Five-year follow-up of laparoscopic bladder neck suspension using synthetic mesh and surgical staples.

We report long-term follow-up of 40 patients who underwent a laparoscopic adaptation of the Burch procedure between May 1990 and December 1992. This procedure, in which synthetic mesh and surgical staples are used in place of sutures to effect the suspension, was previously described by the principal author and colleagues for use in the treatment of genuine stress urinary incontinence (J Laparoendosc Surg 1993;3:563-566). Minimum 5-year follow-up has been obtained for 34 of these patients either by office visit with the principal author (27 patients) or by telephone interview with the patient or the patient's primary-care physician (7 patients). Six patients were lost to follow-up, four after 1 year and two more after 3 years. None of these patients was leaking at last follow-up. This operation initially succeeded in resolving incontinence in 37 of 40 patients (93%). Of the three patients in whom the surgery failed initially, none chose further surgery, and all three were still leaking after 5 years of follow-up. One additional patient developed urgency incontinence 3 years postoperatively. The five-year success rate, defined as no recurrent leaking, was 88% (30 of 34 confirmed outcomes). This modification of the Burch procedure offers the advantages of the laparoscopic approach and affords an inherently shorter learning curve than that associated with laparoscopic suturing in the confined pelvic space.     

A meta-analysis comparing tacker mesh fixation with suture mesh fixation in laparoscopic incisional and ventral hernia repair

Objective

To systematically compare the tacker mesh fixation (TMF) with the suture mesh fixation (SMF) in laparoscopic incisional and ventral hernia (LIVH) repair.

Methods

Trials evaluating the TMF with the SMF in LIVH repair were analysed using the statistical tool RevMan^®. Combined dichotomous and continuous data were expressed as odds ratio (OR) and mean difference (MD), respectively.

Results

Four trials (2 randomised and 2 non-randomised) encompassing 207 patients undergoing LIVH repair with TMF versus SMF were retrieved from the standard electronic databases and analysed systematically. Ninety-nine patients underwent TMF and 108 patients underwent SMF in LIVH repair. There was no statistically significant heterogeneity (p = 0.27)] among trials. In the fixed-effects model, LIVH repair with TMF was associated with shorter operation time (MD, ?23.65; 95 % CI, ?31.06, ?16.25; z = 6.26; p < 0.00001). Four- to six-week postoperative pain score was significantly lower (MD, ?0.69; 95 % CI, ?1.16, ?0.23; z = 2.92; p < 0.004) following TMF. Peri-operative complications (p = 0.65), length of hospital stay (p = 1) and risk of hernia recurrence (OR, 1.54; 95 % CI, 0.38, 6.27; z = 0.61; p = 0.54) following TMF and SMF were statistically not different.

Conclusion

TMF in LIVH repair is associated with shorter operative time and lesser postoperative pain. TMF is comparable with SMF in terms of peri-operative complications, length of hospital stay and hernia recurrence. Therefore, TMF may be used in LIVH repair. However, further randomised trials recruiting higher number of patients are required to validate these findings.     

Extraperitoneal laparoscopic urethropexy with Marlex mesh

OBJECTIVES: Extraperitoneal laparoscopic urethropexy (ELU) has recently been developed as a minimally invasive procedure for the treatment of female stress urinary incontinence (SUI). Use of the laparoscopic stapling device and Marlex mesh in the extraperitoneal space may allow for a technically easier procedure and shorter operative times compared with other laparoscopic techniques without compromising long-term efficacy. We present our initial results and 2.5-year interim analysis with this alternative method of laparoscopic urethropexy. METHODS: Twenty-four consecutive patients with urodynamically demonstrated genuine SUI underwent attempted ELU at a single institution from December 1994 to December 1995. Operative data were collected from the patient chart, and follow-up data were obtained by telephone interview. Treatment was considered successful if, at last follow-up, a patient was using one or fewer pads daily and would recommend the procedure to a friend. RESULTS: ELU was completed in 22 of 24 patients. In 1 patient with a prior history of pelvic surgery, the preperitoneal space was not accessible. Of the 22 patients, 20 were available for follow-up. The mean operative time was 69 minutes. There were no intraoperative complications. At initial follow-up (mean 10.5 months), 18 (90%) of 20 patients reported subjective cure of SUI (one or fewer pads daily). At a mean follow-up of 29 months (range 23 to 34), 16 (80%) of 20 patients had subjective cure of SUI. Six patients would not recommend the procedure to a friend, all of whom had de novo urgency and/or urge incontinence. Thus, using our strict criteria, ELU was successful in 14 (70%) of 20 patients at a mean follow-up of 2.5 years. No patient has had permanent urinary retention. CONCLUSIONS: ELU can be performed rapidly and safely in patients without previous pelvic surgery. De novo urgency incontinence may be problematic. Future analysis of this subset of patients will determine whether this procedure is durable in the long term.     

Extraperitoneal laparoscopic hernia repair with local anesthesia

BACKGROUND: This review aimed to compare laparoscopic preperitoneal herniorrhaphy (LPPH) using a laryngeal mask airway and local anesthesia with conventional open herniorrhaphy using similar anesthetic conditions. METHODS: A retrospective review of 238 hernia operations was conducted from October 1996 through September 1998. Laparoscopic preperitoneal hernia repairs with the patient under laryngeal mask airway anesthesia were performed initially using 10 ml of 0.5% bupivacaine (LPPH+10 group). This was compared with hernia repair using 30 ml of 0.5% bupivacaine (LPPH+30 group). Both LPPH groups were compared with a plug and patch "Gilbert" hernia repair group. Postoperative pain was compared in the recovery room and outpatient suite. RESULTS: The LPPH+30 group required significantly less postoperative pain medication than the LPPH+10 group. The LPPH+30 group required slightly more pain medication in the recovery room than the open hernia repair group, but in the postanesthesia care unit (PACU) unit, the LPPH+30 group used less pain medication. A similar number of LPPH+30 patients, and open hernia repair patients required no pain medication. CONCLUSIONS: The use of a long-acting local anesthetic, (30 ml of 0.5% bupivacaine via laryngeal mask airway) for laparoscopic preperitoneal hernia repair compared favorably with conventional open hernia repair using similar anesthetic techniques.     

Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh

Background  There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however, no human data available. The aim of this study was to evaluate the feasibility and outcome after laparoscopic ventral hernia repair using the Proceed mesh in humans. Methods  Patients presenting for laparoscopic ventral hernia repair in our department from September 2004 to October 2006 were included in the study. All patients had a standard laparoscopic ventral hernia repair using the Proceed mesh secured with tackers with a double crown technique. Patients were discharged according to standard discharge criteria, and follow-up was performed with a search in the national patient database and with manual search in the patients’ files. Results  Our study included 49 patients with a median age of 64 years (range 30–89) and body mass index of 27.8 (19.4–50.5). The dimensions of the mesh varied from 4 × 4 cm to 30 × 40 cm (median 15 × 15 cm). One patient developed an uncomplicated wound infection and none of the 49 patients developed mesh infections or postoperative seroma requiring surgical intervention. Thus, there were no mesh-related complications. During the follow-up period of 17 months (3–27), we have not seen any postoperative recurrences. The median length of stay was 1 day (range 0–63), and there was no mortality. Conclusion  Laparoscopic ventral hernia repair in humans using the Proceed mesh is feasible and has a low complication rate even in obese patients or those with pulmonary disease.     

Morgagni hernia: Repair with a mesh using laparoscopic surgery

The aim of this study is to present two patients diagnosed with diaphragmatic Morgagni hernia and treated by repairing the hernia defect with a mesh by laparoscopic surgery. We describe the placement of a double-layer mesh anchored with helicoidal staples to repair the hernia defect using laparoscopic surgery. Laparoscopic surgery allows repair of these defects whilst avoiding the disadvantages of a major laparotomy or a thoracotomy. The existence of double-layer meshes that can be placed in contact with the abdominal viscera allows the defect to be closed safely and without tension.     

Initial results of an indigenous absorbable tacker for mesh fixation in laparoscopic ventral hernia repair: a retrospective analysis of 158 cases

Hernia - The aim of this study was to evaluate the safety and effectiveness of a Chinese absorbable tack for mesh fixation in laparoscopic abdominal wall hernia repair compared to a widely used...     

Transvaginal needle bladder neck suspension

Like the transabdominal bladder neck suspension, the aim of the transvaginal needle suspension of the bladder neck is to suspend the bladder neck and urethra in a fixed retropubic position. Because the transvaginal technique does not require the splitting of the abdominal wall fascia, postoperative discomfort and convalescence may be lessened. Different techniques of transvaginal needle bladder neck suspension, including suspension of the bladder neck with a fascial sling, are discussed in detail.     

Extraperitoneal laparoscopic approach to Spigelian hernia combined with groin hernias

Spigelian hernia is a rare form of abdominal wall hernia. It occurs when peritoneum with or without organs or preperitoneal fat exists through a defect in the Spigelian fascia. A 63 year old male patient complaint of inguinal hernias and Spigelian hernia treated with laparoscopic approach that has been not previously reported in the literature. The use of the laparoscope has simplified the diagnosis, clarified its localization, and facilitated the subsequent repair of these hernias.     

A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias

Introduction  

After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone.     

Complications of retropubic bladder neck suspension

Seven women who underwent the Stamey endoscopic bladder neck suspension performed by different urologists at a variety of institutions were evaluated at the Lahey Clinic Medical Center. Two to 36 months after operation, each woman sought medical attention because of complaints of pain in the lower abdomen, pelvis, or groin with or without urinary frequency and urgency. Endoscopic examination revealed an acute mucosal inflammatory reaction, perforating sutures or Dacron pledgets, and formation of calculi around a suture. In each patient, sutures or pledgets were removed endoscopically with resolution of presenting complaints.     

Complications of bladder neck suspension procedures

Typical genuine stress urinary incontinence is the result of an anatomic defect, with most procedures designed to restore the support of the proximal urethra and bladder neck. Complications associated with these procedures have been presented to help facilitate an understanding of their etiology and prevention. Careful attention to patient selection, history and physical examination, and surgical detail can prevent most of these complications.     

The stamey endoscopic bladder neck suspension

The Stamey procedure has gained a favourable reputation as a highly effective operation for the treatment of genuine stress incontinence in the female. Technical ease, short operating time, brief hospitalization and minimal postoperative morbidity have all been claimed as particular advantages of this procedure. With correct patient selection and attention to operative detail, this technique has much to offer both young and old women who require surgical correction of genuine stress incontinence.     

Patient satisfaction following bladder neck suspension

Stress urinary incontinence is a common problem; 107 women undergoing bladder neck suspension between 1982 and 1989 were reviewed. Seventyfour responded via questionnaire and underwent chart review. Leakage resolved in 83%, with a mean follow-up of 23 months. Sixty-eight per cent were satisfied with the procedure outcome. Preoperative leakage with coughing and work-related activities predicted procedure success, while symptom resolution, number of postoperative pads required, leakage with preoperative coughing and work-related activities predicted patient satisfaction. Postoperative detrusor instability caused the discrepancy between leakage resolution and patient satisfaction. A complication rate of 15.9% was significantly higher in patients who had undergone prior procedures (p<0.001).     

Complications of endoscopic bladder neck suspension

Endoscopic bladder neck suspension for female urinary incontinence can result in both intraoperative and postoperative complications. Intraoperative complications include hemorrhage and injury to the urethra, bladder or ureters. Postoperative complications include infection, myocardial infarction, pulmonary embolus, suprapubic pain, persistent incontinence, bladder calculi and urinary retention. All of these potential complications can be managed successfully by applying the guidelines outlined.