Endoscopic totally extraperitoneal inguinal hernioplasty for recurrence after open repair

BACKGROUND: Whether endoscopic totally extraperitoneal inguinal hernioplasty (TEP) for recurrent inguinal hernia is as safe and efficacious as that for primary inguinal hernia has rarely been examined. The objective of the present study was to compare the early and late outcomes of TEP for primary and recurrent inguinal hernia. The clinical pattern of recurrence after previous open repair of inguinal hernia was also examined. METHODS: Between August 1999 and November 2003, 100 consecutive patients who underwent TEP for recurrent inguinal hernia were recruited. The outcomes of these patients were compared to a randomly selected control group (n = 100) who had TEP for primary inguinal hernia during the same period. All data had been prospectively collected and analysed. RESULTS: Demographic features were comparable between the two groups. The recurrent group had a significantly higher incidence of direct inguinal hernia than the control group (P < 0.001). Comparison of operative duration, postoperative morbidity, pain score, length of hospital stay and time taken to resume normal activities showed no significant differences between the two groups. However, the incidence of peritoneal tear in the recurrent group (46%) was significantly higher than that of the control group (28%) (P < 0.05). With a mean follow-up of 1 year, the incidences of recurrence and chronic groin pain were similar for both groups. CONCLUSION: Early and late outcomes of TEP for recurrent inguinal hernia were equivalent to those for primary inguinal hernia but a higher incidence of peritoneal tear was encountered during TEP for recurrent inguinal hernia. A predominance of direct hernia was observed in the recurrent group.     

Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty

Background: Chronic groin pain after open inguinal hernia repair is a common long-term morbidity, but its incidence after endoscopic totally extraperitoneal inguinal hernioplasty (TEP) has not been studied in detail. The objective of this study was to evaluate the prevalence and severity of chronic groin pain after TEP. Methods: Between June 1999 and September 2001, 313 consecutive patients who underwent TEP at our institution were recruited. To evaluate the incidence and severity of chronic pain, a cross-sectional telephone survey using a standardized questionnaire was conducted by a research assistant. Clinical data between the chronic pain group and the pain-free group were compared to identify any clinical factors that had a significant association with the subsequent development of chronic groin pain. Results: The prevalence of chronic groin pain was 9.2% (n = 24). The severity of the pain was mild (n = 18), moderate (n = 5), or severe (n = 1). In more than half of the patients, the groin pain occurred less often than once a month and its duration did not exceed 1 min. Only one patient reported an impairment of functional activities as a result of the pain. Multivariate analyses identified a significant association between a high postoperative pain score on coughing on postoperative day 6 and the subsequent development of groin pain. Conclusions: The prevalence of chronic groin pain in patients after TEP was low. The pain was mostly mild and transient without associated sensory symptoms. The occurrence of pain had a negligible impact on daily activities.     

Recurrence following endoscopic extraperitoneal inguinal hernioplasty

Recurrence rate is the utmost outcome parameter in determining the clinical effectiveness of any hernia surgery. Between June 1999 and September 2004, six patients presented with recurrent hernia after endoscopic totally extraperitoneal inguinal hernioplasty (TEP). Four of the six recurrences (67%) occurred within a few months after TEP, indicating a technical failure. Of the 1,093 TEPs performed by the author, a total of three patients developed recurrence, giving an overall recurrence rate of 0.27%. All six patients underwent open Lichtenstein hernioplasty. Intraoperative findings showed recurrent indirect inguinal hernia in all patients. Half of the recurrence (n=3) was due to a sliding lipoma without a peritoneal hernial sac. Untreated herniated retroperitoneal adipose tissue into the internal inguinal ring during initial TEP constitutes the leading cause of recurrence after TEP. Routine exploration of internal ring for any herniated retroperitoneal adipose tissue during TEP is recommended. Herniated retroperitoneal adipose tissue should be resected whenever feasible.     

Pain, analgesic consumption and daily life activities recovery in patients undergoing ambulatory totally extra-peritoneal laparoscopic inguinal hernioplasty versus ambulatory Lichtenstein hernioplasty

Introduction

Although the unique comparison standard of primary inguinal hernia repair is the Lichtenstein technique (LICH), totally extra-peritoneal (TEP) laparoscopic inguinal hernioplasty shows, although not systematically demonstrated, clear advantages as regards, perceived pain, analgesic use, and recovery of daily life activities.

Objective

To demonstrate the differences in perceived pain, analgesic use, and recovery of daily life activities between Lichtenstein hernioplasty and TEP laparoscopy.

Material and methods

A prospective, non-randomised observational study was conducted on 169 consecutive patients subjected to LICH vs TEP. The LICH was performed using local anaesthesia and sedation, and the TEP with general anaesthesia, both being performed as ambulatory surgery. The points of analysis included: analgesic use, level of perceived pain, and recovery of daily life activities.

Results

Analgesic use was less in the TEP group for post-operative day 4 and 5, similar to the perceived pain. As regards recovery of daily life activities, the significantly minimum differences were achieved on post-operative day 7 in favour of TEP.

Conclusions

Our study shows a significant difference as regards perceived pain and analgesic use, as well as in the level of recovery of daily life activities, when comparing both groups. TEP hernioplasty should also be considered in the non-complicated primary unilateral inguinal hernia.     

Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial

OBJECTIVE: We conducted a double-blinded randomized controlled trial to investigate the short- to mid-term neurosensory effect of prophylactic ilioinguinal neurectomy during Lichtenstein repair of inguinal hernia. METHOD: One hundred male patients between the age of 18 and 80 years with unilateral inguinal hernia undergoing Lichtenstein hernia repair were randomized to receive either prophylactic ilioinguinal neurectomy (group A) or ilioinguinal nerve preservation (group B) during operation. All operations were performed by surgeons specialized in hernia repair under local anesthesia or general anesthesia. The primary outcome was the incidence of chronic groin pain at 6 months. Secondary outcomes included incidence of groin numbness, postoperative sensory loss or change at the groin region, and quality of life measurement assessed by SF-36 questionnaire at 6 months. All follow-up and outcome measures were carried out by a designated occupational therapist at 1 and 6 months following surgery in a double-blinded manner. RESULTS: The incidence of chronic groin pain at 6 months was significantly lower in group A than group B (8% vs. 28.6%; P = 0.008). No significant intergroup differences were found regarding the incidence of groin numbness, postoperative sensory loss or changes at the groin region, and quality of life measurement at 6 months after the operation. CONCLUSIONS: Prophylactic ilioinguinal neurectomy significantly decreases the incidence of chronic groin pain after Lichtenstein hernia repair without added morbidities. It should be considered as a routine surgical step during the operation.     

A prospective trial of primary inguinal hernia repair by surgical trainees

The main hypotheses were that the Lichtenstein inguinal hernia repair has a lower recurrence rate and similar incidence of chronic groin pain compared to sutured repairs when performed by surgical trainees. In a U.S. Veterans Administration Hospital, 150 primary hernia repairs were randomized to a Lichtenstein, McVay, or Shouldice repair. The Shouldice repair included a routine relaxing incision. First- and second-year residents, under the supervision of an experienced general surgeon, performed the procedure. Long-term follow-up was obtained in 81% of patients. Hernia recurrence rate was Lichtenstein 8%, McVay 10%, Shouldice 5% (P>0.1) at 6–9 years follow-up. More patients had chronic groin pain following Lichtenstein repair (38%) than after Shouldice repair (7%) (P<0.05). More information is needed on long-term groin pain following anterior mesh repair. The Shouldice inguinal hernia repair may have a role in open primary herniorrhaphy to decrease the risk of chronic groin pain.     

Patients' perception of open and endoscopic extraperitoneal inguinal hernioplasty

Most hernia studies have focused on the assessment of clinical outcomes. Few have examined patients' perception of the operative procedures. The present study was undertaken to evaluate the patients' preferred method of repair in those who had personal experience of both endoscopic totally extraperitoneal inguinal hernioplasty (TEP) and open inguinal hernia repair. Qualitative analysis of their choice of method was also examined. Between June 1999 and February 2003, a prospective survey was conducted on 590 patients who underwent TEP at our institution. Previous experience of open inguinal hernia repair was a prerequisite for entry into the study. Patients were interviewed during the first postoperative follow-up to document their preference of TEP or open repair in the event of future recurrence or development of a contralateral inguinal hernia. A total of 121 patients were recruited into the study. Of these, 102 (84.3%) and 11 (9.1%) patients opted for future TEP and open repair respectively. Documented reasons supporting their choice of TEP included less postoperative pain (n = 69), faster recovery (n = 25), shorter incisions (n = 8), early ambulation (n = 5), and others (n = 11). Eight (6.6%) patients had no particular preference. More than 80% of patients, who had experience of TEP and open repair, preferred to undergo TEP. Patients presenting with primary inguinal hernia should be given the options of TEP and open mesh hernioplasty with detailed explanation of advantages and drawbacks of each procedure. Individual preference for the type of surgery should be considered in the management plan of each patient.     

Long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia

Purpose

To evaluate the long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia.

Methods

The subjects of this prospective, observational study were 24 patients who underwent emergency Lichtenstein hernioplasty for an incarcerated inguinal hernia between September 2002 and January 2006 at the Faculty of Medicine Siriraj Hospital, Thailand. Patients with bowel strangulation and recurrent hernia were excluded. We evaluated the long-term outcomes over at least a 2-year follow-up.

Results

Long-term follow-up was completed for 20 patients (83.3 %). All of the patients were men, with a median age of 60 years (range 19–78 years) at the time of surgery. The median time to resumption of normal daily activities was 3 weeks (range 1–8 weeks). None of the patients had inguinal paresthesia persisting beyond 1 month after the operation. One patient (5 %) experienced chronic groin pain, which subsided within 4 months after surgery. Clinical recurrence was detected in two patients (10 %) during a median follow-up period of 6 years (range 2.3–7.6 years). Contralateral inguinal hernia was found in two patients (10 %) during follow-up.

Conclusions

Lichtenstein hernioplasty is a safe and effective operation for non-strangulated incarcerated inguinal hernia, with a recurrence rate of 10 % at the median follow-up time of 6 years. Chronic groin pain and inguinal paresthesia were rare in this series.     

腹腔镜完全腹膜外疝修补术与李金斯坦术式治疗复发腹股沟疝患者的疗效

目的分析腹腔镜完全腹膜外疝修补术（TEP）和李金斯坦术式对治疗复发腹股沟疝患者疗效的影响。 方法回顾性分析2012年5月至2017年5月,首都医科大学附属北京世纪坛医院接受治疗的复发腹股沟疝92例患者的临床资料,按照术式不同分为2组。试验组患者42例,行TEP术式;对照组患者50例,行李金斯坦术式。观察2组患者术中、术后并发症状况,ELISA法检测患者治疗前后血清Ⅰ型前胶原羧基端肽（PⅠCP）、基质金属蛋白酶抑制因子-1（TIMP-1）、基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶抑制因子-2（TIMP-2）及Ⅲ型前胶原羧基端肽（PⅢNP）含量。 结果试验组患者术中出血量低于对照组,差异有统计学意义（P<0.05）;2组手术、住院及术后下床活动时间比较,差异无统计学意义（P>0.05）;治疗后试验组患者血清PⅠCP、TIMP-1、TIMP-2含量及PⅠCP/PⅢNP比值比治疗前、对照组均上升,MMP-2含量比治疗前、对照组下降,差异均有统计学意义（P<0.05）;试验组术后并发症发生率为9.52%,对照组为36.00%,差异有统计学意义（P<0.05）。 结论复发腹股沟疝患者行TEP较李金斯坦术式术中出血量少,术后并发症少,且可改善患者血清胶原、基质金属抑制酶与蛋白酶含量。     

Beneficial effect of inguinal hernioplasty on testicular perfusion and sexual function

Aim  To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life, testicular volume, and perfusion. Patients and methods  In a prospective study, testicular volume, testicular perfusion, sexual function, generic quality of life, chronic inguinal pain, and groin sepsis were investigated before and 3 and 9 months after surgical hernia repair. Results  Forty male patients completed this study. No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body (P > 0.05). Preoperatively, there was a significantly higher end diastolic velocity (P < 0.04) and resistive index (P < 0.001) on the hernia side compared with the normal side; these elevations returned to normal postoperatively. Three months postoperative, the studied sexual function domains, except orgasm domain, and total sexual score presented significant improvement (P _s < 0.05 and 0.001 respectively). By the end of the study, the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress. The total generic quality-of-life score, general health perception and physical function, vitality, and social domains were statistically recovered at 3 months postoperative (P < 0.05), with further improvement in total score at 9 months. Two patients developed superficial groin sepsis, and seven (17.5%) experienced chronic inguinal pain. Conclusion  Inguinal hernia impaired testicular perfusion that improved postoperatively. Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion.     

应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术28例

目的总结应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术（TEP）治疗腹股沟疝28例的经验技巧体会。方法回顾分析2006年8月至2007年2月共28例腹股沟疝患者的临床资料，患者全部在全麻下行TEP手术，术中应用巴德3DMax补片，且不作钉合固定。结果28例患者共进行32侧TEP手术，手术时间25～90min，平均手术时间单侧40min，双侧75min。术后无需使用镇痛剂，术后住院时间1～4d，平均2．5d。术后并发阴囊血清肿1例，无术后腹股沟区疼痛及异物不适感病例。随访9～13个月，无术后复发。结论应用巴德3DMax补片并行无钉合TEP手术安全可靠，操作简单方便，可使手术时间缩短，减少手术并发症，并有术后疼痛轻，恢复快，复发率低的优点。     

三种疝修补术治疗单侧原发性腹股沟疝的前瞻性随机对照研究

目的 比较开腹无张力填充式腹股沟疝修补术与两种腹腔镜腹股沟疝修补术的疗效.方法 将患有单侧原发性腹股沟疝的患者术前随机分成3组:开腹无张力填充式腹股沟疝修补术(开腹疝修补术)组或腹腔镜经腹腔腹膜前腹股沟疝修补术(transabdominal preperitoneal hernioplasty,TAPP)组或腹腔镜完全腹膜外腹股沟疝修补术(totally extraperitoneal hernioplasty,TEP)组,将临床资料进行对比研究.结果 2006年2月至2009年2月收住院的164例患者参加本研究,其中62例行开腹疝修补术、50例行TAPP、52例行TEP.平均随访(16±8)个月.开腹疝修补术组的平均手术时间明显短于两种腹腔镜手术组(P＜0.01);住院费用也明显低于腹腔镜组(P＜0.01).而开腹疝修补术组的术后疼痛评分明显高于两种腹腔镜手术组(P＜0.01);术后住院时间及完全恢复时间也明显长于腹腔镜组(P＜0.01).3组均无手术严重并发症及术后复发.结论本研究证明三种疝修补术治疗单侧原发性腹股沟疝是安全有效的.TAPP和TEP,术后疼痛轻、恢复快,是值得推荐的外科术式.     

The effects of different hernia repair methods on postoperative pain medication and CRP levels

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.     

Is endoscopic totally extraperitoneal hernioplasty justified for the repair of groin hernia in female patients?

Background Groin hernia is an uncommon surgical pathology in females. The efficacy of the endoscopic approach for the repair of female groin hernia has yet to be examined. The current study was undertaken to compare the clinical outcomes of female patients who underwent open and endoscopic totally extraperitoneal inguinal or femoral hernioplasty (TEP). Methods From July 1998 to June 2004, 108 female patients who underwent elective repair of groin hernia were recruited. The patients were divided into TEP (n = 30) and open groups (n = 78) based on the type of operation. Clinical data and outcome parameters were compared between the two groups. Results The mean ages and hernia types were comparable between the two groups. All TEPs were successfully performed. The mean operative times were 52 min for unilateral TEP and 51 min for open repair. The difference was not statistically significant. Comparisons of the length of hospital stay, postoperative morbidity, pain score, and time taken to resume normal activities showed no significant differences between the two groups. A single patient in the TEP group experienced recurrence of hernia. Conclusions The findings show equivalent postoperative outcomes after TEP and open repair of groin hernia in female patients. Because the wound scar after open repair is well concealed beneath the pubic hair and no superior clinical benefits are observed after TEP, open repair appears to be the technique of choice for the management of primary groin hernia in females. The TEP approach should be reserved for female patients with recurrent or multiple groin hernia. The abstract was presented at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2005, 13–16 April 2005 at Fort Lauderdale, Florida     

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.     

Chronic groin sepsis following tension-free inguinal hernioplasty

BACKGROUND: Chronic groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. The aim of this study was to determine the number of surgeons performing tension-free inguinal hernioplasty in the West of Scotland and assess the frequency with which chronic groin sepsis was encountered. METHODS: A questionnaire was sent to all consultant surgeons performing inguinal hernia repair in the region and follow-up of patients with chronic groin sepsis following tension-free inguinal hernioplasty was undertaken. RESULTS: Of 80 consultants who replied to the questionnaire, 79 were performing tension-free hernioplasty. Of these, 76 were performing only open repairs while three were also undertaking laparoscopic repairs. Sixteen consultants reported 20 patients with groin sepsis after mesh repair. Twelve patients were traced; eight had chronic sinuses and four had groin abscesses. The median interval between repair and presentation was 4 months (range from 2 weeks to 39 months). All have required complete (11 patients) or partial (one) removal of mesh to resolve the symptoms. CONCLUSION: Tension-free inguinal hernioplasty has become the operation of choice for surgeons in the region. Chronic groin sepsis may be more frequent than reported previously. Complete removal of mesh is required to treat this condition.     

Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair

BACKGROUND: Laparoscopic herniorrhaphy has emerged as a recognized operative method for inguinal hernia repair. This study compared the short-term results of two tension-free methods of repair: totally extraperitoneal (TEP) laparoscopic patch repair and the open Lichtenstein mesh technique. METHODS: A total of 1513 men from 11 hospitals who presented with a primary unilateral inguinal hernia were randomized to one of the two methods. Operating time, short-term complications, reoperations, postoperative pain, consumption of analgesics, sick leave and time to resumption of normal physical activities were recorded. RESULTS: Some 1371 of the 1513 men underwent surgery, 665 in the TEP group and 706 in the Lichtenstein group. The median duration of operation was 55 min for both procedures and 91.0 percent of the patients in both groups were discharged on the day of operation. Patients in the TEP group experienced less postoperative pain (P<0.001), consumed fewer analgesics (P<0.001), had a shorter period of sick leave (7 versus 12 days; P<0.001) and a shorter time to resumption of normal physical activity (20 versus 31 days; P<0.001). CONCLUSION: The TEP technique took no longer to perform, and was associated with less postoperative pain, a shorter period of sick leave and a faster recovery, compared with open Lichtenstein hernia repair.     

Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors

Background: Pain is the most common complaint after inguinal hernia surgery. The present study was undertaken to evaluate the significance of various perioperative clinical factors on the severity of postoperative pain following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty.Methods: Between November 1999 and December 2002, 509 patients who underwent unilateral (n = 389) and bilateral (n = 120) TEP were recruited for this study. There were 491 men and 18 women. Severity of postoperative pain at rest and on coughing was assessed by a linear analogue pain score (scale, 0–10) on a daily basis after operation. Univariate and multivariate analyses were performed to identify the significant independent factors affecting pain. Results: By univariate analysis, pain scores at rest were significantly higher in young (65 years) female patients, as well as patients who underwent unilateral and day case TEP. Clinical factors associated with a significantly higher pain score on coughing included mesh fixation by stapling, female sex, and age (65 years). Other factors, including unilateral vs bilateral TEP, seroma formation, direct vs indirect hernia, primary vs recurrent hernia, and operative time, had no impact on postoperative pain. On multiple regression analysis, age and sex were found to be independent predictive factors for mean daily pain score at rest. Independent factors influencing mean pain score on coughing included age, sex, and prosthetic stapling. Conclusions: Patient age and sex are the most significant factors determining the degree of pain after TEP. Analgesic therapy should therefore be adjusted in accordance with the age of the patient. With regard to operative factors, avoidance of prosthetic stapling might help to reduce the severity of pain on coughing.     

Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair: A meta-analysis of outcomes of our current knowledge

BackgroundThe aim of this article is to explore the clinical effects between open extraperitoneal approaches and totally extraperitoneal laparoscopic hernioplasty (TEP) in the repair of inguinal hernias.MethodsThe electronic databases Pubmed, Medline, Embase, Web of science and the Cochrane Library were used to search for articles from January 1992 to March 2013. The present meta-analysis pooled the effects of outcomes of a total of 1157 patients with 1377 hernias enrolled into 10 randomized controlled trials and 2 comparative studies. The data was analyzed using the statistic software Stata12.0 and IBM SPSS Statistics 19.ResultsSignificant advantages of totally extraperitoneal laparoscopic hernioplasty (TEP) compared to the open extraperitoneal approach include a lower incidence of total postoperative complications (Odds Ratio, 0.544; 95% confidence interval, 0.369–0.803), a reduction in urinary problems (0.206[0.064,0.665]), an earlier return to normal activities or work (SMD = ?1.798[?3.322,?0.275]), and a shorter length of hospital stay (?1.995 [?2.358,?1.632]). No difference was found in operative time, the incidence of hernia recurrence, chronic pain, intraoperative complications, seromas or hematomas, wound infection and testicular problems between the two techniques. One significant advantage for the open extraperitoneal inguinal hernia repair was a lower incidence of peritoneal tears (46.504 [15.399,140.437]).ConclusionsTotally extraperitoneal laparoscopic hernioplasty (TEP) and open extraperitoneal mesh repair are equivalent in most of the analyzed outcomes. TEP is associated with shorter hospital stay, quicker return to normal activities or work, lower incidence of total postoperative complications and urinary problems, while the open extraperitoneal method has less incidence of peritoneal tears.     

Chronic groin pain following lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?

Background  

The Lichtenstein mesh hernioplasty is currently the most popular operative technique for open repair of inguinal hernia. The incidence of chronic groin pain (CGP) following this procedure is reported to be high. However, since our experience did not support this observation, this study was undertaken at our centre, to assess the incidence of CGP following Lichtenstein mesh hernioplasty.