Inguinal hernia: obligatory indication for elective surgery?

BACKGROUND: Incarcerated inguinal hernia may be treated effectively by recent surgical techniques with a low rate of complications, but it is unclear whether quality of life is improved by elective inguinal hernia repair. Therefore we investigated the quality of life before and after inguinal hernia repair using plug and patch technique. PATIENTS AND METHODS: Quality of life was prospectively assessed in 123 patients before and 3 months after plug and patch inguinal hernia repair using the Short Form 36 questionaire and a visual analog scale. All patients complained preoperatively of pain associated with the clinical findings of inguinal hernia (visual analog scale: reduced quality of life 6.8+/-2.7; reduced daily activity: 5.5+/-2.6). Clinical characteristics (operation times, in-hospital stay, complications, need for pain medication) were documented. Inclusion criteria were patients with symptomatic inguinal hernia, scheduled for elective unilateral inguinal hernia repair by plug and patch technique. RESULTS: There were no major in-hospital complications. At 3 months no recurrences of inguinal hernia or late onset complications were observed; seven patients complained of dumbness, and eight felt pressure at the operation site with a tendency for resolving pain within this time. At 3 months patients had a significantly improved quality of life regarding freedom from pain, vitality, and physical activity compared to preoperatively. CONCLUSIONS: Plug and patch repair of unilateral inguinal hernia improves quality of life with a very low rate of procedural complications. Regarding freedom from pain, vitality, and physical activity there is significant improvement as compared to preoperatively. Therefore inguinal hernia repair should be intended in all elective cases and plug and patch repair appears as an excellent technique to improve quality of life.     

Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study

Background

Traditionally, repair of an inguinal hernia has been by an open method, but laparoscopic techniques have recently been introduced and are increasing in popularity. This study aimed to compare early and late outcomes following laparoscopic and open repair of inguinal hernia.

Methods

We performed an analysis of inpatient Hospital Episode Statistics. Early-outcome criteria studied include in-hospital mortality, length of hospital stay, complications (infection, bleeding, injury to an organ, and urinary retention), and readmission. Late outcome was assessed by the need for a further inguinal hernia repair on the same side.

Results

Between April 2002 and April 2004 there were 125,342 patients who underwent inguinal hernia repair and were included in the analysis. They were followed until April 2009. There were no differences in postoperative stay between the laparoscopic and open groups except for the laparoscopic bilateral hernia repair patients who had a shorter stay than the open group. Infection and bleeding were more common following open repair, whilst urinary retention and injury to an organ were more frequent after laparoscopic repair. Reoperation for another inguinal hernia was more common after laparoscopic (4.0 %) than after open repair of primary inguinal hernia (2.1 %), mostly in the first year after surgery. There was no difference in reoperation rate following repair of a recurrent inguinal hernia. Consultant caseload was strongly inversely correlated with reoperation following laparoscopic but not open repair of primary inguinal hernia.

Conclusions

Reoperation is more common after laparoscopic than after open repair of primary but not recurrent inguinal hernia. Surgeons with a low laparoscopic hernia repair caseload have an increased reoperation rate following laparoscopic repair of primary inguinal hernia. The increase in reoperation rate following laparoscopic repair is seen in the first year or two following the initial surgery.     

Long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair

Laparoscopic TAPP inguinal hernia repair is an established alternative to open hernia repair, which offers equivalent outcomes with less postoperative pain and faster recovery. Unfortunately, it remains technically challenging, requiring advanced laparoscopic skills which have limited its popularity among surgeons. The robotic platform has the potential to overcome these challenges. The objective of this study was to examine the long-term quality of life and outcomes following robotic assisted TAPP inguinal hernia repair, since these data have not been reported up to now. From October 2012 to October 2015, 159 inguinal hernias in 82 consecutive patients were repaired with 3D mesh (BARD) using da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The patients’ demographics and intraoperative data were documented. Patients were seen 2 and 6 weeks after the surgery and the complications were recorded. Patients were assessed 6 weeks after the surgery by a survey using a universal pain assessment tool to document their post-operative pain, narcotic use and time of return to work and exercise. A modified short form 12 (SF 12) was also sent out to the patients 12–36 months after the surgery to measure their health-related quality of life prior to surgery and at the 12- to 36-month follow-up, and to document any evidence of recurrence. Postoperative health-related quality of life scores were compared to the pre-operative baseline quality of life scores using the unpaired t test. Over the course of 3 years, 159 robotic assisted TAPP inguinal hernia repair were performed in 82 patients, 73 men and 9 women by one surgeon as an outpatient basis. The mean age was 53 and mean body mass index was 26. There were no intraoperative complications or conversions. The average operative time was 99 min. Four patients developed urinary retention post-operatively and one patient developed postoperative bowel obstruction requiring laparoscopic lysis of adhesion with no long-term complications. All patients completed the pain assessment survey and the median pain score, 3 days after the surgery was 3. Narcotics were used for an average of 3.1 days. The modified SF 12 survey assessing for quality of life before and 12–36 months after surgery was completed and returned by 29 patients (response rate of 35.4% and median follow-up of 32 months). Only one recurrence was reported which was repaired with open technique. The analysis of the SF 12 survey that evaluated patient’s quality of life, pain score and the ability to perform activities of daily living before and after surgery revealed a significant improvement in those measures 12–36 months after the surgery compare to their baseline. Hernia recurrence, chronic pain and physical impairment are the major long-term concerns after any type of inguinal hernia repair. Our results demonstrate that robotic assisted TAPP inguinal hernia repair appears to be a technically feasible, reproducible and safe minimally invasive alternative with low recurrence, low chronic pain and high health-related quality of life in the long term.     

三种疝修补术治疗成人腹股沟疝的疗效比较

目的比较腹腔镜下经腹腹膜前疝修补术与传统腹股沟疝修补术、疝环充填式无张力疝修补术治疗成人腹股沟疝的疗效。 方法选取2016年4月至2020年4月芜湖市第一人民医院收治的150例腹股沟疝患者作为研究对象,随机将其分为3组,每组50例。A组行传统腹股沟疝修补术,B组行疝环充填式无张力疝修补术,C组行腹腔镜下经腹腹膜前疝修补术。比较3组患者的临床总有效率,手术时间,出院时间,术中出血量,术后24 h、1周及1个月的疼痛视觉模拟评分（VAS）,复发率以及并发症情况。 结果B组和C组患者在临床总有效率,手术时间、出院时间、术中出血量、术后各时段的VAS评分、复发率及并发症均优于A组,差异有统计学意义（P<0.05）。B组和C组相比,C组在手术时间、住院时间、各时段VAS评分优于B组,差异有统计学意义（P<0.05）。 结论三种手术方式比较发现,腹腔镜下经腹腹膜前疝修补术与疝环填充式无张力疝修补术具有良好的临床效果,恢复迅速,可缩短住院时间,缓解术后疼痛,降低复发率和并发症发生风险,缓解了患者的疼痛,就术后疼痛、术后恢复和手术时间而言,腹腔镜下经腹腹膜前疝修补术更优越。     

Tension-free inguinal hernia repair: the design of a trial to compare open and laparoscopic surgical techniques

BACKGROUND: Inguinal hernia is a common condition in men and represents a large component of health-care expenditures. Approximately 700,000 herniorrhaphies are performed each year in the United States. The most effective method of repair of an inguinal hernia is not known. STUDY DESIGN: A multicenter, randomized, clinical trial was designed to compare open tension-free inguinal hernia repair with laparoscopic tension-free repair on recurrence rates, complications, patient-centered outcomes, and cost. The study design called for randomization of 2,200 men over a period of 3 years. These men will be followed for a minimum of 2 years. This will allow determination of as little as a 3% absolute difference in recurrence rates with 80% power. Randomization is stratified by hospital, whether the hernia is unilateral or bilateral and whether the hernia is primary or recurrent. RESULTS: This is a report of the study design and current status. The study involves 14 Veterans Affairs medical centers with previous experience in laparoscopic hernia repair. After 35 months of enrollment, 2,165 men were randomized and recruitment was then closed. The majority of the patients (82.3%) had unilateral hernias and 90.6% of the hernias were primary. Sixty-seven percent of the patients had an outpatient operation. CONCLUSIONS: We report successful recruitment into a large multicenter trial comparing open and laparoscopic hernia repair. When followup is complete, this study will provide data regarding both clinical (recurrence rates) and patient-centered outcomes.     

单孔与多孔法腹腔镜手术治疗腹股沟疝的回顾性对比研究

目的探讨单孔腹腔镜腹股沟疝修补术的安全性和可行性。方法 2009年12月至2011年3月行单孔腹腔镜腹股沟疝修补术11例（单孔组）,其中直疝2例,斜疝9例。10例行单孔腹腔镜完全腹膜外疝修补术（TEP）,1例行经腹腔腹膜前修补术（TAPP）。同期多孔法腹腔镜手术患者18例（多孔组）,其中直疝5例,斜疝13例。16例行TEP,2例行TAPP。收集两组患者围手术期资料进行比较分析。结果两组在术中出血量（P=0.579）和术后住院时间（P=0.839）方面比较差异无统计学意义。在手术时间方面,单孔组长于多孔组（P=0.016）,差异有统计学意义。术后随访3～18个月,两组术中、术后并发症比较差异无统计学意义。结论单孔腹腔镜腹股沟疝修补术安全、有效,具有可行性。其临床应用价值仍需进一步的临床研究证实。     

Quality of life in patients undergoing inguinal hernia repair.

Inguinal hernia repair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal hernia repair in the context of a randomised controlled trial of laparoscopic versus open hernia repair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open hernia repair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal hernia repair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal hernia repair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures.     

Hospital stay and return to full activity following laparoscopic colorectal surgery.

BACKGROUND: The short-term benefits of laparoscopic surgery are well established, particularly within an enhanced recovery program. Early return to activity is to be expected but has not been quantified. The aim of this study was to measure the hospital stay and return to full activity following laparoscopic colorectal surgery and compare this with laparoscopic cholecystectomy and laparoscopic inguinal hernia repair. METHODS: All totally laparoscopic gallbladder, inguinal hernia, and colorectal operations performed between January 2003 and October 2006 were included. Outcomes were collected from a prospective database and case notes. Post discharge information was collected by telephone interview. A comparison was made by creating 4 groups: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair (Transabdominal PrePeritoneal [TAPP]), laparoscopic colorectal nonresectional, and resectional surgery. RESULTS: The median hospital stay following laparoscopic colorectal resection was 7 days, while in the cholecystectomy and hernia group it was 1 day. The median return to full activity after discharge from the hospital was 4, 5, 3, and 7 days in the laparoscopic cholecystectomy, inguinal hernia repair, nonresection, and colorectal resection groups, respectively. CONCLUSIONS: Following laparoscopic colorectal surgery, patients can be expected to return to their usual activities within a week after discharge from the hospital and less than 2 weeks from surgery.     

Laparoscopic repair of inguinal hernia using Surgisis mesh and fibrin sealant.

OBJECTIVE: We tested the hypothesis that laparoscopic inguinal herniorrhaphy using Surgisis mesh secured with fibrin sealant is an effective long-term treatment for repair of inguinal hernia. This case series involved 38 adult patients with 51 inguinal hernias treated in a primary care center. METHODS: Between December 2002 and May 2005, 38 patients with 45 primary and 6 recurrent inguinal hernias were treated with laparoscopic repair by the total extraperitoneal mesh placement (TEP) technique using Surgisis mesh secured into place with fibrin sealant. Postoperative complications, incidence of pain, and recurrence were recorded, as evaluated at 2 weeks, 6 weeks, 1 year, and with a follow-up questionnaire and telephone interview conducted in May and June 2005. RESULTS: The operations were successfully performed on all patients with no complications or revisions to an open procedure. Average follow-up was 13 months (range, 1 to 30). One hernia recurred (second recurrence of unilateral direct hernia), indicating a 2% recurrence rate. CONCLUSIONS: Laparoscopic repair of inguinal hernia using Surgisis mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, direct, indirect, and bilateral inguinal hernias in adults without complications and minimal recurrence within 1-year of follow-up.     

Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison

OBJECTIVE: To study the long-term recurrence rate and other complications after conventional and laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Reliable long-term follow-up of patients with inguinal hernias treated by laparoscopic repair techniques is lacking. METHODS: The authors performed a randomized, multicenter trial in which 487 patients with inguinal hernia were treated by totally extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior hernia repair. Patients were followed and examined for recurrence and chronic inguinal pain 2, 3, and 5 years after surgery. Risk factors for recurrence and chronic inguinal pain were assessed. RESULTS: Patients who underwent conventional repair had a high risk for recurrence compared to patients who underwent laparoscopic repair. Risk factors for recurrence were operative time and type of conventional repair. Predictive independent risk factors for chronic inguinal pain were conventional repair (Bassini repairs and non-bassini repairs), inguinal pain before surgery, and perioperative lesion of the ilioinguinal nerve. CONCLUSIONS: Patients with inguinal hernia who undergo laparoscopic repair have fewer recurrences and less chronic inguinal pain than those who undergo conventional open repair. The Bassini repair produces unacceptably high recurrence rates.     

Does surgeon frustration and satisfaction with the operation predict outcomes of open or laparoscopic inguinal hernia repair?

BACKGROUND: A surgeon's level of frustration when performing an operation and level of satisfaction at completion may be correlated with patients' outcomes. We evaluated the relationship between the attending surgeons' frustration and satisfaction and recurrence and complications of open and laparoscopic inguinal hernia repair. STUDY DESIGN: Men with detectable inguinal hernias were randomized to undergo open or laparoscopic herniorrhaphy at 14 Veterans Affairs hospitals. After completion of the procedure, surgeons were asked to assess their level of frustration during the operation and their overall satisfaction with the operative result. Two subjective scales ranging from 1 (not frustrated/not satisfied) to 5 (very frustrated/very satisfied) were used to independently assess both parameters. Reasons for surgeon frustration were evaluated. Patients were followed for 2 years for recurrence and complications. RESULTS: Of 1,983 patients who underwent hernia repair, 1,622 were available for analysis; 808 had open repair and 813 had laparoscopic repair. Surgeons reported less frustration and more satisfaction with open than with laparoscopic repair (p = 0.0001 and 0.0001, respectively). Frustration was associated with a higher rate of hernia recurrence at 2 years (adjusted odds ratio, 2.01, 95% CI, 1.15-3.51) in open repair, and a higher overall rate of postoperative complications (adjusted odds ratio, 1.27, 95% CI, 1.03-1.56) in both open and laparoscopic hernia repair. Satisfaction was not correlated with recurrence or complications. CONCLUSIONS: The level of a surgeon's frustration during performance of an inguinal herniorrhaphy was a better predictor of outcomes of the operation than was satisfaction with the procedure. Sources of intraoperative frustration should be controlled to improve outcomes.     

Laparoscopic preperitoneal inguinal hernia repair using preformed polyester mesh without fixation: prospective study with 1-year follow-up results in a rural setting

BACKGROUND: To review our case series regarding the effectiveness, postprocedure pain, and cost of totally extraperitoneal (TEP) procedure for inguinal hernia repair, using a preformed polyester mesh (PEM), without fixation with additional anchoring devices. METHODS: Prospective evaluation of all patients from March 2001 to July 2005 who underwent the above-described procedure in an outpatient setting in the rural southern United States using a preformed anatomic Parietex PEM with a minimum 1-year follow-up. All patients were evaluated at 1, 3-week, and 1-year postprocedure for recurrence, complications, and pain level assessment using a standardized questionnaire employing visual analog scale. RESULTS: A series of 108 patients consisting of 95 males and 13 females were operated on with a total of 157 hernias being repaired using laparoscopic techniques. The 1-year follow-up rate was 88.9% (n=96/108). Only 1 followed-up patient (n=1/96; 1.04%) or 0.71% (n=1/140) followed-up hernia repair had a recurrence after TEP repair noted at 1-week postoperative. Two patients had temporary urinary retention and there were no infectious complications or readmissions to the hospital. Visual analog scale pain score (0 to 10) at 1-month postprocedure averaged 0.37 and decreased to 0.03 at 1 year. The cost difference in our institution for all non-reusable material used in laparoscopic hernia repair was US $ 116.77 more than for an open procedure. This was primarily caused by higher costs for the laparoscopic mesh. CONCLUSIONS: Laparoscopic TEP inguinal hernia repair with preformed PEM without additional fixation can be performed in a rural community hospital setting with minimal long-term postoperative pain and the procedure results are comparable with larger centers with only marginally increased costs over open hernia repair.     

不同术式治疗腹股沟疝的临床疗效及预后分析

目的探讨传统开放式腹股沟疝修补术和腹腔镜腹股沟疝无张力修补的安全性和有效性。 方法收集2014年3月至2017年3月,佛山市第一人民医院、十堰市人民医院和广州市花都区人民医院共完成腹股沟疝修补术124例患者的临床资料,按照术式不同分为2组。试验组患者66例,行腹腔镜无张力腹股沟疝修补术;对照组患者58例,行传统开放式腹股沟疝修补术。跟踪随访记录术后并发症及复发情况。 结果试验组手术时间低于对照组,差异有统计学意义（P<0.01）;2组术后并发症及复发率的构成比较,异物感、血肿和阴囊积液等并发症之间比较,差异无统计学意义（P>0.05）,而切口感染、尿潴留及术后复发方面,试验组明显低于对照组,差异有统计学意义（P<0.05）;患者术前合并症与术后出现并发症具有相关性,差异有统计学意义（P<0.05）。 结论腹腔镜无张力疝修补术是腹股沟疝修补术的一个安全有效的方法,加强术前合并症的治疗有助于提高腹股沟疝修补术的疗效。     

老年腹股沟斜疝患者腹腔镜疝修补术全程护理后干预的恢复情况观察

目的观察老年腹股沟斜疝患者腹腔镜疝修补术全程护理干预后的恢复情况。 方法选取阜阳市妇女儿童医院2020年1至12月收治的60例腹股沟斜疝老年患者作为研究对象,所有患者均行腹腔镜经腹腹膜前疝修补术,按照护理方法不同,分为2组,每组30例。对照组给予常规护理,观察组则给予全程干预护理,观察2组患者的恢复情况包括术后的临床指标、疼痛程度、并发症情况以及生活质量。 结果观察组的术后临床指标恢复时间均短于对照组（P<0.05）;观察组3个阶段的疼痛数字评分量表（NRS）评分有明显改善,且观察组各阶段的NRS评分均低于对照组（P<0.05）;观察组的术后并发症发生率为10.00%低于对照组的26.67%（P<0.05）;护理前的生活质量评价量表评分无差异（P>0.05）,护理后评分均有改善且观察组优于对照组（P<0.05）。 结论对行腹腔镜腹股沟疝修补术的老年患者实施全程干预护理具有显著疗效,可有效促进患者的恢复进程,改善其生活质量。     

Endoscopic repair of bilateral inguinal hernias – short and late outcome

Background: In the last decade there have been dramatic changes in the treatment of inguinal hernia with the introduction of mesh techniques including laparoscopic repair. There is still some controversy regarding the treatment of bilateral inguinal hernia but simultaneous operation has gained popularity. The aim of this study was to evaluate the outcome of laparoscopic simultaneous bilateral hernia with regard to complications, recurrence rate, and late discomfort. Methods: A retrospective analysis was made of 168 patients operated simultaneously for bilateral inguinal hernia using the laparoscopic technique between October 1993 and December 1998. Complications were registered and a follow-up was performed using a combination of questionnaire and selective clinical examination. Results: Complications were seen in 23 patients (13.8%), the majority minor. Ninety-five percent of the patients were followed for a median of 36 months. The recurrence rate was 2.7%. Twenty-six of the follow-up patients (15.5%) reported some discomfort. Conclusions: We conclude that simultaneous laparoscopic operation for bilateral inguinal hernia is safe, with complications, recurrence rate and late discomfort are equivalent to those seen after unilateral operation. Electronic Publication     

Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group.

OBJECTIVE: To determine the cost-effectiveness of laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed. METHODS: After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. RESULTS: Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair. CONCLUSION: A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective.     

腹腔镜手P术与开放手术对老年患者围手术期指标、术后康复及并发症的影响

目的比较腹腔镜完全腹膜外疝修补术（TEP）、腹腔镜经腹腹膜外疝修补术（TAPP）与开放手术对老年患者围手术期指标、术后康复及并发症的影响。 方法选取2015年4月至2019年12月北京市丰台区铁营医院收治的老年腹股沟疝患者157例,采用投掷法随机分为TEP组、TAPP组及开放组,分别接受TEP术、TAPP术及开放手术,统计各组围手术期指标及术后并发症发生、复发情况。采用视觉模拟评分法（VAS）评估术后疼痛程度,应用健康调查简表（SF-36）评估各组手术前后生活质量;术前、术后12 h采集静脉血检测各组患者血清基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶组织抑制物-1（TIMP-1）水平。 结果TEP组手术时间显著高于TAPP组和开放组（P<0.05）;开放组术后排气时间、术后下床活动时间、住院时间、术后24 h VAS评分、MMP-9、TIMP-1水平显著高于TEP组和TAPP组（P<0.05）,住院费用、SF-36评分低于TEP组和TAPP组（P<0.05）;开放组术后并发症发生率高于TEP组和TAPP组（P<0.05）。 结论与开放手术相比,TAPP和TEP术后恢复更快,疼痛程度低,生活质量更优,并发症少。     

Is testicular perfusion influenced during laparoscopic inguınal hernia surgery?

Background The influence of laparoscopic inguinal hernia surgery is still unclear. The aim of this study was to compare the possible early effects of laparoscopic and open inguinal hernia repair on testicular perfusion. Methods In this prospective trial, 44 patients underwent mesh repair of a primary inguinal hernia assigned to one of two procedures: open anterior mesh repair (n = 29) or a laparoscopic totally extraperitoneal approach (n = 15). Doppler ultrasound was used to determine the hemodynamic characteristics of the testicular blood flow. Results No statistically significant differences were found between the two groups in terms of Doppler flow parameters for the preoperative, very early (day 1), and early postoperative (day 7) periods. When Doppler flow parameters of the testicular artery were compared in the conventional group, statistically significant differences were found between preoperative and very early postoperative values (p < 0.05). Meanwhile, comparison among flow parameters of the testicular, capsular, and intratesticular arteries of the laparoscopic group showed statistically significant differences between preoperative and very early postoperative and between preoperative and early postoperative values (p < 0.05). There were no statistically differences in postoperative complications between the two groups. Conclusion Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.     

Laparoscopic totally extraperitoneal mesh repair for femoral hernia

BACKGROUND: The role of laparoscopic repair for femoral hernia has not been clearly defined, although the advantages of this technique for repair of inguinal hernia are well recognized. AIM: The aim of this study was to assess the outcome of laparoscopic total extraperitoneal (TEP) repair of femoral hernia. METHODS: Case records of patients who had laparoscopic TEP repair of femoral hernia between 1994 and 2002 were reviewed retrospectively. Patients' demographic details, presentation, operative details, and follow-up information were gathered from the clinical records. Postoperative complications, chronic pain, and recurrence of the hernia were assessed. RESULTS: Fifteen patients, 10 males and 5 females, with a mean age of 55 years (range, 33-84 years) underwent laparoscopic TEP femoral hernia repair. Fourteen patients (93.3%) had a primary femoral hernia, and one had a recurrent femoral hernia. In 9 (60%) patients the hernia was irreducible but not obstructed. There were no postoperative complications or chronic pain. One patient (7%) with a small (11 x 6 cm) mesh developed an inguinal recurrence. CONCLUSION: Laparoscopic TEP repair is a suitable technique for repair of femoral hernia, including irreducible but not obstructed femoral hernias.