置(UHS)补片无张力疝修补术的临床效果。方法回顾性分析2009年3月至2011年1月年腹腔镜腹股沟疝修补术87例,应用轻量型UHS补片无张力疝修补术53例的临床资料,分析比较手术时间、住院天数、并发症发生率、恢复正常生活和工作时间、术后短期复发率等指标。结果手术时间、术后住院天数、并发症发生率、恢复正常生活和工作时间、术后短期复发率等指标两组相比差异无统计学意义。结论腹腔镜腹股沟疝修补术与应用UHS补片无张力疝修补术两种无张力修补方法治疗腹股沟疝均可取得满意疗效。     

贝朗自主成型补片腹膜前修补治疗股疝

目的:探讨贝朗自主成型补片腹膜前修补治疗股疝的可行性。方法:2008年—2011年应用贝朗自主成型补片对12例股疝行腹膜前修补。方法:术中切开腹横筋膜、回纳疝囊后,继续分离腹膜外间隙,将圆形网状多层补片以股环为中心展开平铺,缝合腹横筋膜以及其余各层腹壁。观察手术时间、术中出血量以及术后局部感觉异常、慢性疼痛的发生率和股疝复发率。结果:手术操作顺利,患者手术时间45～65 min,平均50 min;术中患者出血0～10 mL,术后无特殊不适,无复发。结论:贝朗自主成型补片腹膜前修补治疗股疝操作简便,效果可靠。