Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial

BACKGROUND: The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. METHODS: Patients with primary unilateral inguinal hernias were randomized to Shouldice repair, Bassini operation, tension-free hernioplasty (Lichtenstein repair), laparoscopic transabdominal extraperitoneal hernioplasty (TEP), or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). The primary outcome parameter was the rate of recurrence at 3 years. The secondary outcome was the rate of intraoperative, perioperative, and long-term complications. Follow-up comprised of clinical examination after 1, 2, and 3 years. RESULTS: Three hundred and sixty-five patients were randomly assigned to one of the five procedures. The intention-to-treat analysis showed that the cumulative 3-year recurrence rate was 3.4% in the Bassini group, 4.7% in the Shouldice group, 0% in the Lichtenstein group, 4.7% in the TAPP group, and 5.9% in the TEP group (p = 0.48). Comparing open (Bassini, Shouldice, Lichtenstein) versus laparoscopic (TAPP, TEP) techniques (p = 0.29) and comparing the use of mesh prostheses (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) (p = 0.74) showed no significance in the rate of recurrence. The rates of intraoperative (p = 0.15), perioperative (p = 0.09), and long-term complications (p = 0.13) were without significance between the five groups. Comparing mesh techniques (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) showed no significance in the rate of complications. The per-protocol analysis for the comparison of mesh (Lichtenstein, TAPP, TEP) versus suturing (Bassini, Shouldice) techniques revealed that recurrences (p = 0.74), intraoperative (p = 0.64), perioperative (p = 0.27), and long-term complications (p = 0.91) were evenly distributed. CONCLUSIONS: In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.     

Postoperative convalescence after inguinal hernia surgery: Prospective randomized multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1042 patients

Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal preperitoneal patch technique (TAPP; n=518) and the Shouldice technique (n=524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of analgesics, functional status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare. The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional status, and shorter sick leave, but at the price of a longer operating time. Electronic Publication     

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.     

Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group

Background In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse. Methods One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation. Results Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found. Conclusion There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.     

Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair

Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection. The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration, mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications. Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after prior open hernia repair.     

Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol

Background  In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal hernia repair. Methods  A total of 160 patients were assigned in a randomized manner into two groups. Group L received 8 mg lornoxicam i.v. at the end of the operation, followed by 8 mg 12 h after the operation. Group T received 1 mg/kg tramadol at the end of the operation and every 6 h up to 24 h postoperatively. The visual analog scale (VAS) score was assessed at 0, 2, 4, 8, 12, and 24 h after surgery. Results  All patients completed the study. All vital signs were within normal ranges. The mean VAS score in Group L and in Group T was 21.66 ± 14.64 and 19.75 ± 11.82, respectively. No significant differences were found between groups with respect to VAS score. Eight (10%) patients in Group T had nausea. Conclusion  Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia repair provided rapid and effective analgesia and was well tolerated.     

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.     

A prospective cost and outcome comparison of inguinal hernia repairs

We previously showed that patients undergoing transabdominal preperitoneal laparoscopic inguinal herniorrhaphy (TAPP) returned to activity twice as fast as open herniorrhaphy without mesh but that TAPP was twice as expensive. However, it was not clear if the immediate postoperative benefits offered by TAPP resulted from smaller incisions and less tissue dissection or from the requisite tension-free placement of mesh. We have therefore completed a prospective outcome and cost analysis comparing TAPP (n=59) to open preperitoneal mesh herniorrhaphy (PPO) (n=40) to determine the differences between the two different surgical techniques. When comparing unilateral repairs, there was no difference in hernia type. PPO patients were older (P<0.05) and their operations were shorter (P<0.01). Comparison of outcome parameters of pill days, out-of-house activity, and intial day to full activity revealed no difference. Cost analysis showed that total costs, disposable equipment costs, and operating room time costs were significantly less for PPO (P<0.01). There were two major complications (3%) and twelve minor complications (20%) in the TAPP group while PPO exhibited no major and five minor complications (12%). Follow-up data revealed one recurrence in the TAPP group. There were no recurrences in the PPO group at only 7 months average follow-up. We conclude that since both procedures had similar outcomes in the immediate postoperative period, the increased cost of TAPP and increased potential for both major and minor complications make it difficult to justify its routine use.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

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.     

Pain, quality of life and recovery after laparoscopic ventral hernia repair

Background  Laparoscopic ventral hernia repair (LVHR) is a well established procedure in the treatment of ventral hernias. It is our clinical experience that patients suffer intense postoperative pain, but this issue and other recovery parameters have not been studied in detail. Methods  Thirty-five patients with hernias >3 cm prospectively underwent LVHR using “double-crown” titanium tack mesh fixation. Pre- and postoperative pain was measured on a 0–100-mm visual analogue scale (VAS) and health-related quality of life was measured using the Short Form 36 questionnaire (SF-36). Several other recovery parameters were measured systematically in the 6 months follow-up period. Results  We observed no recurrences or severe complications in the follow-up period (n = 31 at day 30 and n = 28 after 6 months). The median in-hospital stay was 2 days (range 0–5). Patients reported significantly more pain during activity than at rest at all times (p < 0.05). The median VAS-pain score during activity vs. at rest at discharge was 60 and 31, respectively. The median VAS-pain score during activity on the day of operation (day 0) was 78; it returned to baseline values at day 30 (p = 0.148) and, after 6 months, it was below the preoperative score (p = 0.01). The scores for general well-being and fatigue returned to baseline values at days 3 and 30, respectively, and at 6 months, they had both significantly improved compared with preoperative values (p = 0.005). The SF-36 scores were significantly worse in three domains at day 30 (p < 0.005). After 6 months, the bodily pain score had increased significantly compared with preoperative values (p < 0.005) and all eight scales were comparable to the Danish reference population scores. Patients resumed normal daily activities after a median of 14 days (range 1–38). Smokers and patients with hard physical demands at work took a significantly longer amount of time to resume work compared with non-smokers (30 vs. 9 days, p < 0.005) and patients with light work demands (29 vs. 9 days, p < 0.05), respectively. VAS-pain scores were strongly correlated to general well-being (r = −0.8, p < 0.001), patient satisfaction (r = −0.67, p < 0.001) and quality of life (r = −0.63, p < 0.001). We found no significant correlation between the number of tacks used (median 59) and postoperative pain. Conclusion  LVHR was associated with considerable postoperative pain and fatigue in the first postoperative month, prolonging the time of convalescence and significantly affecting patients’ quality of life up to 6 months postoperatively. Mesh fixation with fibrin glue or other non-invasive/degradable products seems promising for reducing pain and it should be investigated in future randomised trials.     

腹腔镜疝修补术与开放疝修补术对高原地区患者术后疼痛及创伤应激影响的对比研究

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）与开放疝修补术（PLUG）对高原地区腹股沟疝患者术后疼痛及创伤应激的影响。 方法选取2017年1月至2018年5月在我院接受治疗的腹股沟疝患者96例,根据治疗方法不同分为研究组及对照组,各48例,分别行TAPP及开放无张力腹股沟疝修补术。比较2组手术指标、术后疼痛及创伤应激指标水平;记录术后并发症情况。 结果研究组患者手术时间较对照组延长,而术中失血量、术后排气时间以及术后住院时间显著少于或短于对照组（均P<0.05）;术后12、24 h以及3 d时比较,研究组VAS评分均显著低于对照组（均P<0.05）;术后3 d,2组患者血清C反应蛋白（CRP）、皮质醇和白细胞介素-6（IL-6）水平均较术前显著升高（P<0.05）;组间比较,研究组均显著低于对照组（均P<0.05）;研究组和对照组患者的并发症发生率分别为术后尿潴留（2.08% vs. 4.17%）、血清肿（29.17% vs. 22.92%）、阴囊血肿（2.08% vs. 4.17%）、复发（0 vs. 2.08%）、感染（0% vs. 2.08%）,2组患者均未出现慢性疼痛的病例,2组比较无明显差异（P>0.05）。 结论TAPP治疗高原地区腹股沟疝可明显减少术中出血及术后疼痛感,降低机体创伤应激反应,但手术时间较长,相应的医疗费用增加,因此临床应根据患者具体情况选择术式。     

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.     

腹腔镜下经腹腔腹膜前疝修补术治疗嵌顿性股疝的临床效果研究

目的 探讨腹腔镜经腹腹膜前无张力疝修补术(TAPP)在治疗嵌顿性股疝方面的安全性及有效性。方法:回顾分析2017年4月—2021年12月天津中医药大学第一附属医院收治的30例嵌顿性股疝患者的临床资料,根据手术方式分为腹腔镜组17例,开放组13例,比较两组患者的手术情况、住院时间、并发症及随访结果等。结果:腹腔镜组手术时间[(71.35±10.48)min vs (86.90±12.54)min, P=0.010]、术中出血量[(17.06±3.40)mL vs (33.69±6.55)mL,P<0.001]、住院天数少于开放组[(5.90±1.30)d vs (8.23±9.93)d,P<0.001],术后疼痛评分低于开放组[(1.12±0.33) vs (2.09±0.70),P<0.001],术后排气时间短于开放组[(14.82±4.20)h vs (21.64±3.17)h,P<0.001],差异均有统计学意义;两组术后并发症无统计差异,术后随访1年,两组患者均未见复发。结论:TAPP手术治疗嵌顿性股疝是安全有效的,具有减少手术时间及出血,促进患者康复的优势。     

The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature

Background and methods  This study reviews the existing literature examining chronic pain and health-related quality of life (HRQL) outcomes in hernia repair studies. A PubMed/Medline and Embase search was carried out to identify relevant papers. Studies meeting pre-specified inclusion/exclusion criteria were included and fully reviewed. Reference lists were scanned for additional studies. Only studies examining chronic (>3 months) post-operative inguinal hernia repair (IHR)-related pain were included in this review. Results and conclusions  Twenty-three studies were identified. The majority of studies used the visual analogue scale (VAS) for pain measurement and the Medical Outcomes Study Short-Form 36 (SF-36) for the measurement of HRQL. A reasonably consistent picture emerged from the literature, with the HRQL domains most often affected by pain (social functioning/mental health). Estimates of the prevalence of chronic pain and discomfort following IHR vary widely between studies. This is probably a reflection of the range of methods used for measuring pain, many of which do not have established psychometric properties. Our review suggests that a proportion of patients experience chronic pain and discomfort, which has a significant impact on HRQL. However, the current instruments used in the evaluation of chronic pain after IHR are not comparable and standardisation is required.     

Minimally invasive operation techniques for inguinal hernia: spectrum of indications in Austria

At the beginning of the 1990s, the introduction of endoscopic surgery led to the surgical treatment of hernias being reconsidered. At present, there are three groups of surgical procedures: conventional procedures (Shouldice, Bassini), open, tension-free mesh procedures (Lichtenstein, Gilbert, Rutkow) and endoscopic procedures, predominantly transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP). The debate about the optimum treatment for hernias provoked by the endoscopic procedures is understandable in view of the large number of hernia operations performed. Numerous studies, some randomised, have demonstrated both advantages and disadvantages for the individual surgical procedures. In addition to the recurrence and complication rates, the cost factor and socio-economic aspects of the operations are playing an increasingly important role in deciding which method should be used. In December 1995, Austrian surgeons concerned with the problems of hernia repair both before and since the introduction of laparoscopic hernia repair came together for a consensus conference. During the meeting, the relevant aspects were summarised and a range of indications were established for surgical interventions. The main recommendation was that conventional open surgery, which can be performed under local anaesthesia, is indicated in unilateral uncomplicated primary hernias. Endoscopic hernioplasty is indicated if the contralateral findings are inconclusive or the hernia is bilateral or recurrent. The Zürser Hernienforum (Zürs Hernia Forum) has now been founded. The function of this forum is to carry out a prospective randomised study of inguinal hernia surgery throughout Austria. Electronic Publication     

Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair

Background: Controversy exists regarding whether it is necessary to secure the mesh prosthesis during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, or port-site hernia. Methods: We conducted a prospective randomized trial comparing stapled with nonstapled laparoscopic TAPP inguinal hernia repairs in a series of 502 consecutive patients undergoing elective inguinal hernia repair at two institutions between January 1995 and March 1997. Results: In all, 263 nonstapled and 273 stapled repairs were performed in 502 patients. Patients were evaluated at a median follow-up of 16 months (range, 1–32 months) by independent surgeons. There was no statistical difference in the incidence of recurrence (0 to 263 nonstapled, 3 to 273 stapled; chi-square p= 0.09). The overall recurrence rate was 0.6%. There was no significant difference in operative time, port-site hernia, chronic pain or neuralgia between the two groups. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair, allowing a reduction in the size of the ports. Received: 28 July 1998/Accepted: 25 November 1998     

Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair

Abstract Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures. Electronic Publication     

Open randomized clinical trial of laparoscopic versus open incisional hernia repair

Background  Incisional hernia is a common complication following abdominal surgery. Although the use of prosthetics has decreased recurrence rates, the standard open approach is still unsatisfactory. Laparoscopic techniques are an attempt to provide similar outcomes with the advantages of minimally invasive surgery. Methods  Open randomized controlled clinical trial with follow-up at 1, 2, 3, 7, and 15 days, and 1, 3, and 12 months from hernia repair. The study was carried out in the surgery departments of three general hospitals of the Valencia Health Agency. Objectives  To compare laparoscopic with anterior open repair using health-related quality of life outcomes as main endpoints. Results  Eighty-four patients with incisional hernia were randomly allocated to an open group (OG) (n = 39) or to a laparoscopic group (LG) (n = 45). Seventy-four patients completed 1-year follow up. Mean length of stay and time to oral intake were similar between groups. Operative time was 32 min longer in the LG (p < 0.001). Conversion rate was 11%. The local complication rate was superior in the LG (33.3% versus 5.2%) (p < 0.001). Recurrence rate at 1 year (7.9% versus 9.7%) was similar in the two groups. There were no significant differences in the pain scores or the EQ5D tariffs between the two groups during follow-up. Conclusions  Laparoscopic incisional hernia repair does not seem to be a better procedure than the open anterior technique in terms of operative time, hospitalization, complications, pain or quality of life.     

Diagnosis and classification of inguinal hernias

Background: The aim of this prospective clinical study was to determine whether the presence of a hernia, its size, and its type can be established preoperatively by clinical and ultrasound, examination. Methods: The study population comprised 220 consecutive patients referred to our department for the surgical management of an inguinal hernia. On admission, both inguinal regions were examined clinically and by ultrasound. All patients were operated on laparoscopically. Results: In regard to the intraoperative findings for both inguinal regions, clinical and ultrasound examination for the diagnosis of inguinal hernia yielded a high total rate of accuracy of 93% respective 94%. However, when the same methods were used to differentiate between lateral and medial hernia, the total rate of accuracy fell to only 54% respective 62%. In the determination of inguinal hernia size, it was even lower: 50% respective 53%. Conclusions: Although a diagnosis of inguinal hernia can be established reliably by clinical and ultrasound examination, only an approximate classification is possible by these methods.     

腹腔镜经腹腹膜前疝修补术对患者术后应激反应及疼痛的影响

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）对患者术后并发症及疼痛的影响。 方法收集2018年4~11月收治的128例腹股沟斜疝患者,随机数表法分为TAPP组（64例）和对照组无张力疝修补术（64例）。比较2组临床指标、应激激素水平、疼痛情况和并发症。 结果TAPP组术后下床时间、术后疼痛持续时间和平均住院时间均低于对照组（P<0.05）,2组患者的术后进食时间无明显统计学差异（P>0.05）。与术前比较,术后3 d 2组皮质醇（Cor）和醛固酮（ALD）水平均升高（P<0.05）,对照组去甲肾上腺素（NE）水平显著升高（P<0.05）。术后3 d,TAPP组Cor、NE和ALD水平低于对照组,差异具有统计学意义（P<0.05）。与术后24 h比较,术后72 h 2组简式疼痛问卷表（SF-MPQ）评分和视觉模拟评分（VAS）均降低（P<0.05）,且TAPP组VAS评分和SF-MPQ评分低于对照组（P<0.05）。 结论TAPP手术是治疗腹股沟疝的有效手段,与无张力疝修补术相比在减少术后疼痛和并发症方面具有明显优势,术后应激反应较低。