Shouldice, Lichtensteino ir laparoskopinių transabdominalinių preperitoninių kirkšninių išvaržų operacijų ankstyvieji rezultatai

Vytautas Lipnickas1, Mindaugas Kiudelis2, Andrius Gradauskas3, Nerijus Kaselis4, Kęstutis Strupas11 Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius;2 Kauno medicinos universiteto klinikų Chirurgijos klinika;3 Vilniaus miesto universitetinė ligoninė;4 Klaipėdos miesto ligoninėEl paštas: [email protected] Įvadas / tikslas Kirkšninių išvaržų chirurginio gydymo būdų yra daug. Kuris geriausias – nėra aišku. Lietuvoje atlikta pirmoji daugiacentrė perspektyvioji atsitiktinių imčių klinikinė studija. Šio straipsnio tikslas – pateikti minėtos studijos, kurioje palygintos Shouldice, Lichtensteino ir laparoskopinės TAPP kirkšninių išvaržų operacijos, ankstyvuosius rezultatus. Ligoniai ir metodai 2003 metų sausio–gruodžio mėnesiais keturiose Lietuvos ligoninėse pagal Lietuvos bioetikos komiteto patvirtintą daugiacentrės perspektyviosios atsitiktinių imčių klinikinės studijos protokolą buvo operuoti 248 ligoniai. Operacijos atliktos pagal standartizuotus Shouldice, Lichtensteino ir laparoskopinės TAPP kirkšninių išvaržų operacijų protokolus. Rezultatai Ankstyvieji studijos rezultatai parodė, kad visos operacijos yra saugios. Statistiškai reikšmingas skirtumas gautas vertinant operacijos trukmę bei hospitalizacijos laiką – laparoskopinės TAPP operacijos trunka statistiškai reikšmingai ilgiau nei atvirosios, tačiau po laparoskopinių operacijų hospitalizacijos laikas yra statistiškai reikšmingai trumpesnis (p = 0,026 lyginant laparoskopines ir Lichtensteino operacijas). Ankstyvas pooperacinis skausmas statistiškai reikšmingai mažesnis (p < 0,05 po 8 val., p < 0,01 po 24 val.) buvo po laparoskopinių operacijų. Praėjus dviem savaitėms skausmą operacijos vietoje nurodė 36 (42,3%) pacientai po Shouldice operacijos, 23 (28,4%) – po Lichtensteino ir tik 2 (2,4%) – po laparoskopinės TAPP operacijos, o jokių skundų neturėjo atitinkamai 38 (44,7%), 45 (55,6%) ir 63 (76,8%) ligoniai. Išvados Laparoskopinė TAPP operacija yra mažiausią skausmą sukelianti ir labiausiai ligoniui patogi operacija; be to, po šios operacijos hospitalizacijos laikas yra trumpiausias. Tačiau operacija trunka statistiškai reikšmingai ilgiau ir jai atlikti reikia bendrinės nejautros. Reikšminiai žodžiai: kirkšninė išvarža, transabdominalinė preperitoninė (TAPP) hernioplastika, ankstyvieji rezultatai Early results of Shouldice vs Lichtenstein vs laparoscopic transabdominal preperitoneal inguinal hernia repair: multicenter randomized clinical trial Vytautas Lipnickas1, Mindaugas Kiudelis2, Andrius Gradauskas3, Nerijus Kaselis4, Kęstutis Strupas11 Vilnius University Hospital Santariškių Klinikos, Centre of Abdominal Surgery,Santariškių 2, LT-08661 Vilnius, Lithuania;2 Kaunas University of Medicine, Clinic of Surgery;3 Vilnius City University Hospital;4 Klaipėda City HospitalE-mail: [email protected] Background / objective Open anterior inguinal hernia repair is a time-tested, safe and well-understood operation with a high success rate, while laparoscopic techniques are fairly recent; their short- and long-term outcomes are still being evaluated, but the best method of inguinal hernia repair is still unclear. Methods A prospective randomized multicenter clinical trial was performed in four surgical centers of Lithuania. Patients were operated on from January to December, 2003. Intraoperative, early and late postoperative complications, time of operation, hospital stay, postoperative pain evaluation, frequency of recurrence and changes of quality of life of laparoscopic TAPP (n = 82), Lichtenstein (n = 81) and Shouldice (n = 85) hernia repair were compared. Results The mean operative time in the laparoscopic TAPP group was significantly longer than the mean operative time in Lichtenstein and Shouldice hernia repair group. There were no major intraoperative complications and only two postoperative wound infections in the Shouldice and Lichtenstein group. There was no difference in the frequency of minor intraoperative and early postoperative complications in the groups. The mean pain scores in the laparoscopic TAPP group were significantly lower than the corresponding scores in the Lichtenstein and Shouldice group (p < 0.05 at 8 h after operation and p < 0.01 at 24 h after operation). Statistically significant differences were found in hospital stay, the shortest stay being recorded in the laparoscopic TAPP group (p = 0.026 comparing laparoscopic TAPP and Lichtenstein hernia repair). 36 (42.3%) patients in the Shouldice and 23 (28.4%) in the Lichtenstein group felt a moderate or mild pain 2 weeks postoperatively, while there were only 2 (2.4%) patients with a mild pain in the laparoscopic TAPP group. There were 38 (44.7%) patients in the Shouldice group, 45 (55.6%) in Lichtenstein group and 63 (76.8%) patients in laparoscopic TAPP group without any complaint after 2 weeks. There were no recurrences at 2 weeks postoperatively. Conclusions The laparoscopic TAPP, Lichtenstein and Shouldice hernia repair are equally safe and have no major intraoperative complications. The laparoscopic TAPP inguinal hernia repair is associated with less postoperative pain and sensitivity disorders, shortest hospital stay, but it requires general anaesthesia and a longer operating time. Keywords: groin hernia, transabdominal preperitoneal (TAPP) hernioplasty, early results

Download Full-text

Outcomes of an innovative training course in laparoscopic hernia repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0094 ◽

2017 ◽

Vol 99 (8) ◽

pp. 614-616 ◽

Cited By ~ 1

Author(s):

D Light ◽

S Bawa ◽

P Gallagher ◽

L Horgan

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Ventral Hernia ◽

Inguinal Hernia Repair ◽

Ventral Hernia Repair ◽

Operative Time ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Hernia Surgery ◽

The Mean

Introduction The Ethicon™ laparoscopic inguinal groin hernia training (LIGHT) course is an educational course based on three days of teaching on laparoscopic hernia surgery. The first day involves didactic lectures with tutorials. The second day involves practical cadaveric procedures in laparoscopic hernia surgery. The third day involves direct supervision by a consultant surgeon during laparoscopic hernia surgery on a real patient. We reviewed our outcomes for procedures performed on real patients on the final day of the course for early complications and outcomes. Methods A retrospective study was undertaken of patients who had laparoscopic hernia surgery as part of the LIGHT course from 2013 to 2015. A matched control cohort of patients who had elective laparoscopic hernia surgery over the study period was identified. These patients had their surgery performed by the same consultant general surgeons involved in delivering the course. All patients were followed up at 6 weeks postoperatively. Results A total of 60 patients had a laparoscopic inguinal hernia repair and 23 patients had a laparoscopic ventral hernia repair during the course. The mean operative time for laparoscopic inguinal hernia repair was 48 minutes for trainees (range 22–90 minutes) and 35 minutes for consultant surgeons (range 18–80 minutes). There were no intraoperative injuries or returns to theatre in either group. All the patients operated on during the course were successfully performed as daycase procedures. The mean operative time for laparoscopic ventral hernia repair was 64 minutes for trainees (range 40–120 minutes) and 51 minutes for consultant surgeons (range 30–130 minutes). Conclusions The outcomes of patients operated on during the LIGHT course are comparable to procedures performed by a consultant. Supervised operating by trainees is a safe and effective educational model in hernia surgery.

Download Full-text

Laparoscopic Inguinal Hernia Repair—TAPP versus TEP: Results of 301 Consecutive Patients

Surgical Technology Online ◽

10.52198/21.sti.39.hr1427 ◽

2021 ◽

Vol 39 ◽

Author(s):

Beslen Goksoy ◽

◽

Gokhan Yilmaz ◽

Ibrahim Azamat ◽

Ibrahim Ozata ◽

...

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Laparoscopic Inguinal Hernia Repair ◽

Secondary Outcome ◽

Unilateral Inguinal Hernia ◽

Laparoscopic Inguinal Hernia ◽

The Mean

Introduction: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are the two most commonly used techniques in laparoscopic inguinal hernia repair, and the results of comparative studies are conflicting. The objective of this study is to compare the two methods in unilateral inguinal hernia repair. Materials and Methods: The data of consecutive patients who underwent TEP and TAPP due to unilateral inguinal hernia between December 7, 2017, and March 15, 2020, were analyzed retrospectively. The primary outcome was to compare the clinical outcomes of the two techniques in terms of complications, conversion, pain, and operative time. The secondary outcome was recurrence rates. Results: A total of 301 (TEP n=234, TAPP n=67) patients were included in the study. The mean age was 43 years, and the follow-up period was two years. The groups were similar in terms of demographic characteristics and hernia type. The mean operative time was longer in the TAPP group than in the TEP group (67 min and 58 min, p=0.007). The recurrence rate was 4.3% in the TEP group and 5.9% in the TAPP group (p>0.05). The conversion rate was 6% in both groups. In total, 19 (6.3%) patients had intraoperative complications (TEP n=16, TAPP n=3), and 23 (7.6%) patients had postoperative complications (TEP n=16, TAPP n=7). Both intraoperative and postoperative complication rates were similar between the groups (p=0.31 and p=0.051, respectively). The early postoperative pain was less in the TEP group (p=0.004). Conclusion: Less early postoperative pain and shorter operative time were detected in patients who underwent TEP.

Download Full-text

A COMPARATIVE AND RANDOMIZED STUDY BETWEEN TRANS ABDOMINAL PRE-PERITONEAL VERSUS TOTALLY EXTRA-PERITONEAL LAPAROSCOPIC TECHNIQUES OF INGUINAL HERNIA REPAIR

10.36106/ijsr/6207373 ◽

2020 ◽

pp. 26-29

Author(s):

Nikhil Agrawal ◽

Swapnil Sen

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Length Of Hospital Stay ◽

Statistical Hypothesis ◽

Categorical Variables ◽

Chi Squared

A hernia, an abnormal protrusion of an organ or tissue through a defect in its surrounding wall is a very common surgical problem. Approximately 75% of all hernias are usually groin hernias, among which 95% are inguinal region hernias. Various methods of repair have been employed which have progressed from open repair to various laparoscopic approaches. There is insufficient data to draw conclusions about the relative effectiveness of the two laparoscopic methods. Overall superiority of the two laparoscopic methods has not been demonstrated in available literature. AIM: The purpose of this study is to compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. MATERIALS AND METHODS: Hospital based comparative randomised study on 100 patients admitted in General Surgical wards with Inguinal hernia at a tertiary care centre of Eastern India. Randomization in two groups was done by lottery system. A well designed proforma containing various parameters under study was used for data collection. Baseline information were collected via structured interview using predesigned questionnaire. For statistical analysis data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS version 24 and GraphPad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Two-sample t-tests for a difference in mean involved independent samples or unpaired samples. Paired t-tests were a form of blocking and had greater power than unpaired tests. A chi-squared test (χ2 test) was any statistical hypothesis test wherein the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. Unpaired proportions were compared by Chi-square test or Fischer’s exact test, as appropriate. RESULTS: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP. Visceral injury and vascular injury were found more in TAPP as compared to TEP but this was not statistically significant. Seroma, port site hernia, persisting numbness and mesh/deep infection was higher in group-A (TAPP) as compared to group-B (TEP) but this was not statistically significant. Conversion to open procedure and persistent pain were comparable among the two methods. Hernia recurrence rates were higher in the TEP group in this study although it was statistically insignificant. CONCLUSION: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP.

Download Full-text

Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial

Surgical Endoscopy ◽

10.1007/s00464-007-9510-7 ◽

2007 ◽

Vol 22 (3) ◽

pp. 757-762 ◽

Cited By ~ 87

Author(s):

Craig Taylor ◽

Laurent Layani ◽

Victor Liew ◽

Michael Ghusn ◽

Nic Crampton ◽

...

Keyword(s):

Clinical Trial ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Randomised Clinical Trial ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Early Results

Download Full-text

Laparoscopic totally extra peritoneal (TEP) inguinal hernia repair: A series of 47 cases

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v5i4.18608 ◽

2017 ◽

Vol 5 (4) ◽

pp. 120-123

Author(s):

Suman Kumar Shrestha

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

College Teaching ◽

Operation Time ◽

Medical College ◽

Inguinal Hernias ◽

Total Extraperitoneal ◽

The Mean

Background: Over the past years, several surgical techniques have been evolved, among which total extraperitoneal inguinal hernia repair is the laparoscopic technique which is more popular now.Objective: To evaluate the outcome of totally extra peritoneal laparoscopic hernioplasty in terms of operation time, hospital stay and complications.Methods: The prospectively designed descriptive study was carried out at Department of Surgery Unit III, Kathmandu Medical College Teaching Hospital from February 2014 to April 2015. Forty seven consecutive patients above 15 years of age underwent totally extra peritoneal repairs for inguinal hernias. The selection criteria were reducible primary or recurrent, unilateral, direct and indirect inguinal hernias. All the relevant details of each patient were noted subsequently and analyzed statistically using Statistical Program for Social Sciences (SPSS) version 15.Results: The mean age of patient was 49±2.5 years. The mean operation time was 65±5.3 minutes. There were no serious complications except four (8.5%) cases of groin seroma which resolved after single time aspiration. Three (6.3%) cases had developed recurrence, two (4.2%) had developed hydrocele in a median follow up period of 6±1.5 (range, 3-9months). The mean inpatient hospital stay was 1.7±0.2 (range, 1-2.4days).Conclusion: Total extra peritoneal hernioplasty is safe and feasible with acceptable complications and recurrence rates.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page: 120-123

Download Full-text

Laparoscopic totally extraperitoneal repair of inguinal hernia using three-dimensional mesh: a 5 years experience at a tertiary care hospital in Kashmir, India

International Surgery Journal ◽

10.18203/2349-2902.isj20180822 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1016

Author(s):

Iqbal Saleem Mir ◽

Tajamul Rashid ◽

Irfan Nazir Mir ◽

Suhail Nazir ◽

Imtiyaz Ali ◽

...

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Intraoperative Complications ◽

Three Dimensional ◽

Care Hospital ◽

3D Mesh ◽

The Mean

Background: Inguinal hernia repair by laparoscopy is gaining acceptance worldwide. A flat mesh used in laparoscopic inguinal hernia repair is associated with more complications especially early and late postoperative pain owing to the need of mechanical fixation of this mesh. A three-dimensional mesh in this context is an emerging alternative which needs no or minimal fixation.Methods: A retrospective study of 123 patients was carried out from July 2012 to August 2017. All patients who underwent TEP by a single surgical team using three-dimensional mesh were included in the study. Data collected was analysed retrospectively.Results: Out of a total of 123 patients, 114 patients had unilateral hernia and 9 had bilateral hernia. A total of 132 laparoscopic hernia repairs were done using three-dimensional mesh. All the patients were male aged 29 to 75 years with a mean age of 51.5 years. Indirect hernias were more common comprising of 87.7%. The mean operative time was 46.9 minutes. The average mesh fixation time was 12.6 minutes. No major intraoperative complications were noted in any of the patients. Three patients (2.45%) experienced severe postoperative pain. Most of the patients 117 (95.12%) were discharged within 24 hours of surgery. Mean hospital stay in our study was 1 day. The mean length of follow-up was 12 months. Mild persistent groin pain was found in four patients (3.25%). Seroma was noted in five patients (4.06%). Hematoma and wound infection was noted in none. One patient (0.81%) had recurrence after completion of follow up. We found use of 3D mesh costly.Conclusions: Laparoscopic inguinal mesh hernioplasty using 3D mesh is a viable alternative of hernioplasty with minimal post-operative pain and recurrence and using 3D mesh has a technical advantage of easy insertion in an anatomically correct position with minimal fixation.

Download Full-text

Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i5.1358 ◽

2020 ◽

Vol 24 (5) ◽

Author(s):

Carla Hipólito ◽

Vicente Vieira ◽

Virginia Antunes ◽

Petra Alves ◽

Adriana Rodrigues ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Airway Management ◽

Inguinal Hernia Repair ◽

Neuromuscular Blockade ◽

Retrospective Review ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Increased Risk ◽

The Mean

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

Download Full-text