High recurrence rate 12 years after primary inguinal hernia repair.

OBJECTIVE: To find out the long term recurrence rate after repair of the inguinal ligament (Griffith) for inguinal hernia in one hospital. DESIGN: Retrospective study. SETTINGS: Teaching hospital, The Netherlands. SUBJECTS AND INTERVENTION: All patients who had had a Griffith repair for a primary inguinal hernia in 1985 were re-examined after at least 12 years by an independent examiner. RESULTS: Of the 102 patients included in the study, 45 patients had died and 17 could not be traced. Of the remaining 40 patients (45 hernias), 10 (22%) had developed recurrences. In 4 patients the asymptomatic hernia was discovered by the investigator. 11 further patients had developed a hernia on the opposite site resulting in a total of 16 patients (40%) with bilateral hernias. CONCLUSIONS: The long term recurrence rate of an inguinal hernia by reconstruction of the inguinal ligament is high and even higher when assessed by physical examination. The high recurrence rate and frequent bilateral recurrence might favour repairs with mesh reinforcement.     

Surgical training and inguinal hernia repair

AIMS: To evaluate influence of surgical experience on inguinal hernia repair. PATIENTS: From 1997 to 2003, 380 patients (mean age 55 years old) with primary unilateral inguinal hernia were treated by Lichtenstein technique. METHODS: In this retrospective study, surgeons were classified in three groups: group 1: hernia repair was performed by an experimented surgeon (consultant or senior registrar) and a young surgical trainee (resident) (161 cases); group 2: surgery was performed by a junior surgeon (resident) under the control of an experimented surgeon (135 cases) and in the group 3 (84 cases), Lichtenstein technique was performed by two residents, alone, supervised by an experimented surgeon, in the operative room. Evaluation criterion were operative time, hospital stay, morbidity, time to return to normal and professional activities, recurrences and chronic pain with a follow up of, at least, 2 years. RESULTS: The three groups were comparable in term of socio economic data, hernia and follow up. The only significant (P=0.01) difference concern operative time which increased from 20% for group 2 and 3 (residents) compared to the group 1. There was also no difference between junior and senior resident. CONCLUSION: Lichtenstein hernia repair should be performed by young surgeon in training alone in condition of precise teaching organization and experimented surgeon supervision. For patient, in this condition, there is no trouble in term of surgical results.     

Causes of recurrence in laparoscopic inguinal hernia repair

Purpose

Recurrence after laparoscopic inguinal herniorrhaphy is poorly understood. Reports suggest that up to 13% of all inguinal herniorrhaphies worldwide, irrespective of the approach, are repaired for recurrence. We aim to review the risk factors responsible for these recurrences in laparoscopic mesh techniques.

Methods

A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English language, peer reviewed articles on the causes of recurrence following laparoscopic mesh inguinal herniorrhaphy published between 1990 and 2018. The search terms included ‘Laparoscopic methods’, ‘Inguinal hernia; Mesh repair’, ‘Recurrence’, ‘Causes’, ‘Humans’.

Results

The literature revealed several contributing risk factors that were responsible for recurrence following laparoscopic mesh inguinal herniorrhaphy. These included modifiable and non-modifiable risk factors related to patient and surgical techniques.

Conclusions

Recurrence can occur at any stage following inguinal hernia surgery. Patients’ risk factors such as higher BMI, smoking, diabetes and postoperative surgical site infections increase the risk of recurrence and can be modified. Amongst the surgical factors, surgeon’s experience, larger mesh with better tissue overlap and careful surgical techniques to reduce the incidence of seroma or hematoma help reduce the recurrence rate. Other factors including type of mesh and fixation of mesh have not shown any difference in the incidence of recurrence. It is hoped that future randomized controlled trials will address some of these issues and initiate preoperative management strategies to modify some of these risk factors to lower the risk of recurrence following laparoscopic inguinal herniorrhaphy.

     

Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia

BACKGROUND: The Shouldice technique is the 'gold standard' of open non-mesh hernia repair. The aim of this study was to compare 5-year recurrence rates after Shouldice and laparoscopic transabdominal preperitoneal patch (TAPP) repair for primary inguinal hernia. METHOD: Men with a primary unilateral inguinal hernia were randomized to either Shouldice or TAPP operation. An independent observer scored the surgeons' performance. Follow-up comprised clinical examination after 1 year, a questionnaire after 2 and 3 years, and a clinical examination after 5 years. RESULTS: Between February 1993 and March 1996, 1183 patients were included. Nine hundred and twenty patients were followed for 5 years, 454 in the TAPP group and 466 in the Shouldice group. Recurrences were evenly distributed between groups throughout the follow-up period. The cumulative recurrence rate after 5 years was 6.6 per cent in the TAPP group and 6.7 per cent in the Shouldice group. Postoperative pain was a risk factor for recurrence after Shouldice operation but not after TAPP repair. There was a correlation between a low surgeon's performance score and recurrence. CONCLUSION: The 5-year recurrence rate is acceptable, with no difference between TAPP and Shouldice repair. Poor operative performance resulted in a higher recurrence rate. The TAPP operation represents an excellent alternative for primary inguinal hernia repair.     

Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair

Background/Purpose

Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons.

Methods

All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The χ² test was used for nominal data and the Student's t test was used for continuous variables. Probabilities were calculated based on a logistic regression model.

Results

Of 20,545 eligible hernia repairs, 50.3% were performed by pediatric surgeons and 49.7% were performed by general surgeons. Pediatric surgeons operated on 62.4% of children younger than 2 years, 51.8% of children aged 26 years, and 37% of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10% vs 0.45%, P < .001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons.

Conclusions

Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.     

腹腔镜经腹腹膜前疝修补术后复发的危险因素分析及风险模型的建立

目的分析腹腔镜经腹腹膜前疝修补术（TAPP）术后复发的危险因素,并建立风险预测模型。 方法回顾性分析2018年3月至2020年7月铜陵市人民医院及安庆市立医院行TAPP诊治的230例腹股沟疝患者的临床资料,单因素分析和Logistic多因素回归分析筛选经TAPP腹股沟疝修补术后复发的危险因素,以构建风险预测模型,并对模型进行验证。 结果操作TAPP的例数（OR=3.337,95% CI：1.357~8.401）、术中出血量>10 ml（OR=2.925,95% CI：1.027~8.328）、手术时间>2 h（OR=2.492,95% CI：0.885~7.014）、疝囊最大直径>5 cm（OR=2.675,95% CI：1.018~7.031）、嵌顿疝（OR=7.329,95% CI：2.162~24.56）是经TAPP腹股沟疝修补术后复发的独立危险因素,基于五项独立危险因素构建预测术后复发的风险列线图模型,并验证模型的预测准确度,实际值比较接近预测值,一致性指数C-index为0.833（95% CI：0.814~0.851）,表明该模型预测精准度较好。 结论操作TAPP的例数、术中出血量>10 ml、手术时间>2 h、疝囊最大直径>5 cm及嵌顿疝是经TAPP腹股沟疝修补术后复发的独立危险因素,其建立的风险预测模型精准度较高,可以指导医务人员分析患者术后复发的风险程度,具有较高的临床应用价值。     

Hernia recurrence following inguinal hernia repair in children

Purpose

We aimed to describe the incidence, timing, and predictors of recurrence following inguinal hernia repair (IHR) in children.

Laparoscopic treatment (reTAPP) for recurrence after laparoscopic inguinal hernia repair

Hernia - For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following...     

麻醉方式对开放腹股沟疝修补术后疼痛因素的影响

目的探讨开放腹股沟疝修补术后疼痛的相关因素。 方法前瞻性收集2016年3月至2018年2月中日友好医院普外科进行手术治疗的腹股沟疝患者188例。所有手术均由同一位主刀医师完成。收集患者的基本临床信息,利用数字量表评分（NRS）对患者术前输液穿刺疼痛,术后6、24 h伤口疼痛程度进行评估。相关性分析采用Pearson相关分析和Spearman秩相关分析。采用多因素Logistic回归分析风险因素与疼痛的独立相关关系。 结果术后6 h伤口疼痛与年龄呈负相关（R=-0.152,P<0.05）。与麻醉方式具有显著相关性（R=0.164,P<0.05）。与性别、体质量指数（BMI）、手术部位、腹股沟疝分型、手术方式、手术时间无显著相关性。术后24 h伤口疼痛与年龄呈负相关（R=-0.18,P<0.05）。与手术部位、麻醉方式及手术时间具有显著相关性（P<0.05）。与性别、BMI、腹股沟疝分型、手术方式无显著相关性。经过性别、年龄和BMI校正,Logistic多因素分析结果显示麻醉方式是术后伤口疼痛的独立相关因素。 结论在局部麻醉加强化的麻醉方式下施行小切口无张力疝修补术,能有效减轻患者术后伤口早期疼痛感,有利于患者早期出院,对临床具有一定的参考意义。     

Pyoderma gangrenosum after inguinal hernia repair

Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic illness. In rare cases, PG occurs after surgery, which can lead to delayed diagnosis as other causes such as wound breakdown or bacterial/fungal infection are considered. We report a rare case of PG following the repair of an inguinal hernia, and review the presentation of this disease after surgery.     

Adhesions after laparoscopic inguinal hernia repair

Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n=15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P=0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.Paper based on a communication to the European Association for Endoscopic Surgery in Cologne, Germany, June 1993     

Pseudo-recurrence after laparoscopic inguinal hernia repair

Aim-Background

Pseudo-recurrence after laparoscopic hernia repair, though known, is poorly understood. Common causes of pseudo-recurrence are pneumoscrotum, haematoma, seroma, cord thickening and persistent cough impulse.

Aim

To analyze the incidence of pseudo-recurrence and its impact on morbidity after laparoscopic inguinal hernia repair.

Methods

All laparoscopic inguinal hernia repair cases performed by a single surgical unit over a period of five years from April 2007 till March 2012 were retrospectively analyzed.

Results

Among 243 operated laparoscopic inguinal hernia repairs (TEP and TAPP) included in the study, twenty (8.26%) cases displayed a pneumoscrotum, eighteen (7.43%) a haematoma, twenty-four (9.98%) a seroma, eight (3.29%) cord thickening, and six (2.46%) persistent cough impulse. All patients were managed conservatively with the exception of one case of seroma which had to be aspirated.

Conclusion

Pseudo-recurrence following laparoscopic inguinal hernia repair, though common, has no significant impact on morbidity. Recognition of the problem is important to continue conservative management and avoid intervention.

     

Incidence of inguinal hernia recurrence. Effect of time off work after repair.

A survey of 260 adult male patients who had undergone inguinal hernia repair was carried out to see how long they stayed off work after operation. There was no evidence that a prolonged convalescent period reduced the subsequent hernia recurrence rate. Evidence from the North American literature suggests that patients can resume their usual physical activity without ill effect much sooner after operation than is the current practice in the United Kingdom. General practitioners should be informed of the advice that has been given to their patients about the resumption of physical activities after operation.     

腹腔镜腹股沟疝修补与开放性腹股沟疝修补的疗效对比研究

【摘要】〓目的〓比较腹腔镜腹股沟疝修补与开放性腹股沟疝修补的优缺点。方法 对2012年5月~2013年5月中山市中医院240例成人腹股沟疝修补术进行回顾性分析,其中开放性疝修补术(开腹疝修补组)148例,腹腔镜疝修补术(腔镜疝修补组)92例。收集两组患者的手术时间、住院时间、住院费用、术后复发、术后慢性疼痛、术后阴囊积液及术后感染的临床资料并进行比较。 结果 开腹疝修补组患者在平均手术时间、平均住院费用少于腔镜疝修补(P均<0.01);开腹疝修补组术后复发(3例)、术后慢性疼痛(11例)、术后阴囊积液(2例)及术后感染(1例)等总并发症高于腔镜疝修补组(P<0.05);两组的平均住院时间差异无统计学意义。结论 腔镜组腹股沟疝修补术具有较少的术后并发症,但在住院时间、住院费用方面没有优势。     

Chronic pain after Kugel inguinal hernia repair

Background The incidence of chronic pain after Kugel herniorrhaphy is not well documented, since it was not used as a primary outcome measure in studies reporting on the Kugel technique. The aim of the present study was to report on the incidence and severity of chronic pain 1 year after Kugel herniorrhaphy and to identify the risk factors associated with the development of chronic pain. Methods The study population comprised all patients in our teaching hospital who underwent a Kugel inguinal hernia repair between January 2002 and June 2005. Postoperative complications, analgesia consumption and postoperative functional impairment were recorded during an outpatient clinic after 4–6 weeks. Chronic pain and cutaneous sensory changes were followed-up by means of a telephone questionnaire 1 year after surgery. Results After 1 year, 57 (15.1%) of 377 patients complained of mild to moderate pain. The incidence of mild and moderate chronic pain was 14.3 and 0.8%, respectively. None of the patients had severe chronic pain. Only one patient reported numbness in the groin area. Age and immediate postoperative pain were significant risk factors associated with chronic pain after Kugel inguinal herniorrhaphy. Although the difference was not significant, female patients seemed to be more prone to develop chronic pain. Conclusions The Kugel inguinal hernia repair is associated with a low rate of postoperative chronic pain. The minimally invasive preperitoneal approach of the Kugel technique probably causes less nerve damage and subsequent neuropathic pain. Chronic pain seems to be more common in young female patients with immediate postoperative pain.     

Towards a near-zero recurrence rate in laparoscopic inguinal hernia repair for pediatric patients of all ages

Background/Purpose

The recurrence rate in laparoscopic inguinal hernia (LIH) repair remains high. The aim of this study was to assess whether the introduction of technical improvements, including (1) decreasing tension on the purse-string knot when closing the internal hernia opening by injecting normal saline extraperitoneally, (2) using an airtight knot, and (3) stress-testing the airtightness of the knot by increasing intraperitoneal gas pressure, could eliminate recurrence in LIH repair in pediatric patients of all ages.

Methods

A retrospective review was performed of the prospectively collected data of 451 LIH repairs in 314 children of various ages in our institution from September 2002 to September 2006. The technical improvements mentioned above to prevent recurrence were introduced in the second half of the series of operations (tensionless repair [TL]). The data on both groups of operations were then compared.

Results

A total of 225 hernias were repaired in the first group (164 patients), compared with 226 in the TL group (150 patients). The differences between the ratio of boys to girls (129:35 vs 112:38) and the mean ages (50.84 ± 48.15 vs 45.59 ± 47.95 m) in the 2 groups were not statistically significant. The recurrence rate in the TL group was much lower than in the first group (0.4% vs 4.88%, P = .003). There was no postoperative testicular atrophy in either group of patients.

Conclusion

It is possible to achieve a near-zero recurrence rate in laparoscopic hernia repair in pediatric patients of all ages.     

Pain characteristics after laparoscopic inguinal hernia repair

Background  

Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP).