A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair

Introduction

The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients.

Materials and methods

Our study is a prospective, randomized, controlled clinical trial conducted from August 2011 to June 2013. Fifty patients aged between 21 and 80 years undergoing surgery for unilateral inguinal hernia were randomised into two groups: conventional laparoscopic TEP inguinal hernia repair versus single-port TEP repair. Clinical data on patient demographics, surgical technique and findings, postoperative complications and pain scores were collected. Primary endpoint is the postoperative pain while secondary endpoints are recurrence, chronic pain, postoperative hospital stay and complications.

Results

Out of the 50 patients, 26 underwent single-port hernia TEP repair and 24 had conventional 3-port TEP hernia repair after randomization. Mean operative time was 51.7 (±13.4) min in the multiport group and 59.3 (±14.9) min in the single-port group, respectively (P = 0.064). Mean hospital stay was 19.7 (±4.8) h in the conventional group and 22.1 (±4.5) h in the single-port group (P = 0.079). No statistically significant differences were observed between the two groups for postoperative complications, and no recurrence reported at 11 months follow-up. There was no significant difference in the pain scores (visual analog scale) between the two groups at regular intervals post surgery.

Discussion

The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique.     

Single-port laparoscopic extraperitoneal repair of pediatric inguinal hernias and hydroceles by using modified Kirschner pin: a novel technique

Background

The development of laparoscopic processus vaginalis repair has provided an alternative approach to the management of inguinal hernia and hydroceles in children. Here we describe our new technique for laparoscopic extraperitoneal ligation of processus vaginalis with subumbilical single-port using a modified Kirschner pin.

Methods

A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision. A Kirschner pin with a hole in one flat terminal was inserted at the point of the internal inguinal ring. The processus vaginalis was closed extracorporeally by a non-absorbable suture, which was introduced into the abdomen through the Kirschner pin performing dissection within the extraperitoneal space in a series of movements. When a contralateral patent processus vaginalis is present, laparoscopic-assisted extracorporeal ligation is performed during the same operation.

Results

Between September 2010 and September 2012, 211 children (130 cases of inguinal hernia and 81 cases of hydrocele) underwent processus vaginalis repair using this novel technique. A contralateral patent processus vaginalis was present and thus simultaneously closed in 20 patients with unilateral inguinal hernias and 12 patients with unilateral hydroceles. The mean operative time was 18 min (8–35 min). The mean follow-up period is 12 months (range 5–24 months), and no recurrence and complications has been observed to date.

Conclusions

This article describes a unique technique of extracorporeal circuit ligation of processus vaginalis using a minimally invasive technique as afforded by a reused modified Kirschner pin. Single-port laparoscopic processus vaginalis repair using this instrument is feasible and seems to be safe.     

Robotic single-port hernia surgery

Background and Objectives:

Since the introduction of single-incision laparoscopic surgery in 2009, an increasing number of surgical procedures including hernia repair are being performed using this technique. However, its large-scale adoption awaits results of prospective randomized controlled studies confirming its potential benefits. Parallel with single-port surgery development, the issue of the chronic lack of good camera assistants is being addressed by the robotic Freehand® camera controller, which has the potential to replace camera assistants in a large percentage of routine laparoscopic surgery. Although the robotic Freehand has been used in certain operations in urology and gynecology, there have been no published reports in robotic (single-port) hernia surgery.

Methods:

This study reports the first case and a series of 16 patients who underwent robotic single-port total extraperitoneal inguinal hernia repair compared to 16 consecutive cases of conventional single-port inguinal hernia repair. Patients were matched for age, sex, body mass index, American Society of Anesthesiologists classification, and types of hernia.

Results:

Although operation time was comparable in both, the time wasted for scope cleaning was 8.5 minutes for conventional compared to 1.5 minutes for robotic surgery.

Conclusion:

Robotic single-port inguinal hernia repair is feasible and efficient. This represents a further milestone in laparoscopic surgery.     

Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective,randomized, controlled clinical trial

Background

The advantage of single-port total extra-peritoneal (TEP) inguinal hernia repair over the conventional technique is still debatable. Our objective was to compare the outcomes of TEP inguinal hernia repair using either a single-port or conventional surgical technique, in two blind randomized groups of patients.

Methods

In this prospective, randomized, double-blind, controlled clinical trial, 100 patients undergoing surgery for unilateral inguinal hernia were randomized into two groups: One group underwent conventional laparoscopic TEP inguinal hernia repair, while the other was selected for single-port TEP repair. Primary endpoint is postoperative pain (VAS), while secondary endpoints are recurrence, chronic pain and complications.

Results

From 100 patients, 49 underwent single-port hernia TEP repair, 50 had conventional three-port TEP hernia repair, and one patient declined to participate after randomization. The two groups were comparable in terms of patient demographics and operative findings. Mean operative time was 49.1(±13.8) min in the conventional group and 54.1(±14.4) min in the single-port group (p = 0.08). Mean hospital stay was 19.7(±5.8) h in the conventional group and 20.5(±6.4) h in the single-port group (p = 0.489). No major complications and no recurrence reported at 11-month follow-up. No statistically significant difference noted in postoperative pain between the two groups at regular intervals.

Conclusions

The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are similar but not superior to the conventional technique.

     

Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study

Background

Traditionally, repair of an inguinal hernia has been by an open method, but laparoscopic techniques have recently been introduced and are increasing in popularity. This study aimed to compare early and late outcomes following laparoscopic and open repair of inguinal hernia.

Methods

We performed an analysis of inpatient Hospital Episode Statistics. Early-outcome criteria studied include in-hospital mortality, length of hospital stay, complications (infection, bleeding, injury to an organ, and urinary retention), and readmission. Late outcome was assessed by the need for a further inguinal hernia repair on the same side.

Results

Between April 2002 and April 2004 there were 125,342 patients who underwent inguinal hernia repair and were included in the analysis. They were followed until April 2009. There were no differences in postoperative stay between the laparoscopic and open groups except for the laparoscopic bilateral hernia repair patients who had a shorter stay than the open group. Infection and bleeding were more common following open repair, whilst urinary retention and injury to an organ were more frequent after laparoscopic repair. Reoperation for another inguinal hernia was more common after laparoscopic (4.0 %) than after open repair of primary inguinal hernia (2.1 %), mostly in the first year after surgery. There was no difference in reoperation rate following repair of a recurrent inguinal hernia. Consultant caseload was strongly inversely correlated with reoperation following laparoscopic but not open repair of primary inguinal hernia.

Conclusions

Reoperation is more common after laparoscopic than after open repair of primary but not recurrent inguinal hernia. Surgeons with a low laparoscopic hernia repair caseload have an increased reoperation rate following laparoscopic repair of primary inguinal hernia. The increase in reoperation rate following laparoscopic repair is seen in the first year or two following the initial surgery.     

Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip™ mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months

Introduction

The aim of this study was to demonstrate the safety and the efficacy of the self-gripping Parietex ProGrip? mesh (Sofradim Production, Trévoux, France) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 12 months was evaluated.

Methods

Data were collected retrospectively from patient files and were analyzed for 169 male and female patients with 220 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip? meshes performed in the same clinical center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after 12 months was performed prospectively. Complications, pain scored on a 0–10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed.

Results

The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar’s site (2 cases), hematuria, emphysema in the inguinal regions (both sides) and swelling above the genital organs (1 case for each). At mean follow-up at 22.8 months, there were only 3 reports of hernia recurrence: 1.4 % of the hernias. Most patients (95.9 %) were satisfied or very satisfied with their hernia repair with only 1.2 % reporting severe pain (NRS score 7–10) and 3.6 % reported mild pain.

Conclusion

This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip? self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate.     

Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia

Purpose

Small femoral hernias may be difficult to diagnose by physical examination and are sometimes identified unexpectedly by laparoscopy. The aim of this study was to examine the incidence of unsuspected femoral hernia discovered during laparoscopic inguinal hernia repair in two well-defined patient groups.

Methods

Patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair from April 2000 until December 2009 (n?=?561) were prospectively registered including data on previous hernia operations and identified type of hernia during surgery. We included patients whose preoperative diagnosis was either bilateral primary inguinal hernia (Primary Group) or recurrent inguinal hernia (Recurrent Group).

Results

Four hundred and sixty-one (82.2?%) patients were included in the study, of whom 211 (45.8?%) was in the Primary Group and 250 (54.2?%) in the Recurrent Group. The incidence of unsuspected femoral hernia in the Recurrent Group [23/250, 9.2?% (95?% CI 5.9–13.5?%)] was significantly higher than in the Primary Group [8/211, 3.8?% (95?% CI 1.7–7.3?%)], p?=?0.02. Furthermore, 38.1?% of women operated on for a recurrent inguinal hernia, presented with an unsuspected femoral hernia at surgery as opposed to 6.6?% of the men, p?=?0.003.

Conclusion

Unsuspected femoral hernias are more prevalent in patients with recurrent hernia than in patients with primary hernia in the inguinal region. Femoral hernias may be unrecognized at the primary inguinal hernia operation, or the previous inguinal hernia operation may facilitate the formation of a femoral hernia. Unsuspected femoral hernias are especially frequent in women with recurrent inguinal hernia. In women with a groin hernia, a femoral hernia should always be excluded by laparoscopy or by open exploration of the preperitoneal space.     

Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials

Background

Laparoscopic total extraperitoneal (TEP) inguinal hernioplasty is significantly less painful than open repair, but it is not completely painless. Local anesthetics are thought to decrease postoperative pain when placed at the surgical site. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of extraperitoneal bupivacaine treatment during laparoscopic inguinal hernia repair for the reduction of postoperative pain.

Methods

We conducted a systematic review and meta-analysis of RCTs that investigated the outcomes of extraperitoneal bupivacaine analgesia versus control in laparoscopic TEP hernia repair. Pain was assessed using a visual analog scale at 4–6 h and at 24 h following the surgery. The secondary outcomes included complications and analgesia consumption.

Results

We reviewed eight trials that included a total of 373 patients. We found no difference between the groups in postoperative pain reduction following laparoscopic TEP inguinal hernia repair. The intensity of pain was not significantly different between the bupivacaine treatment group and the control group. The pooled mean differences in pain scores were ?0.26 (95 % CI ?0.72 to 0.21) at 4–6 h and ?0.47 (95 % CI ?1.24 to 0.29) at 24 h. No bupivacaine-related complications were reported.

Conclusion

Extraperitoneal bupivacaine treatment during laparoscopic TEP inguinal hernioplasty is not more efficacious for the reduction of postoperative pain than placebo.     

Patient perception of laparoscopic versus open mesh repair of inguinal hernia, the hard sell

Background

Inguinal hernia repairs are one of the most commonly performed procedures in the UK. This study examined the adequacy of the consent process for inguinal hernia repair focusing on the patients’ understanding of the relative risks and benefits of laparoscopic versus open repair.

Methods

The study consisted of a retrospective postal questionnaire poll of 200 patients (162 males and 38 females) aged between 42 and 85 who had been assessed in the surgical outpatients (within the last 12?months) and received counselling regarding their inguinal hernia repair. Patient perception regarding the risks and merit of laparoscopic versus open repair was surveyed using a multiple-choice questionnaire.

Results

One hundred and twenty patients (60?%) returned their questionnaires, after excluding recurrent and bilateral hernias; 97 patients were entered into the study. The majority of patients reported a perception that a laparoscopic repair was safer and quicker than open (61.5 and 75.4?%, respectively); 29.2?% of patients felt that the recurrence rate was lower with a laparoscopic repair with 50.8?% of patients expressing that open repair had a higher complication rate than laparoscopic treatment; 81.5?% of patients correctly appreciated that laparoscopic repair had a quicker return to work; and 76.9?% of patients felt that laparoscopic repair was the only method, which could be undertaken as a day case procedure.

Conclusion

The results show that many patients have an incorrect perception of laparoscopic inguinal hernia repair, which may reflect an inadequate consent and counselling process. No definitive evidence exists regarding the superior safety and efficacy of one method over another, but it would appear that a significant number of patients are unaware of this.     

Laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments: a 15-year, single-center experience in 317 patients

Background

Laparoscopic inguinal hernia repair is associated with a decrease in postoperative pain, shortened hospital stay, earlier return to normal activity, and decrease in chronic pain. Moreover, laparoscopic surgery performed with needlescopic instruments has more advantages than conventional laparoscopic surgery. However, there are few reports of large-scale laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments (nTAPP). This report reviews our experiences with 352 nTAPP in 317 patients during the 15-year period from April 1996 to April 2011.

Methods

We performed nTAPP as the method of choice in 88.5% of all patients presenting with inguinal hernia. To perform the nTAPP, 3-mm instruments were used. A 5-mm laparoscope was inserted from the umbilicus, and surgical instruments were inserted through 5- and 3-mm trocars. After reduction of the hernia sac and dissection of the preperitoneal space, we placed polyester mesh or polypropylene soft mesh with staple fixation. The peritoneum was closed with 3–0 silk interrupted sutures.

Results

The mean operative time was 102.9?min for unilateral hernias and 155.8?min for bilateral hernias. There was no conversion to open repair. Forty-three patients (13.6%) used postoperative analgesics, and the mean frequency of use was 0.5 times. Regarding intraoperative complications, we observed one bladder injury, but no bowel injuries or major vessel injuries. Postoperative complications occurred in 32 patients (10.1%). One patient with a retained lipoma required reoperation. There was no incidence of chronic pain or mesh infection. The operative time for experienced surgeons (≥20 repairs) was significantly shorter than that of inexperienced surgeons (<20 repairs; P?Conclusions The nTAPP was a safe and useful technique for inguinal hernia repair. Large prospective, randomized controlled trials will be required to establish the benefit of nTAPP.     

Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study

Background

Multiple prospective studies have confirmed safety and efficacy of laparoscopic inguinal herniorraphy with single-port compared to multiport surgery. This prospective randomized controlled trial aimed to assess safety, efficacy and potential benefits of single-port total extraperitoneal inguinal herniorraphy beyond the learning curve.

Methods

All referred patients with inguinal/femoral hernias were enrolled from December 2011 to February 2013. Exclusion criteria included workers compensation cases. Identical balloon dissector, light-weight mesh and non-absorbable tacks were used in all cases. For single-port cases Triport? was used while structural balloon trocar/inflation bulb for multiport cases. Results were analyzed with IBM^® SPSS^® version 22 for Windows.

Results

Participation rate was 100 % with 157 inguinal/femoral hernias in 100 patients: 51 randomized to single-port and 49 to multiport group. There was no conversion to open surgery/need for additional ports. There were no statistical differences between single-port and multiport groups with respect to age, sex, body mass index, American Society of Anesthesiologists scores, preoperative pain, hernia defect sizes and length of hospital stay. Operation times were equivalent for single-port and multiport 60.0 vs 61.0 min, P = 0.23, respectively. Significantly, single-port patients ingested fewer pain killers: 6 tablets vs 14 Dextropropoxyphene tablets, P < 0.001, experienced less pain (visual analog scores) on day 1 and 7 post-op op: 2.5 and 0, P < 0.001 compared to 4.5 and 2.5, P < 0.001, respectively, returned to work/normal physical activities 7 days quicker: 7.0 vs 14.0, P < 0.001 and had higher cosmetic scar scores at 6-week follow-up: 24 vs 21, P < 0.001, compared to multiport patients. There were no mortalities, morbidities or recurrences after follow-up of 6–21 months.

Conclusions

Compared to multiport, single-port laparoscopic total extraperitoneal inguinal herniorraphy, when performed by a high-volume and highly dedicated hernia surgeon, resulted in significantly reduced postoperative pain, analgesic requirements, quicker return to work/normal activities, improved cosmesis, and equivalent safety and efficacy.     

Extending the limitations of liver surgery: outcomes of initial human experience in a high-volume center performing single-port laparoscopic liver resection for hepatocellular carcinoma

Background

Single-port laparoscopic surgery is slowly but steadily gaining popularity among surgeons performing minimally invasive abdominal surgeries. The aim of the present study is to assess our initial experience with single-port laparoscopic liver resection for hepatocellular carcinoma.

Methods

Between March 2009 and April 2011, 24 patients underwent single-port laparoscopic liver resection for hepatocellular carcinoma. Of these, 13 were laparoscopic segmentectomies, 4 were laparoscopic left lateral sectionectomies, 1 was a right hepatectomy, 1 was a left hepatectomy, and 4 were nonanatomical resections.

Results

Median operating time and blood loss were 205?min (95–545?min) and 500?ml (100–2,500?ml), respectively. Two procedures were converted to multiport laparoscopic hepatectomy due to instrument length limitations, and four were converted to open surgery. There were no serious intraoperative or postoperative complications in this series. Median postoperative stay was 8.5?days (5–16?days).

Conclusions

Although the procedure requires a lot of technical expertise added to the skill of liver surgery, single-port laparoscopic liver resection for hepatocellular carcinoma seems a feasible approach in a variety of well-selected cases. In spite of the demanding nature of the procedure and the requirement of better instrumentation for single-port laparoscopic surgery, the results seem to compare favorably with conventional laparoscopic surgery and open surgery.     

Single-port laparoscopic herniorrhaphy using a two-hooked cannula device with hydrodissection

Background

Laparoscopic percutaneous extraperitoneal closure (LPEC) with variable devices seems to be one of the most simple and reliable methods. We described our modifications of single-port laparoscopic herniorrhaphy using an inner two-hooked cannula device with preperitoneal hydrodissection.

Modified single-port vs two-port laparoscopic herniorrhaphy for children with concealed deferent duct: a retrospective study from a single institution

Purpose

Single-port laparoscopic herniorrhaphy is widely employed for indirect inguinal hernia repair in children. However, few surgeons utilize the single-port technique to repair such hernias with concealed deferent ducts. The aim of this study was to assess the application of the modified single-port laparoscopic technique (MSPT) in cases with concealed deferent ducts and to compare the results to those obtained with the two-port technique (TPT).

Methods

Between January 2006 and January 2012, all consecutive cases were retrospectively studied. The inclusion criteria were as follows: (1) age no more than 3 years; and (2) a concealed deferent duct identified by laparoscopy. Two-hundred and three children were treated using TPT from January 2006 to December 2008. One-hundred and ninety-three children were treated using MSPT from January 2009 to January 2012. The clinical variables and surgical outcomes were compared between the two groups.

Results

The differences in operation duration, vessel injury, conversion, postoperative hydrocele occurrence and umbilical hernia were not significant between the two groups. Ipsilateral groin swelling was more common in the MSPT group. No wound infection, recurrence, metachronous hernia or testicular atrophy occurred in either group.

Conclusions

Despite the high incidence of ipsilateral groin swelling, MSPT is a feasible alternative to TPT in children with indirect inguinal hernias with multiple peritoneal folds. Furthermore, we have developed a new method to explore the contralateral groin using a single-port technique.

     

The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions

Purpose

Experience with a novel hernioplasty procedure—the ONSTEP approach—for inguinal hernia repair in a large series of patients performed by two surgeons at two institutions is described, focusing in particular on the duration of surgery, the time taken to return to normal activities, chronic pain, complication and recurrence rates.

Methods

Adult patients underwent inguinal hernia repair using the ONSTEP approach. The hernia defect was repaired using a PolySoft? hernia patch. Patients were followed up for 1 year for pain, complications and recurrences.

Results

A total of 693 patients underwent ONSTEP inguinal hernia repair. The mean duration of surgery (±SD) was 17 ± 6 min; the time to discharge from hospital was less than 24 h in all patients; and the mean time to return to normal daily activities was 6.1 ± 3.0 days. The overall complication rate was 1.0 % and the overall recurrence rate was 0.6 %. Residual pain was present in 4 patients at 6 months and was cured by removal of the memory ring in 3 patients and disappeared spontaneously in one case, so that there was no case of chronic pain at 1 year.

Conclusions

The ONSTEP inguinal hernia repair technique described is simple, quick to perform, produces consistent results and is associated with very low overall complication, chronic pain and recurrence rates. It may offer an alternative to both Lichtenstein and laparoscopic inguinal hernia repair.     

Direct and Recurrent Inguinal Hernias Are Associated with Ventral Hernia Repair: A Database Study

Background

A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery.

Methods

In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair.

Results

Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08–1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39–2.23]) inguinal hernias were significantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic).

Conclusions

Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the first study to show that herniogenesis is associated with type of inguinal hernia.     

Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal (TEP) groin hernia repairs using fibrin glue (Tisseel?): a United Kingdom experience

Purpose

The use of fibrin sealant (FS) (Tisseel?) for mesh fixation in patients undergoing laparoscopic groin hernia surgery is a well-recognised technique in Europe, but no study to date has examined effect on quality of life (QoL) on patients undergoing FS mesh fixation. A prospective study was therefore conducted to examine the effects on QoL of patients undergoing laparoscopic groin hernia surgery using FS in the United Kingdom.

Materials and methods

Between March 2007 and January 2011, all patients undergoing laparoscopic total extra preperitoneal (TEP) groin hernia repair using FS were included in the study. A validated hernia questionnaire from The Royal College of Surgeons of England supplemented by the EORTC QLQ C-30 to assess the pre- and postoperative QoL, pain scores and health outcome measures was used. All the patient??s demographics, duration of surgery, size of hernia, recurrence, morbidity and hospital stay were recorded.

Results

Data from 92 patients (87 males and 5 females) with a median age of 46?years (range, 19?C82?years) was collected for the study (response rate of 92/121, 73?%). A total of 58 patients (63?%) had a unilateral and 34 patients (37?%) a bilateral hernia repair, of which 6 (7?%) were recurrent inguinal hernia. The mean operating time for a unilateral hernia was 36?min (30?C62), and that for a bilateral hernia was 59?min (51?C83). There were no conversions to open surgery out of the 92 patients included with the recorded morbidity of 7?%. There were no early recurrences. Eighty-nine patients (98?%) of patients were discharged in the first 24?h after surgery. There was a significant statistical difference recorded in patients visual analogue pain score (VAS 0?C10) before and after surgery (P?<?0.0001, Mann?CWhitney U test). The physical, emotional, social and health components of the questionnaire were statistically significant pre- and postoperatively (P?<?0.001 Mann?CWhitney U test).

Conclusion

Groin hernia TEP repair with FS fixation did not have a detrimental effect on QoL and pain scores. In addition, the low early recurrence rate provided good evidence of the mesh fixation properties of FS. FS can therefore be continued to be recommended, as an alternative fixation method in laparoscopic groin hernia surgery.     

Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study

Purpose

Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation.

Methods

This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005.

Results

There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014).

Conclusions

An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.     

Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis

Background

Reinforcement of inguinal hernia repair with prosthetic mesh is standard practice but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in lighter-weight mesh. Minimally invasive approaches have also significantly reduced postoperative recovery from inguinal hernia repair. The aim of this systematic review was to compare the outcomes after laparoscopic inguinal repair using new lightweight or traditional heavyweight mesh in published randomised controlled trials.

Methods

Medline, Embase, trial registries, conference proceedings, and reference lists were searched for controlled trials of heavyweight versus lightweight mesh for laparoscopic repair of inguinal hernias. The primary outcomes were recurrence and chronic pain. Secondary outcomes were visual analogue pain score at 7?days postoperatively, seroma formation, and time to return to work. Risk differences were calculated for categorical outcomes and standardised mean differences for continuous outcomes.

Results

Eight trials were included in the analysis of 1,667 hernias in 1,592 patients. Mean study follow-up was between 2 and 60?months. There was no effect on recurrence [pooled analysis risk difference 0.00 (95% CI ?0.01 to 0.01), p?=?0.86] or chronic pain [pooled analysis risk difference ?0.02 (95% CI ?0.04 to 0.00); p?=?0.1]. Lightweight and heavyweight mesh repair had similar outcomes with regard to postoperative pain, seroma development, and time to return to work.

Conclusion

Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.     

Single incision laparoscopic totally extraperitoneal inguinal hernia repair

Aims

Various single incision laparoscopic surgeries (SILS) and natural orifice transluminal endoscopic surgeries (NOTES) have been reported recently. Herein we performed SILS for totally extraperitoneal inguinal hernia repair (TEP) on three cases.

Cases

Three males of 72, 49, and 73?years old with the diagnoses of bilateral primary inguinal hernia underwent single incision TEP. The operative steps of single incision TEP are very similar to those of a traditional laparoscopic TEP. The difference between them is a 2?cm infraumbilical incision for the placement of three (5?mm) trocars in single incision TEP. We preferred to use a 30° 5?mm laparoscope with some routine laparoscopic instruments during the surgical procedure. All the hernia defects were repaired with VyproII of 15?×?10?cm (Ethicon, NJ, USA). The operations took 32, 26, and 65?min, respectively, with no obvious inconvenience.

Results

All three patients were discharged on the second postoperative day uneventfully. The postoperative follow-up showed no recurrence in the three patients up to now.

Conclusion

The single incision TEP using an access port device is safe and feasible. Meanwhile SILS may reduce medical costs and complication rates through practice and improvement of SILS instruments.