Laparoscopic transabdominal preperitoneal repair of spigelian hernia.

BACKGROUND: A Spigelian hernia is a congenital defect in the transversus aponeurosis fascia. Traditionally, an anterior hernioplasty was used to repair these defects. This study aimed to document our experience with laparoscopic transabdominal preperitoneal repair for Spigelian hernia. METHODS: Eight patients underwent laparoscopic transabdominal Spigelian hernia repair. All patients underwent creation of a peritoneal flap, sac dissection, identification and approximation of the fascial defect, mesh reinforcement, and reperitonealization. RESULTS: All patients presented with pain. An intermittent palpable mass was noticed in 4 patients. One third of the patients had undergone prior surgery and none had an incisional hernia. Only 1 patient presented with severe pain for 1 day; however, there was no bowel strangulation intraoperatively. All patients underwent laparoscopic transabdominal preperitoneal repair. No postoperative complications occurred. There have been no recurrences at a mean follow-up of 41 months (range, 8 to 96). CONCLUSION: Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.     

成人脐疝巴德改良Kugel补片腹膜前修补术20例临床分析

目的探讨巴德改良Kugel补片腹膜前修补方法治疗成人脐疝的临床效果。方法回顾性分析2010年3月至2016年3月武汉科技大学附属孝感医院收治的成人脐疝病人20例的临床资料,其中男性8例,女性12例,年龄28~81岁,病史2~15年,合并肝硬化3例,合并慢性阻塞性肺疾病5例,合并心房纤颤7例,腹腔镜术后并发脐疝5例。全部病人行腹部CT检查,明确肚脐处缺损大小。脐环直径2.0~4.5 cm。全部采取改良Kugel补片行腹膜前修补。结果手术时间为(40±10)min,术中出血(20±5)ml,术后即可进食、下床活动,术后无需止痛,术后2~3 d出院。术后无明显脐部异物感。电话随访5个月至5年无复发及慢性疼痛感。结论改良Kugel补片腹膜前修补方法是治疗成人脐疝的理想方法,值得临床推广使用。     

腹腔镜下腹壁切口疝补片修补术的初步经验

目的:探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法:对我院2004年3月～11月间收治的25例腹壁切口疝病人,进行腹腔镜下修补术。结果:24例(96%)手术成功,1例(4%)因腹腔内广泛粘连而中转为剖腹修补。平均手术时间为110min,平均术后住院6d,6例(24%)病人术中发现有一个以上的隐匿性缺损。术后并发症有:术后短期内修补区腹壁明显疼痛21例(84%),腹壁缝合点较长时间疼痛6例(24%),浆液肿3例(12%);无修补区感染,也未发现早期复发的病例。结论:对腹壁切口疝,多数病人是可以经腹腔镜进行粘连松解及补片修补术的,还可在术中发现其他隐性缺损。对腹腔内广泛粘连而影响操作器械的进入及分离者,应及时中转剖腹手术。     

Inguinal hernia repair: results using an open preperitoneal approach

Background: Laparoscopic surgical approaches to the repair of inguinal hernias have shown the advantages of placing mesh in the preperitoneal space. Despite those advantages, laparoscopic hernia repairs have been associated with increased cost, longer operating times, and advanced laparoscopic skills. An open preperitoneal approach has the benefit of mesh in the preperitoneal position without the disadvantages of a laparoscopic procedure.Methods: We present our experience with the use of an open preperitoneal mesh repair (KugelMesh, Bard, Inc.). The study was conducted in a prospective fashion from January 1998 through October 2001. 1072 hernias were repaired in two community hospitals by three general surgeons. Patients with recurrent hernias were excluded if the initial repair was from a preperitoneal approach. Operative time, cost, post-operative pain, and complications were analyzed.Results: Recurrences occurred in five patients (0.47%) during a mean follow-up time of 23 months (range: 2–47). The average operating time was 32.4 min (range: 16–62). Post-operative narcotic pain medication usage averaged 5.8 pills (range: 0–26) per repair. Average surgical charges were less for the open preperitoneal approach ($2253) than for laparoscopic repairs ($4826).Conclusions: The open preperitoneal hernia repair using the Kugel mesh offers many advantages. It is inexpensive, has a low recurrence rate, and allows the surgeon to cover all potential defects with one piece of mesh. Postoperative recovery is short and postoperative pain is minimal.     

Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach

Summary This report describes a laparoscopic procedure for prosthetic repair of inguinal hernias using an extraperitoneal approach. A total of 51 primary direct and indirect hernias were repaired in this series, including 11 recurrent and 12 bilateral hernias. Operative time for this laparoscopic procedure was similar to that of the comparable open surgery and no unusual complications were noted. All patients were discharged the day following surgery and returned to work within 7 days.     

Laparoscopic repair of umbilical hernias in conjunction with other laparoscopic procedures.

BACKGROUND: This study evaluates the feasibility of laparoscopic transfascial suture repair of umbilical hernias when combined with another laparoscopic procedure that potentially contaminates the peritoneal cavity. METHOD: From August 1997 to November 2001, 32 patients underwent laparoscopic umbilical suture repair in association with another laparoscopic procedure. The repair was performed with the Carter-Thomason suture passer. RESULTS: Of the 32, 26 patients with more than 1-year follow-up were included in the study. The mean diameter of the umbilical hernia defect was 1.67 cm (range, 0.5 to 3). At a mean follow-up of 34 months (range, 12 to 60), there were only 2 recurrences (7.7%) both of which happened in patients with hernia defects larger than 2 cm in diameter. Apart from 2 wound infections, no other complications occurred. CONCLUSION: Laparoscopic suture repair of umbilical hernias with the suture passer method is effective and durable even when combined with other laparoscopic procedures that potentially contaminate the peritoneal cavity with bile or enteric contents.     

Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients.

OBJECTIVE: The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. METHODS: Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 x 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 x 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 cases, PTFE Dual Mesh Plus with holes was employed. RESULTS: Average surgery time was 62 minutes. One procedure was converted to open surgery, and only one patient required a second operation in the early postoperative period. Minor complications included 2 patients with abdominal wall edema, 10 seromas, and 3 subcutaneous hematomas. There were no trocar site infections. Two patients developed hernia relapse (2%) in the first month after surgery and were reoperated with a similar laparoscopic technique. Oral intake and mobilization began a few hours after surgery. The mean stay in hospital was 28 hours. CONCLUSIONS: Laparoscopic technique makes it possible to avoid large incisions, the placement of drains, and produces a lower number of seromas, infections and relapses. Laparoscopic access considerably shortens the time spent in the hospital.     

Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study

Background

The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with the well-known advantages of a minimally invasive approach. However, general anesthesia is routinely required for the procedure. Based on our previous experience in regional anesthesia for laparoscopic procedures, we designed a pilot study to assess the feasibility and safety of performing laparoscopic TAPP repair under spinal anesthesia.

Methods

Forty-five American Society of Anesthesiologists I or II patients with a total of 50 inguinal hernias underwent TAPP repair under spinal anesthesia, using a low-pressure CO₂ pneumoperitoneum. Five patients had bilateral hernias, and 4 patients had recurrent hernias. Thirty hernias were indirect and the remaining direct. Intraoperative incidents, postoperative pain complications, and recovery in general as well as patient satisfaction at the follow-up examination were prospectively recorded.

Results

There was 1 conversion from spinal to general anesthesia and 2 conversions from laparoscopic to the open procedure at a median operative time of 50 minutes (range 30-130). Ten patients complained of shoulder pain during the procedure, and 6 patients suffered hypotension intraoperatively. The median pain score (visual analog scale) was 1 (0-5) at 4 hours after the completion of the procedure, 1.5 (0-6) at 8 hours, and 1.5 (0-5) at 24 hours, and the median hospital stay was 1 day (range 1-2). Sixteen patients had urinary retention requiring instant catheterization. At a median follow-up of 20 months (range 10 months-28 months), no recurrence was detected.

Conclusions

TAPP repair is feasible and safe under spinal anesthesia. However, it seems to be associated with a high incidence of urinary retention. Further studies are required to validate this technique.     

Laparoscopic transabdominal preperitoneal approach to place a polypropylene mesh on the abdominal wall: an experimental swine model of a technique that can be used for incisional hernia repair

Background The placement of intraabdominal polypropylene mesh entails risks of adhesions and fistulas that can be avoided by preperitoneal placement.Methods This comparative, open, experimental, prospective, randomized, and transversal study randomized pigs into two groups of 11 each for intraperitoneal (IPOM) or preperitoneal (TAPP) polypropylene mesh placement by laparoscopy. Diagnostic laparoscopy and tissue en-bloc resection was performed 28 days postoperatively for histopathologic analysis.Results The following data were observed for the two study groups: surgical time (IPOM: 35.73 ± 4.22 min; TAPP: 58.09 ± 6.28 min; p = <0.0001); adhesions (IPOM: 81.81%; TAPP: 27.27%; p = 0.032), grade III for IPOM and grade II for TAPP (p = 0.001); and interloop adhesions (IPOM: 81.81%; TAPP: 9.09%; p = 0.003). No fistulas were found in either group. The TAPP procedure showed better integration of mesh, without lesion to abdominal organs. Two complications, occurred with IPOM, and one with TAPP (p = 1.0, not significant).Conclusions The perperitoneal technique requires more time, but has fewer adhesions and less intraabdominal inflammatory response. It is a feasible technique that may diminish risks in the laparoscopic treatment of incisional hernias with polypropylene mesh.     

Suture versus preperitoneal polypropylene mesh for elective umbilical hernia repairs

Background

Repair of primary ventral hernias (PVH) such as umbilical hernias is a common surgical procedure. There is a paucity of risk-adjusted data comparing suture versus mesh repair of these hernias. We compared preperitoneal polypropylene (PP) repair versus suture repair for elective umbilical hernia repair.

Methods

A retrospective review of all elective open PVH repairs at a single institution from 2000–2010 was performed. Only patients with suture or PP repair of umbilical hernias were included. Univariate analysis was conducted and propensity for treatment-adjusted multivariate logistic regression.

Results

There were 442 elective open PVH repairs performed; 392 met our inclusion criteria. Of these patients, 126 (32.1%) had a PP repair and 266 (67.9%) underwent suture repair. Median (range) follow-up was 60 mo (1–143). Patients who underwent PP repair had more surgical site infections (SSIs; 19.8% versus 7.9%, P < 0.01) and seromas (14.3% versus 4.1%, P < 0.01). There was no difference in recurrence (5.6% versus 7.5%, P = 0.53). On propensity score–adjusted multivariate analysis, we found that body mass index (odds ratio [OR], 1.10) and smoking status (OR, 2.3) were associated with recurrence. Mesh (OR, 2.34) and American Society of Anesthesiologists (OR, 1.95) were associated with SSI. Only mesh (OR, 3.41) was associated with seroma formation.

Conclusions

Although there was a trend toward more recurrence with suture repair in our study, this was not statistically significant. Mesh repair was associated with more SSI and seromas. Further prospective randomized controlled trial is needed to clarify the role of suture and mesh repair in PVH.     

腹腔镜脐环缝扎术治疗小儿脐疝的体会

目的:探讨腹腔镜脐环缝扎术治疗小儿脐疝的临床疗效。方法:回顾分析为21例脐疝患儿行腹腔镜脐环缝扎术的临床资料。结果:21例手术均获成功。手术时间20～45 min,平均32.5 min;术中均无出血,术后康复快。术后18例患儿随访6～72个月,无复发或肠粘连、肠梗阻等并发症发生。结论:腹腔镜脐环缝扎术治疗小儿脐疝安全、有效,手术微创、美观,值得推广应用。     

Laparoscopic cure of small ventral hernias with composite mesh

BACKGROUND: The use of mesh is recommended to reduce the rate of recurrence after the curing of ventral hernias. METHODS: A multicentre prospective trial was conducted to assess the laparoscopic cure of small ventral hernias with a composite mesh. RESULTS: Around 222 patients entered the trial and received laparoscopic repair for ventral hernias of less than 5 cm. There was one conversion. The mean length of post-operative hospitalisation was 2.5 days. At 1 year, the recurrence rate was 2%. Two meshes were removed due to infection, 3% of the patients were using analgesics and 86.1% of the patients described no pain on EVA scoring. CONCLUSION: The laparoscopic cure of small ventral hernias with composite mesh is efficient. Further technical progress is warranted to reduce the rate of seroma formation.     

经腹腔腹膜前补片腹腔镜腹股沟疝修补术170例报告

目的:探讨经腹腔腹膜前补片腹腔镜腹股沟疝修补术(TAPP)治疗腹股沟疝的方法与经验。方法:1995年6月~2005年7月应用TAPP治疗170例腹股沟疝,采用网状补片常规固定、腹膜常规连续缝合关闭等方法。结果:170例手术均获成功,无中转开放手术,平均手术时间52.5(40~120)m in,术后平均住院4.5d。术后随访1~11年,1例直疝复发。结论:TAPP是一种安全可靠的疝修补术,具有复发率低等优点,特别适于复发疝、双侧疝等,值得推广应用。     

Quality of life after open versus laparoscopic preperitoneal mesh repair for unilateral inguinal hernias

BackgroundBoth the open transinguinal preperitoneal repair (TIPP) and the laparoscopic total extraperitoneal mesh repair (TEP) show excellent outcomes. Direct comparative data between these 2 preperitoneal techniques is lacking. The aim of this study was to assess postoperative outcomes and quality of life (QoL) for these open and laparoscopic preperitoneal repair techniques.MethodsBetween 2014 and 2016, 204 male patients underwent unilateral inguinal hernia repair through TIPP (n = 135) or TEP (n = 69). Data recorded include demographic profile, preoperative and intraoperative variables, postoperative complications and postoperative quality of life. Two validated hernia-specific QoL questionnaires, the Carolinas Comfort Scale (CCS) and the European Registry for Abdominal Wall Hernias Quality of Life score (EuraHS QoL) were used to assess postoperative QoL.ResultsThe TIPP group consisted of 135 patients, the TEP group of 69 patients. The mean age of patients was significantly higher in TIPP (64.07 ± 17.10 years) than in TEP (59.0 ± 15.53 years) (p = 0.022). A total of 96 patients (47.1%) responded to our invitation for longterm follow-up: 58 in the TIPP group (43%) and 38 in the TEP group (55.1%). There was no difference in mean follow-up time between the surgical procedure and filling in the questionnaires: 37.4 ± 12.8 months for TIPP and 33.5 ± 11.3 months for TEP group (p = 0.13). No significant differences in quality of life were found between TIPP and TEP for all explored domains.ConclusionTIPP and TEP show equivalent results considering postoperative quality of life. Compared to existing literature on mesh repair for unilateral inguinal hernias, we may conclude that the preperitoneal location of the mesh probably is a more decisive factor for quality of life than the surgical approach used.     

Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study

OBJECTIVE: Parastomal hernia is a common complication after stoma formation. The objective of the study was to see whether placing prophylactic preperitoneal mesh could reduce the incidence of parastomal hernia. METHOD: Patients having elective bowel surgery requiring permanent stoma were included in this study. The time required for mesh insertion, day of stoma function, and early complications were recorded. Follow up was at 6 weeks, 3-monthly for the first year and at 6-monthly intervals thereafter. RESULTS: Eighteen patients fulfilled the inclusion criteria and were followed up for 6-28 months (mean 16.05). The time taken for mesh placement was 12-22 min (mean 14). One patient had to have revision surgery on day 1 for stomal necrosis - the mesh was left in situ in that instance. This patient developed superficial laparotomy wound infection. During the follow up, no patients developed parastomal hernia, stomal prolapse, stenosis, retraction, fistula or obstruction. CONCLUSION: The early results, in this group of patients, show that prophylactic polypropylene mesh insertion at the time of permanent stoma formation is encouraging and long-term results are awaited.     

The open preperitoneal approach to recurrent inguinal hernias in high-risk patients

Background Whether it is an open anterior, laparoscopic, or open preperitoneal approach, we have no general consensus on the preferred approach to recurrent inguinal hernia repairs. Recent reevaluations of the previously described open preperitoneal approach have shown promising results. We critically evaluate our experience with this procedure in our high-risk patient population and compare the results to other useful techniques.Methods We present a retrospective study of 48 consecutive patients with 49 recurrent inguinal hernias. All patients underwent an open preperitoneal approach using a Bard Kugel Patch supervised by the senior author. Complications and recurrences were evaluated with all patients returning to the clinic postoperatively.Results Among the 49 (6%) hernia repairs, there were three recurrences. The overall complication rate was 8%, including postoperative hematoma requiring drainage (1), pain leading to the patch being removed (1), and postoperative urinary retention (2).Conclusion The open preperitoneal approach using the Bard Kugel Patch for recurrent inguinal hernias results in a low recurrence rate and an acceptable complication rate. It is the preferred approach at our institution.     

Laparoscopic repair of parastomal hernias: early results

Background: Open repair of parastomal hernias is associated with high rates of morbidity and recurrence. Laparoscopic repair with mesh has been described, and good results have been reported in small case series with short-term follow-up. The purpose of this study was to review our institutions experience with the laparoscopic repair of parastomal hernias. Methods: Nine patients with symptomatic parastomal hernias (five ileal conduits, two ileostomies, and two sigmoid colostomies) underwent laparoscopic repair with mesh between April 1998 and September 2001. Demographics, operative details, postoperative complications, and hernia recurrences were recorded retroprospectively. Results: All of the patients were men; their average age was 66 years (range, 53–77). A single piece of Gore-Tex Dual Mesh with a slit to accommodate the stoma was used in seven of nine repairs; in the other two patients, two pieces of mesh were used. Concurrent incisional hernias were repaired in three of nine patients (33.3%). The average operating time was 243 min (range, 136–360). The average postoperative length of stay was 4.7 days (range, 2–7). Immediate postoperative complications occurred in three patients (33.3%) (one ileus, one urinary retention, and one ulnar neuropathy). Recurrences developed in four patients (44.4%), and in one patient (11.1%) the stoma prolapsed; all of these failures occurred within 6 months of the operation. One patient died 10 months postoperatively, without evidence of hernia recurrence. Three patients are without evidence of recurrence after 18, 21, and 33 months (average, 24) of follow-up, respectively. Conclusion: In this series, laparoscopic repair of parastomal hernia failed in 56% of patients, all within 6 months of the operation. Although the laparoscopic approach has potential advantages compared to the conventional open methods, the initial results are disappointing. Advances in the technique may improve the early results, and further prospective studies are needed to determine the efficacy of this approach.     

肝硬化腹水合并脐疝的Onlay和腹膜前疝修补术对比研究

目的探讨在肝硬化腹水合并脐疝患者的外科治疗中Onlay术式和腹膜前疝修补术式治疗效果的差异。 方法回顾性分析2010年1月至2018年1月,上海交通大学医学院附属第一人民医院收治的肝硬化腹水合并脐疝25例患者的临床资料。根据术式不同分为2组,对照组患者13例行Onlay术式,试验组患者12例行腹膜前疝修补术。比较2组手术时间、排气时间、住院时间、伤口愈合情况及术后复发等观察指标,并进行统计学分析。 结果对照组平均手术时间（56.9±16.3）min,住院时间（8.7±5.8）d,排气时间（2.6±0.7）d。试验组平均手术时间（49.4±17.1）min,住院时间（10.8±4.7）d,排气时间（2.7±0.6）d。2组术后疼痛评分、伤口愈合情况等比较,差异均无统计学意义（P>0.05）。观察期内对照组出现轻微伤口感染患者1例,2组患者均未出现复发情况。 结论对于肝硬化腹水合并脐疝患者,Onlay和腹膜前疝修补两种术式在治疗效果可能无明显差异。     

Description of M-shaped preperitoneal hernioplasty for inguinocrural hernias

BACKGROUND: The efficacy of preperitoneal herniorrhaphy is controversial in the surgical literature. The development of totally extraperitoneal video-assisted hernioplasty has stimulated further interest in long-term results of open techniques. Some of the main advantages of the two most extended preperitoneal open approaches (Stoppa and Nyhus operations) are combined in the author's technique described here. METHODS: Between March 1995 and June 1998, 180 consecutive patients with a total of 202 inguinocrural hernias were treated by an open sutureless preperitoneal repair, using a lateral approach, with placement of a 12 x 10 cm polypropylene mesh. RESULTS: Mean operating time was 48 minutes. Overall morbidity rate was 7%. Mean hospital length of stay was 2.16 days. After an average follow up of 3.5 years, the overall recurrence rate was 0.57%. CONCLUSIONS: M-shaped preperitoneal hernioplasty is a single, safe, and easy repair for inguinocrural hernias, regardless of the type of hernia or the concomitant clinicopathological features of the patient.