Laparoscopic Hernia Repair with the Extraperitoneal Approach versus Open Hernia Repair in Pediatric Inguinal Hernia: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis investigated the feasibility and effectiveness of laparoscopic hernia repair with the extraperitoneal approach in pediatric inguinal hernias. Summary Background Data: Inguinal hernia repair is the most common operation in pediatric surgical practice. Although open hernia repair (OHR) is a well-established procedure with good outcomes, studies have reported acceptable or even better outcomes of laparoscopic hernia repair with the extraperitoneal approach (LHRE). However, a meta-analysis comparing LHRE with OHR is lacking. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) and comparative studies (prospective or retrospective). Outcomes were metachronous contralateral inguinal hernia (MCIH), hernia recurrence, surgical site infection, operation time, and hospitalization length. A meta-analysis was performed, and risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were calculated using random-effects models. Results: Five RCTs and 21 comparative studies involving 24,479 patients were included. Lower MCIH incidence (RR: 0.11, 95% CI: 0.07 to 0.17; p < 0.00001) and a trend of shorter operation time (WMD: −11.90 min, 95% CI: −16.63 to −7.44; p < 0.00001) were found in the LHRE group. No significant differences in ipsilateral recurrence hernias, surgical site infection, and length of hospitalization were found between the groups. Conclusions: LHRE presented lower MCIH incidence and shorter operation times, with no increase in hernia recurrence, surgical site infection, or length of hospitalization. As more surgeons are increasingly becoming familiar with LHRE, LHRE would be a feasible and effective choice for pediatric inguinal hernia repair.

Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis

Background: During lower abdominal marginal hernia repair, the peritoneal flap is routinely freed to facilitate mesh placement and closed to conclude the procedure. This procedure is generally called trans-abdominal partial extra-peritoneal (TAPE). However, the necessity of closing the free peritoneal flap is still controversial. This study aimed to investigate the safety and feasibility of leaving the free peritoneal flap in-situ.Methods: A retrospective review was conducted on 68 patients (16 male, 52 female) who underwent laparoscopic hernia repair between June 2014 and March 2021. Patients were diagnosed as the lower abdominal hernia and all required freeing the peritoneal flap during the operation. Patients were divided into 2 groups: one group was TAPE group with the closed free peritoneal flap, another group left the free peritoneal flap unclosed. Analyses were performed to compare both intraoperative parameters and postoperative complications.Results: There were no significant differences in demographic, comorbidity, hernia characteristics and ASA classification. The intra-operative bleeding volume, visceral injury, hospital stay, urinary retention, visual analog scale (VAS) score, dysuria, intestinal obstruction, surgical site infection, mesh infection, recurrence rate and hospital stay were similar among the two groups. Mean operative time of the flap closing procedure was higher than for patients with the free peritoneal flap left in-situ (p = 0.002). Comparisons of postoperative complications showed flap closure resulted in a higher incidence of seroma formation (p = 0.005).Conclusion: Providing a barrier-coated mesh is used during laparoscopic lower abdominal marginal hernia repair, it is safe to leave the free peritoneal flap in-situ and this approach may prevent the occurrence of seromas.

Nationwide Readmissions Analysis of Minimally Invasive Versus Open Ventral Hernia Repair: A Retrospective Population-Based Study

Introduction Minimally invasive ventral hernia repair (MISVHR) has been performed for almost 30 years; recently, there has been an accelerated adoption of the robotic platform leading to renewed comparisons to open ventral hernia repair (OVHR). The present study evaluates patterns and outcomes of readmissions for MISVHR and OVHR patients. Methods The Nationwide Readmissions Database (NRD) was queried for patients undergoing OVHR and MISVHR from 2016 to 2018. Demographic characteristics, complications, and 90-day readmissions were determined. A subgroup analysis was performed to compare robotic ventral hernia repair (RVHR) vs laparoscopic hernia repair (LVHR). Standard statistical methods and logistic regression were used. Results Over the 3-year period, there were 25 795 MISVHR and 180 635 OVHR admissions. Minimally invasive ventral hernia repair was associated with a lower rate of 90-day readmission (11.3% vs 17.3%, P < .01), length of stay (LOS) (4.0 vs 7.9 days, P < .01), and hospital charges ($68,240 ± 75 680 vs $87,701 ± 73 165, P < .01), which remained true when elective and non-elective repairs were evaluated independently. Postoperative infection was the most common reason for readmission but was less common in the MISVHR group (8.4% vs 16.8%, P < .01). Robotic ventral hernia repair increased over the 3-year period and was associated with decreased LOS (3.7 vs 4.1 days, P < .01) and comparable readmissions (11.3% vs 11.2%, P = .74) to LVHR, but was nearly $20,000 more expensive. In logistic regression, OVHR, non-elective operation, urban-teaching hospital, increased LOS, comorbidities, and payer type were predictive of readmission. Conclusions Open ventral hernia repair was associated with increased LOS and increased readmissions compared to MISVHR. Robotic ventral hernia repair had comparable readmissions and decreased LOS to LVHR, but it was more expensive.

P143 INSTRUCTION AND FEEDBACK METHOD FOR LAPAROSCOPIC HERNIA REPAIR USING SELF-MADE MANUAL WITH SELF-ASSESSMENT SHEET

Aim We use the self-made manual to understand procedures easily, and the self-assessment sheet to improve trainees' skills efficiently. We investigated the effect of this method for trainees in laparoscopic inguinal hernia repair. Material and Methods In the original manual, surgical procedures and how to make surgical fields are explained using intraoperative photos, in order to clarify the purpose of the procedures in each scene of surgery. We also made the self-assessment sheet that sets goals according to the manual, and evaluates the trainee's attainment objectively. Trainees score the assessment sheet after every surgery. Trainers evaluate their sheets and give feedback on their skills with a radar chart. Results By using the same manual, trainees and trainers could share the same terms and thoughts easily during surgery. The self-assessment sheet made trainees effective to understand their weak points and improve their skills. At the beginning of the training, the much-experienced trainee got a higher score. As trainees experienced surgeries, they became getting higher scores. There was a significant correlation between a high score and a short operation time. A radar chart helped efficiently to understand trainees' weak points. Conclusions Using the self-made manual and the self-assessment sheet together was useful for both the trainer and the trainees to evaluate their attainment objectively. Scores and graphs helped trainees assess their skills efficiently.

One inch incision-mesh plug repair versus laparoscopic trans-abdominal preperitoneal repair of the primary indirect inguinal hernia: a prospective comparative study

Background: Management of inguinal hernia by minimally invasive incision and minimal dissection with optimal outcomes remains an unmet need for general surgeons. The most common hernia repair procedures are Lichtenstein hernioplasty and laparoscopic hernia repair; TAPP and TEP. The modification of mesh plug repair (MPR); one inch incision-MPR (OI-MPR); could achieve optimal outcomes comparable to that of laparoscopic hernia repair. The objective of the study was to assess OI-MPR approach for management of primary indirect inguinal hernia and its outcomes in comparison to laparoscopic TAPP repair.Methods: During the period from September 2017 to March 2019, 63 patients with indirect inguinal hernia were selected randomly to one of two groups; group-A included 35 patients underwent one inch incision-mesh plug repair (OI-MPR), group-B included 28 patients underwent laparoscopic TAPP.Results: The mean operative time of group-A was 31.74±4.74 min which was significantly shorter than that of group-B (81.22±7.44 min). The mean hospital stay duration in group-A was 0.57±0.18 day and in group-B, it was 1.18±0.39 day. The patients of group-A returned to normal physical activities earlier than the patients of group-B. The duration of postoperative pain was shorter and less severe in group-A than that of group-B. Regarding complications, there was no statistically significant difference found between both groups.Conclusions: One inch incision-MPR is a simple, feasible and cost-effective approach with low morbidities and low burden on the patients and the healthcare facilities.

COMPARATIVE ANALYSIS OF THE RESULTS OF PLASTIC INGUINAL HERNIA LAPAROSCOPIC AND TRADITIONAL METHODS

Purpose of the study. Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical departments at “A.N. Syzganov National Scientific Center of Surgery”, Almaty, Kazakhstan. Materials and methods. In the period from January 2017 to December 2020 137 patients were operated at the “A.N. Syzganov National Scientific Center of Surgery” in a planned manner for inguinal hernia and all patients were divided into 2 main groups: operated by traditional methods and laparoscopic method. Results.The data of the analysis suggests that the laparoscopic method of hernioplasty has an advantage over the traditional methods. Conclusion. Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes. Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.

Comparative Study between Laparoscopic versus Open Hernioplasty in Repair of Unilateral Non Recurrent Inguinal Hernia

Background Laparoscopic surgery has led to many changes in the management of surgical patients and significantly reduced the incidence of complications associated with open surgical procedures 1. At present, laparoscopic hernia repair has gained clinical significance in patients with bilateral or recurrent hernia. 2 Objectives The aim of this study is to compare open hernioplasty and laparoscopic hernia repair in unilateral non recurrent inguinal hernia. The present study will be performed on 30 patients to compare the effectiveness of laparoscopic hernia repair and open hernioplasty and to assess the intra operative and post-operative complications, duration of surgery, hospital stay, postoperative morbidity, recurrence and patient satisfaction. Patients and Methods . Comparative studies on 30 patients were classified according the type of operative technique into 2 groups: Group A patients underwent laparoscopic technique (15 patients), group B patients underwent open technique (15 patients) to evaluate and compare the open and laparoscopic techniques in unilateral non recurrent inguinal hernia repair as regard operative time,post operative pain, hospital stay, urine retention, parathesia, numbness, seroma,, wound infection and recurrence Results Our study revealed highly significant increase in operative time in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value &lt; 0.0001), highly significant decrease in post-operative pain score in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.00434),highly significant decrease in postoperative hospital stay in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.000003), significant decrease in post operative parathesia and numbness in laparoscopic group; compared to open group of patients; (p value =0.000414),highly significant decrease in post-operative urine retention in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value= 0.000267). Conclusion The laparoscopic technique is superior to the open technique of tensionfree repair, in terms of immediate post-operative complications and delayed pain and paresthesia also in terms of safety.