EARLY RESULTS OF INGUINAL HERNIA REPAIR BY THE “MESH PLUG” TECHNIQUE

2012 ◽  
pp. 43-51
Author(s):  
Doan Van Phu Nguyen ◽  
Loc Le ◽  
Van Lieu Nguyen

Background: In 1989, Lichtenstein I. L., Shulman A. G., Amid P. K., and Montlor M. M. presented an idea of using Mesh Plug to repair the defect inguinal canal. The new technique quickly became accepted by surgeons all over the world for several reasons: faster overall rehabilitation, less postoperative pain, less complication, shorter stay in the hospital and early return to normal activities and work. Materials and method: From Dec 2011 to July 2012, 42 patients with inguinal hernia were surgically treated with 48 Mesh Plugs applied at the Surgery Unit of Hue University of Medicine and Pharmacy. Result: The patients’ average age was 49.12±21.17. There were 25 patients over 40 years old, accounting for 59,5%, and 39 of the group were males, accounting for 92.8%. 10 cases were direct hernia, accounting for 20.8%, and 38 cases were indirect hernia accounting for 79.2%. Based on Nyhus’s classification, there were 33 cases of IIIA and IIIB (68.8%). Based on the position of protrusion, there were 30 cases of right inguinal hernia (62.5%), 18 cases of left inguinal hernia (37.5%), and 6 cases of hernia on both sides. The average size of the deep ring is 2.16±1.64cm. 24 cases used Mesh Plug of medium size (54.5%). The mean operating time was 35.75 minutes. The time of staying in the hospital was 3.52±1.14 days. Quality of life assessment after the surgery showed 46 very good and good cases 95.8% and 2 cases (4.2%) with satisfactory result. No case of bad outcome was recorded. Conclusion: Surgical treatment of inguinal hernia by the Mesh Plug technique is really effective, safe with faster postoperative rehabilitation, less postoperative pain, less complications, shorter hospital stay and early return to normal activities and work.

2014 ◽  
pp. 40-46
Author(s):  
Doan Van Phu Nguyen ◽  
Loc Le ◽  
Van Lieu Nguyen

Background:In 1989, Lichtenstein I. L., Shulman A. G., Amid P. K., and Montlor M. M. presented an idea of using Mesh Plug to repair the defect inguinal canal. The new technique quickly became accepted by surgeons all over the world for several reasons: faster overall rehabilitation, less postoperative pain, less complication, shorter stay in the hospital and early return to normal activities and work. Materials and method:From December 2011 to October 2012, 97 patients with inguinal hernia were surgically treated with 110 Mesh Plugs applied at the Surgery Unit of Hue University of Medicine and Pharmacy. Result:The patients’ mean age was 48.96±23.19. There were 60 patients over 40 years old, accounting for 61.9%, and 93 of the group were males, accounting for 95.8%. 24 cases were direct hernia, accounting for 21.8%, 86 cases were indirect hernia accounting for 78.2% and 11cases were direct hernia associated with indirect hernia. Based on Nyhus’s classification, there were 76 cases of IIIA and IIIB (69.1%). Based on the position of protrusion, there were 66 cases of right inguinal hernia (60.0%), 44 cases of left inguinal hernia (40.0%), and 13 cases of hernia on both sides. The average size of the deep ring is 2.19±1.54cm. 65 cases used Mesh Plug of medium size (59.1%). The mean operating time was 37.26 minutes. The time of staying in the hospital was 3.58±1.17 days. Quality of life assessment after the surgery showed 93 very good and good cases 95.8% and 4 cases (4.2%) with satisfactory result. No case of bad outcome was recorded. Conclusion: Surgical treatment of inguinal hernia by the Mesh Plug technique is really effective, safe with faster postoperative rehabilitation, less postoperative pain, less complications, shorter hospital stay and early return to normal activities and work. Key words: Inguinal hernia, Mesh Plug.


2020 ◽  
Vol 23 (2) ◽  
pp. 47-51
Author(s):  
Rohit Prasad Yadav ◽  
Manish Gautam ◽  
Ashok Koirala ◽  
Sameer Bhattarai ◽  
Sachhidanand Shah ◽  
...  

Introduction: Laparoscopic inguinal hernia repair is a tension-free mesh repair that is based on pre-peritoneal approach of repair. It provides mechanical advantage to the surgeon, by being able to place a large piece of mesh and by using the natural force of the abdominal wall to disperse the intra-abdominal pressure over a large area to support the mesh. This retrospective study is aimed to study the demography of inguinal hernia and to compare operating time, complications and postoperative pain between patients undergoing Total Extrapritoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair.Methods: A retrospective comparative study was conducted in patients with inguinal hernia who underwent laparoscopic repair by either TEP or TAPP, between April 2019 to July 2020 at Nobel Medical Collage Teaching Hospital, Biratnagar, Morang. Age, sex, type of hernia, duration of operation, post-operative complications, severity of pain and duration hospital stay were analyzed between two groups of patients undergoingsurgery by either TEP or TAPP.Results: One hundred and five patients underwent either TEP or TAPP during study period. There were 96 males and 9 females. There were 50 patients with right, 40 with left and 6 patients with bilateral inguinal hernia. Four patients had left sided irreducible inguinal hernia, 2 patients had bilateral recurrent inguinal hernia, 2 patients had right sided recurrent inguinal hernia and 1 patient had left sided recurrent inguinal hernia.There was significant difference in duration of operation (TEP 64.43min) / (TAPP 84.46min), p<0. 001. Total duration of hospital stay and postoperative pain were not significant between patients operated with TEPor TAPP. Accidental pneumoperitoneum was noticed in 8 cases, 10 cases of subcutaneous emphysema, 5 cases of seroma and 1 case of scrotal hematoma in TEP group. In TAPP group scrotal hematoma occurred in 4 cases and seroma in 5 cases which was not significantly different from TEP group.Conclusion: TAPP had significantly longer operating time as compared to TEP. However, there was no significant difference in post-operative pain and hospital stay in both group.


2019 ◽  
Vol 17 (2) ◽  
pp. 66-72
Author(s):  
Md Atiar Rahman ◽  
Md Shahidul Lslam ◽  
Md Shahadot Hossain Sheikh ◽  
Md Ibrahim Siddique ◽  
Md Ahsan Ullah ◽  
...  

Objective: The introduction of a Longo’s technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time, rapid healing and an early return to full activity. The outcome of Longo’s technique was compared with that of current standard surgery in a randomized controlled study, and followed up two years. Methods: In a prospective randomized study, 140 patients requiring surgical treatment for haemorrhoids grade 2, 3 and 4 were assigned to either MMF (Milligan-Morgan, Park Ferguson) or PPH (Procedure for prolapse and haemorrhoids) 70 each. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded. Results: The Longo’s group had a shorter operating time, less frequent postoperative analgesia intake, and earlier return to normal activity. Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated. After a mean follow-up of 24 months (12-46), recurrent haemorrhoidal symptoms, mostly mild and temporary, were reported after both MMF and PPH (Table-3). Four patients (5.71 %) complained of recurrent prolapse and/or external swelling after PPH, requiring re-do surgery in 3 of them between 18 to 32 months. Recurrent prolapse or external piles were also observed in 5 patients (7.14%) after MMF and re-do surgery was needed in 3 of them between 14 and 41 months. Long term patient's satisfaction after PPH was more or less same like after MMF. None of the patients had anal stenosis, incontinence, fecal urgency or sepsis. Conclusions: Postoperative pain is less after PPH. This advantage disappears if any resection is associated with the stapling. Use of a Longo's technique in the treatment of haemorrhoidal disease promotes rapid healing, shorter hospital stay and early return to normal activities. Journal of Surgical Sciences (2013) Vol. 17 (2) :66-72


2015 ◽  
Vol 4 (4) ◽  
pp. 7-11
Author(s):  
R S Bhandari ◽  
P J Lakhey ◽  
Y P Singh ◽  
P R Mishra ◽  
K P Singh

Open haemorrhoidectomy (OH) treatment has been reserved for prolapsing haemorrhoidal disease (third and fourth grade) and comprehends excision of haemorrhoidal tissue and is associated with significant postoperative pain. As an alternative approach, many randomized controlled trials have shown consistent advantage with haemorrhoidopexy (SH) in terms of postoperative pain, analgesic requirement, length of surgical procedure, short recovery time and early return to normal activities. This study has been conducted to compare the short-term outcome of SH with OH. A prospective comparative study, which included grade 3 and 4 haemorrhoids and comparing short Term outcomes between SH and OH was conducted in the Surgical Gastroenterology units of University Teaching Hospital. A total 44 patients, 22 in each group were compared. Age (SH 42±10.80 Vs. OH 45±13.30) and sex (SH, M:F-9:13 Vs. OH, M:F-14:8) distribution was comparable. Also, the groups were comparable in terms of symptom duration in years (SH, 3.20±2.26 Vs. OH, 2.31±2.47) and distribution of haemorrhoid grades. The SH group showed significant advantage in terms of postoperative pain (Average pain score SH, 2.73±1.20 Vs. OH, 5.20±1.91) and analgesic use (SH 2.32±0.94 Vs. OH 9.32±2.62). Similarly the operating time (time in minutes SH, 42±7.34 Vs. OH, 57.50±8.27), hospitals stay (days of stay SH, 2.90±0.68 Vs. OH, 3.77±0.86) and return to preoperative activity (days to return SH, 7.9±4.90 Vs. OH, 13.6±5.60) were also significantly shorter in the SH group than the OH group. The short-term complications were similar in both groups (P value >0.05). In conclusion, SH has better short-term outcome compared with OH and SH is a viable addition to the therapy options available for haemorrhoids.DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11956


2018 ◽  
Vol 5 (6) ◽  
pp. 2238
Author(s):  
Ram Sagar Shah ◽  
Ajay Kumar

Background: Inguinal hernia is a common problem and its repair is one of the most frequently performed operation in general surgical practice. There are appreciable advantages of Lichtenstein over Shouldice repair in terms of simplicity, less time consuming and postoperative pain; there in the context of less developed countries with limited economic resources, however Shouldice repair is more cost effective and there are no differences in recurrences and other complications which would be a better proposition. The present study aims at comparing the results of Shouldice versus Lichtenstein’s repair in inguinal hernia in adult male (≥18 years).Methods: Total of fifty cases was included in this study, were equally divided into 2 groups; Group A and Group B and subjected for Shouldice and Lichtenstein mesh repair respectively. Operating time, postoperative complications as Wound infection, Seroma, Hematoma, Postoperative pain, and days of hospital stay, total costs and time to return to usual activity was noted.Results: Out of 50 patients, 36 (72%) were had indirect hernia and most of them were in between 18-29.9 years of age. There were no difference between two groups with respect to postoperative pain, Wound infection 12% and 8%, Seroma  8% and 4% and Hematoma 4% and 4% in Group A and Group B respectively. However, there is significant difference noted in operating time period in which Shouldice repair took more time (Mean time in Shouldice 84.16 min and Lichtenstein 58.80 min). There were no recurrences in either group.Conclusions: So, comparing our results of both groups, Lichtenstein repair were found to be better as it is simple procedure and is less time consuming than Shouldice repair.  However, Shouldice repair was found to be cost effective which could be an important consideration in developing countries.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Viêt Khánh Lê ◽  

Tóm tắt Đặt vấn đề: Đánh giá kết quả của phẫu thuật nội soi đặt lưới trước phúc mạc, đường vào qua phúc mạc (Trans-Abdominal Pre-Peritoneal: TAPP) điều trị thoát vị bẹn tái phát và so sánh với phương pháp Lichtenstein Phương pháp nghiên cứu: Nhóm nghiên cứu: 11 người bệnh (NB) (nam) được thực hiện phẫu thuật TAPP điều trị thoát vị bẹn tái phát sau mổ mở; nhóm chứng: 8 người bệnh thoát vị bẹn tái phát được thực hiện phẫu thuật Kết quả: Các đặc điểm về tuổi, chỉ số khối cơ thể (BMI), số bệnh lý kèm theo, đường kính cổ bao thoát vị và thời gian tái phát của người bệnh giữa 2 nhóm có sự tương đồng; ở nhóm phẫu thuật TAPP thời gian phẫu thuật dài hơn (TAPP 103,6 và Lich 86,9 phút, p = 0,223); thời gian sử dụng giảm đau sau mổ ngắn hơn (TAPP 1,9 và Lich 2,8 ngày, p = 0,009); thời gian nằm viện ngắn hơn (TAPP 4,2 và Lich 5,9 ngày, p = 0,009); thời gian trở lại công việc sớm hơn (TAPP 19,2 và Lich 26,0 ngày, p = 0,035); nhóm nghiên cứu không có biến chứng trong khi nhóm chứng có 2 trường hợp nhiễm trùng vết mổ và 2 trường hợp đau sau mổ. Kết luận: Phẫu thuật TAPP có hiệu quả tốt trong điều trị thoát vị bẹn tái phát sau mổ mở, sau mổ người bệnh ít đau hơn, giảm thời gian nằm viện, giảm biến chứng sau mổ Abstract Introduction: This study is to evaluate the early results of laparoscopic repair with mesh hernia by Trans-Abdominal Pre-Peritoneal (TAPP) compared with Lichtenstein Materials and Methods: 11 male patients were reoperated with TAPP repair for the recurrent inguinal hernia after open repair enrolled in research group; Control group including 8 patients were reoperated with Lichtenstein technique. Results: The characteristics of patients such as ages, body mass index (BMI), comorbid pathologies, size of neck of the inguinal sac and the recurrent times were similar in both groups; in research group, the operating time was longer (TAPP 103,6 vs Lich 86,9 mins, p=0,223) however the time for pain medication used was shorter (TAPP 1,9 vs Lich 2,8 days, p=0,009), the length of hospital stay was shorter (TAPP 4,2 vs Lich 5,9 days, p=0,009) than control group; in research group, there were no postoperative complication while in control group, there were two patients with postoperative surgical site infections, and two patients with postoperative pains. Conclusion: TAPP repair is an effective option for the treatment of recurrent inguinal hernia; shorter hospital stay, less pains as well as complications. Keywords: Recurrent inguinal hernia, TAPP, Lichtenstein


2010 ◽  
Vol 17 (01) ◽  
pp. 35-39
Author(s):  
SHAHZAD AVIAS ◽  
E. REHMAN ◽  
M. ZAKIR ◽  
Masood Rashid

Objective: To evaluate early results of laparoscopic repair of inguinal hernia by totally extraperitoneal approach (TEP) performed.Setting: At Surgical unit III, Jinnah hospital Lahore. Period: From August 2005 to July2008. Methods: 97 patients over the age of 30 yearsunderwent TEP repair of their inguinal hernia. Post operative assessment of the patients included pain score assessment and analgesiarequirement, along with ability to walk upright comfortably, time taken to return to normal activity and early complications like seroma,haematoma, infection etc. Results: Post-operative pain assessment at 8 hours after surgery showed 43(44.3%) patients required extraanalgesia while 24 hours after surgery only 13(13.4%) patients required extra analgesia. Mean operative time was 95 min (range 55-130min)for unilateral hernia. However, as experience increased with TEP repair, mean operating time decreased to 75mins in the second half of thecases. 21(20.6%) patients at 24hrs and 51(52.6%) patients at 48hrs could walk upright without any help. Median period for return to normalactivity at domestic level was 5days (range 3-23).Incidence of early complications is shown in table-Ill. Conclusion: Our results of TEPlaparoscopic hernia repair are comparable to European experience in terms of postoperative pain, mobility of patient and rehabilitation, as wellas early complications.


2019 ◽  
Vol 6 (10) ◽  
pp. 3590
Author(s):  
Abhishek Thakur ◽  
Dhruv Kumar Sharma ◽  
K. J. S. Jaswal

Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery. 


2016 ◽  
Vol 4 (1) ◽  
pp. 282
Author(s):  
Suraj Singh ◽  
Rajkumar Prakash ◽  
Vasundhara Singh

Background:Hernia may be generally defined as the protrusion of an abdominal viscus outside the abdominal cavity through a natural or acquired defect. Latin meaning of the word “hernia” is tear or rupture. A Clinical study on inguinal hernia is undertaken to assess the incidence of inguinal hernia in relation to age, gender and occupation, the different types and modes of clinical presentation of patients, the management of patients with special consideration to laparoscopic (TAPP) repair, to evaluate the operating time, pre-operative and post-operative complications, duration of hospital stay, time taken for recovery, recurrence rate and limitations with respect to laparoscopic TAPP repair.Methods: This is a prospective study of 54 cases of inguinal hernia admitted and underwent surgery for inguinal hernia in Department of General Surgery in Guwahati Medical College and Hospital during the study period of August 2014 to July 2015.Results:The highest number of cases presenting with inguinal hernia were over 45 years and it was more common in males which constituted 96.3 percent of cases. It is more common on right side and indirect hernia is more common than direct hernia. The major possible risk factors are smoking and strenuous work. The commonest presenting mode was swelling followed by swelling with pain. The mean time taken for TAPP was 91.85±15.85 minutes and the median time was 87.50 minutes. There were no intra operative (neurovascular, visceral) complications in any of the patient and there was no conversion to open surgery. There was no mortality in present study and none of the patient had any testicular complication.Conclusions:Laparoscopic hernia repair is associated with steep learning curve for surgeons and is more costly both to patients and health care system in the present scenario. Laparoscopic TAPP hernia repair is found to have encouraging results which is a safe and viable option for repair of inguinal hernia with less postoperative pain and discomfort, improved cosmesis, less post-operative complications and early return to work.


2020 ◽  
Vol 8 (1) ◽  
pp. 220
Author(s):  
Avinash Jose ◽  
Sunil Sadanandan

Background: Post-operative pain is a disabling complication of inguinal hernia repair. Sutures that are used to anchor the mesh are blamed for tissue tension and nerve entrapment leading to postoperative pain. Self-fixating mesh, a bicomponent mesh with resorbable polylactic acid gripping system can produce a tension-free repair without sutures, reducing the potential of post-operative pain. The objectives of the study were to compare postoperative pain, the operating time and the efficacy in terms of recurrence among patients undergoing Lichtenstein’s inguinal hernia repair with self-fixating mesh and conventional polypropylene mesh.  Methods: A prospective observational study was conducted among 120 patients. Half of them underwent Lichtenstein’s inguinal hernia repair with self-fixating mesh which did not require sutures and the other half with conventional polypropylene mesh which were anchored with polypropylene sutures. Time taken to complete surgery was noted. Postoperative pain was charted using a visual analogue scale at 15 days, 3 months, 6 months and at 1 year during the follow up.Results: Median postoperative pain score and operating time was significantly lower in patients who underwent repair with self-fixating mesh. None of the patients had recurrence at the end of 1 year follow up period.  Conclusions: Self-fixating mesh can reduce the postoperative pain and the operating time in patients undergoing Lichtenstein’s inguinal hernia repair when compared with a conventional polypropylene mesh. The self-fixating mesh is as efficacious as conventional polypropylene mesh in preventing recurrences.  


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