O15 LESS PAIN AFTER TACK FIXATION OF MESH THAN WITH SELF-GRIPPING MESH FOLLOWING LAPAROSCOPIC INGUINAL HERNIA REPAIR: A RANDOMIZED CLINICAL TRIAL

Aim Acute pain following transabdominal preperitoneal inguinal hernia repair (TAPP) may be attributed to mesh fixation. The aim of the present study was to determine short and long-term complications following laparoscopic TAPP repair using either a self-gripping mesh or a tacked mesh. Material and Methods Healthy male subjects referred for unilateral inguinal hernia repair were randomized to a TAPP procedure using either a tacked mesh (Parietix, Medtronic; AbsorbaTack, Medtronic) or a self-gripping mesh (ProGripTM, Medtronic). Acute postoperative pain and short and long-term complications were recorded using an e-mail generated questionnaire preoperatively and at days 1 and 7 and at 1, 3, 6 and 12 months postoperatively. Acute pain was assessed using the visual analogue scale (VAS). Results A total of 333 male subjects underwent elective repair of a medial (n = 107, 32%) or a lateral (n = 226, 68%) inguinal hernia. Patients were randomized to either a tacked (T = 178) or non-tacked procedure (N = 155). Mean follow-up time was 141 days. Mean number of tacks applied was 2.7 per operation. Mean preoperative VAS score was 2.21 (T) vs 1.78 (N) (P = 0.06). Postoperatively, the mean VAS-score (average within the observation period) was 2.80 (T) vs 3.12 (N) (P < 0.01), resulting in a 10% lower VAS-score following the tacked repair compared to the self-gripping mesh (P < 0.01). Patient-reported signs of recurrence at 12 months was 4.7% (T) vs 7.5% (N) (P = 0.35). Conclusions Postoperative acute pain after laparoscopic inguinal hernia repair is lower following a tacked than a non-tacked (self-adhesive mesh) procedure. Patient-reported recurrence did not differ between groups

Assessment of Intra-Operative Difficulties and Early Post-Operative Complications in Laparoscopic Inguinal Hernia Repair using Conventional Polypropylene Mesh Versus 3D Mesh

Background The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. Aim of the Work To assess intra-operative difficulties of laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative time. And early post-operative complications including post-operative seroma, early postoperative pain, chronic pain and limitation of function. Patients and Methods In our study 30 patients were recruited according to our preset inclusion and exclusion criteria. They were divided randomly into two groups, a group in which the 3D mesh was used and a group in which the polypropylene mesh was used. The study was conducted in Ain Shams University hospitals for 6 months, in which patients where followed up from 3 to 6 months and compared in terms of intraoperative time, post-operative pain after one week, restriction of physical activity, seroma formation and presence of chronic pain. Results In our study the mean application time (minutes) in 3D group was found to be 7.07 ± 2.66 while in PP group it was found to be 12.53±3.66 with highly statistically significant difference between them at p < 0.001. We believe that this difference in fixation time in our present study is attributed to easy insertion through the port, easy intraoperative handling, and easy unfolding of 3D mesh. Conclusion The use of three-dimensional mesh (3D mesh) for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, shorter hospital stays, early recovery with a better movement limitation score. Whereas chronic pain was found to be similar in both groups. Further, elimination of tacks for fixation and shorter hospital stay may reduce the cost of 3D mesh. Longer-term studies are recommended with a larger sample size and follow up duration for better assessment of chronic pain, also for following up on recurrence.

Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis

Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.