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Zamkowski M, Ś Mietański M, Franczak P, Górski D, Grabias J, Janik M, Król A, Mitura K, Mędraś O, Nawacki Ł, Romańczuk M, Rymkiewicz P, Saluk S, Sroczyński P, Sułkowski L, Wieczorek D, Włodarczyk M. MEsh FIxation STudy in Laparoendoscopic Repair of M3 Inguinal Hernias: Multicenter, Double-blind, Randomized Controlled Trial-MEFISTO Trial. Ann Surg 2025; 281:921-927. [PMID: 39945075 DOI: 10.1097/sla.0000000000006669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
OBJECTIVE To evaluate the efficacy of non-fixation versus fixation of meshes in laparoendoscopic repair of M3 inguinal hernias in terms of recurrence, postoperative pain, and surgical complications. BACKGROUND International guidelines recommend mesh fixation for large M3 inguinal hernias during laparoendoscopic repairs due to high recurrence rates. However, emerging experimental and registry data suggest that anatomically shaped, rigid, and three-dimensional (3D) meshes may maintain stability without fixation. This study aimed to address this knowledge gap through a multicenter randomized controlled trial. METHODS The MEsh FIxation STudy trial is a prospective, multicenter, double-blind, randomized controlled trial conducted in 12 surgical centers. A total of 204 patients with M3 inguinal hernias were randomized into 2 groups: a "non-fixation" group using 3D, rigid, anatomic meshes. "Fixation" group using flat lightweight meshes fixed with tissue adhesive. The primary outcome was the recurrence rate at 12 months. The secondary outcomes included postoperative pain (Visual Analog Scale) and surgical site occurrence. Data were analyzed using appropriate statistical methods for noninferiority studies. RESULTS The recurrence rate at 12 months was 3.1% and 2.1% in the non-fixation and fixation groups respectively ( P = 0.6847). No differences were observed in pain at discharge, 7 to 10 days postsurgery, or 12 months postsurgery. No significant differences were found in surgical complications or operative times between groups. CONCLUSIONS Non-fixation of 3D meshes is noninferior to fixation of flat lightweight meshes for M3 inguinal hernia repair. These findings support the potential revision of international hernia management guidelines to incorporate non-fixation approaches with appropriate mesh types.
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Affiliation(s)
- Mateusz Zamkowski
- General Surgery and Hernia Center, Swissmed Hospital, Gdańsk, Poland
- Department of Radiology, Gdańsk Medical University, Gdańsk, Poland
| | - Maciej Ś Mietański
- General Surgery and Hernia Center, Swissmed Hospital, Gdańsk, Poland
- II Department of Radiology, Gdańsk Medical University, Gdańsk, Poland
| | - Paula Franczak
- Department of General and Oncological Surgery, Hospital in Wejherowo, Wejherowo, Poland
| | - Dominik Górski
- Department of General Surgery, District Hospital, Szczytno, Poland
| | - Jacek Grabias
- Department of General and Oncological Surgery, Prof. S. T. Dąbrowski Hospital, Puszczykowo, Poland
| | - Michał Janik
- Clinic of General Surgery, Military Institute of Aviation Medicine (WIML), Warsaw, Poland
| | - Aleksander Król
- Department of General Surgery, Dr. K. Jonscher Hospital, Łódź, Poland
| | - Kryspin Mitura
- Department of General Surgery, Municipal Hospital SPZOZ in Siedlce, University in Siedlce, Faculty of Medical and Health Sciences, Siedlce, Poland
| | - Olaf Mędraś
- Department of General and Oncological Surgery, Regional Health Centre, Lubin, Poland
| | - Łukasz Nawacki
- Clinic of General, Oncological, and Endocrine Surgery, Provincial Integrated Hospital, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Michał Romańczuk
- Department of General Surgery, Municipal Hospital SPZOZ in Siedlce, University in Siedlce, Faculty of Medical and Health Sciences, Siedlce, Poland
| | - Przemysław Rymkiewicz
- Clinical Department of General Surgery, Subunit for Bariatric Surgery, Municipal Integrated Hospital, Olsztyn, Poland
| | - Sławomir Saluk
- Clinical Department of General Surgery, Subunit for Bariatric Surgery, Municipal Integrated Hospital, Olsztyn, Poland
| | - Przemysław Sroczyński
- Clinic of General Surgery, Military Institute of Aviation Medicine (WIML), Warsaw, Poland
| | - Leszek Sułkowski
- Department of General Surgery, Regional Specialist Hospital, Częstochowa, Poland
| | | | - Marcin Włodarczyk
- Department of General and Oncological Surgery, Medical University of Łódź, Faculty of Medicine, Łódź, Poland
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Shologan A, Farooq O, Bostick G, Macedo L, Durand-Moreau Q, Peters MR, Gross DP. A pilot randomized controlled trial examining the feasibility of perioperative rehabilitation for inguinal hernia repair surgery. PLoS One 2025; 20:e0324907. [PMID: 40403095 PMCID: PMC12097709 DOI: 10.1371/journal.pone.0324907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 04/30/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND Despite the high frequency of inguinal hernia repair (IHR) surgery, there is little research investigating pre- or post-operative exercise and education in this population. Recommendations regarding perioperative physical activity are inconsistent and largely based on clinical opinion. We conducted a pilot randomized controlled trial to examine the feasibility of perioperative rehabilitation for inguinal hernia repair surgery in terms of recruitment rate, assessment, and protocol implementation. METHODS Participants were randomized into an intervention group and control group. Descriptive and patient-reported data were collected through online surveys at baseline, post-prehabilitation (prehab), 1-week post-operative (post-op), and 12-week post-op. Eligible participants completed a performance-based modified Short Form Functional Capacity Evaluation conducted by a masked observer at baseline, after 6 weeks of exercise and/or education, and at 12-week post-op. Participants in the intervention group received 6 weeks of exercise and education prior to and then after surgery. The control group received care as usual. RESULTS Thirty-one participants awaiting IHR with a mean age of 49 years were recruited (recruitment rate of 51.7%). Thirty participants were randomized into control (n = 16) and intervention groups (n = 14), while 1 dropped out prior to beginning the study due to being unable to take time off work for assessment. Twenty-four participants completed the final 12-week post-op follow-ups. Twenty-one participants returned to work by the 12-week post-op follow-up. Sixty-seven percent of participants in the intervention group exercised at least 3 times per week post-operatively. One participant in each group experienced exacerbations of hernia symptoms that were unrelated to study activities. Functional testing resulted in minimal symptom exacerbation in either group, but the intervention group reported less pain at 12-week post-op than controls. CONCLUSION A randomized trial of perioperative rehabilitation for patients undergoing inguinal hernia repair appears feasible, but protocol adjustments are needed to improve recruitment rate, assessment, and participant retention. Trial Registration: This trial is registered with ClinicalTrials.gov Identifier: NCT05069142.
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Affiliation(s)
- Anna Shologan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Omar Farooq
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Geoffrey Bostick
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Meaghan Ray Peters
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P. Gross
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Meuzelaar RR, Schiphorst AHW, Burgmans JPJ. Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study. Hernia 2025; 29:164. [PMID: 40374818 DOI: 10.1007/s10029-025-03327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 03/22/2025] [Indexed: 05/18/2025]
Abstract
PURPOSE Although the recurrence rate after inguinal hernia repair is low, it remains an important postoperative outcome. To further reduce this rate, modifiable risk factors should be addressed. This study assessed reoperations for recurrence-like complaints following adjustments to the intraoperative protocol aimed at preventing recurrent inguinal hernias. These adjustments included fixating mesh in large unilateral direct defects and large bilateral hernias, and thoroughly reducing inguinal lipomas. METHODS Elective totally extraperitoneal (TEP) repairs in adults performed between January 1, 2013, and October 25, 2023, were retrospectively included. The cohort was subsequently divided into two groups based on the timing of their TEP repair: before (pre-implementation) or after (post-implementation) the protocol adjustments. The primary outcome was reoperation for recurrence-like complaints following the initial TEP repair. Secondary outcomes included mesh fixation and lipoma reduction. RESULTS A total of 12,878 TEP repairs in 12,507 patients were included (pre-implementation: 5,454; post-implementation: 7,424). Reoperation rate decreased from 0.97% pre-implementation to 0.65% post-implementation (p = 0.630). Following protocol implementation, mesh fixation for unilateral hernias significantly increased from 3.2% to 5.4% (p < 0.001), and for bilateral hernias from 9.8% to 16.3% (p < 0.001). Lipoma reduction was similar between the groups (unilateral: 32.3-32.6%, p = 0.625; bilateral: 36.0-38.1%, p = 0.288). CONCLUSION The adjusted intraoperative protocol demonstrated a non-significant declining trend of reoperations for recurrence-like complaints. Lipoma reduction was already well-implemented. While mesh fixation increased, it had no significant effect on the recurrence rate, so careful selection of hernias requiring fixation warrants attention.
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Affiliation(s)
- R R Meuzelaar
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - A H W Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - J P J Burgmans
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
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Shrivastava R, Shaikh N. Optimizing laparoscopic eTEP inguinal hernia repair: challenges and solutions. Hernia 2025; 29:163. [PMID: 40338376 DOI: 10.1007/s10029-025-03353-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/21/2025] [Indexed: 05/09/2025]
Abstract
PURPOSE The field of hernia repair has been revolutionized since the advent of totally extraperitoneal(TEP) repairs. The concept of eTEP(extended view TEP) repairs have further expanded horizons by overcoming the challenges faced in TEP repairs. Although laparoscopic ETEP hernia repairs offer a myriad of advantages, these procedures pose a steep learning curve and may pose complications which maybe difficult to manage. This observational study aims to highlight the complications faced during laparoscopicETEP inguinal hernia repairs at our centre and provide possible solutions for the same. METHODS This is a high volume single-centre, single team prospective observational data of patients undergoing laparoscopicETEP inguinal hernia repairs from January2020 to October2023. We reviewed a total of 252 such patients and collected demographic details, co-morbidities, intra-operative complications and post-operative recovery of the patients. RESULTS We have highlighted the possible complications and recommended trouble-shooting approaches to tackle them. The incidence of intra-operative and early complications like early pneumoperitoneum, injury to brick's artery, injury to inferior epigastric artery, peritoneal rents, urinary retention in our study was 5.15%,1.98%,0.4%,10.32%,1.9% respectively. Late complications like seroma, hematoma, chronic pain showed an incidence of 1.59%,0.4%,1.98% respectively. Our cohort did not have any cases of visceral injury(bowel/bladder) or surgical site infection. CONCLUSION It is essential to identify and address complications faced during laparoscopic eTEP repairs to ensure patient safety, improved outcomes, reduced recurrences and surgical site infections. Implementing the suggested strategies may help improve the surgical outcome and in turn post-operative patient well-being and quality of life in patients undergoing eTEP repairs.
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Affiliation(s)
- Rajesh Shrivastava
- Department of General Surgery, Shreeji Hospital, Deheli, Bhilad, Valsad, Gujarat, 396105, India
| | - Nazrah Shaikh
- Department of General Surgery, Shreeji Hospital, Deheli, Bhilad, Valsad, Gujarat, 396105, India.
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Korah MM, Chan PH, Prentice HA, Sucher K, Park CL, Heitmann GM, Paxton EW, Mostaedi R, Brill ER. Risk of adverse outcomes by plug and flat mesh following 90,319 open inguinal hernia repairs. Hernia 2025; 29:159. [PMID: 40327184 DOI: 10.1007/s10029-025-03342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 04/07/2025] [Indexed: 05/07/2025]
Abstract
PURPOSE We sought to evaluate the risks for reoperation, recurrence, and groin pain following open inguinal hernia repair with a plug versus flat mesh. METHODS We conducted a cohort study including 90,319 patients ≥ 18 years who underwent first elective open inguinal hernia repair with polyester/polypropylene mesh within a US integrated healthcare system (1/2010-6/2023). Plug versus flat mesh were the treatment groups. Reoperation related to the index hernia repair, as well as other reoperation reasons, and recurrence during follow-up were primary outcomes, while 5-year postoperative groin pain (excluding first 6-month postoperative acute recovery period) was a secondary outcome. Multiple Cox regression was used to evaluate risk of longitudinal outcomes, while multiple logistic regression was used to evaluate groin pain, with covariate adjustment. RESULTS Plugs were used in 37,490 (41.5%) repairs; plug use declined from 53.0% in 2010 to 13.9% in the first six months of 2023. No difference in risk for reoperation (hazard ratio [HR] = 1.03, 95% confidence interval [CI] = 0.92-1.16) or recurrence (HR = 0.93, 95% CI = 0.83-1.04) was found for plug compared to flat mesh. A higher risk of reoperation for device infection was observed with plug use compared to flat mesh (HR = 2.71, 95% CI = 1.09-6.77). In adjusted analysis, no difference in the likelihood of groin pain was observed (odds ratio = 1.08, 95% CI = 1.00-1.17). CONCLUSION Plug mesh for open inguinal hernia repairs were not found to have improved outcomes compared to flat mesh but a higher risk of reoperation for infection. These findings align with the current literature, which generally advises against the use of mesh plugs due to associated risks and complications.
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Affiliation(s)
- Maria M Korah
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Priscilla H Chan
- Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Heather A Prentice
- Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Kenneth Sucher
- Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Cheryl L Park
- Department of Surgery, Southern California Permanente Medical Group, Woodland Hills, CA, USA
| | - Gregory M Heitmann
- Department of Surgery, Southern California Permanente Medical Group, Woodland Hills, CA, USA
| | - Elizabeth W Paxton
- Medical Device Surveillance & Assessment, Southern California Permanente Medical Group, San Diego, CA, USA
| | - Rouzbeh Mostaedi
- Department of Surgery, The Permanente Medical Group, Richmond, CA, USA
| | - Elliott R Brill
- Department of Surgery, The Permanente Medical Group, Santa Clara, CA, USA.
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Bulut A, Akın Mİ. A comparative evaluation of laparoscopic TAPP videos on YouTube and WebSurg: surgical steps and educational value. Hernia 2025; 29:155. [PMID: 40317323 PMCID: PMC12049284 DOI: 10.1007/s10029-025-03341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 04/07/2025] [Indexed: 05/07/2025]
Abstract
PURPOSE Laparoscopic Transabdominal Preperitoneal (TAPP) videos on YouTube and WebSurg have an important place in surgical training. However, there are differences between these platforms in terms of training quality and compliance with standard surgical steps. The aim of this study was to compare laparoscopic TAPP videos on YouTube (limited to individually uploaded content) and WebSurg in terms of surgical technique and educational quality. METHODS Twelve videos meeting specific criteria were selected from both platforms. The 2 groups were compared using the 9 Commandments, which assessed compliance with surgical steps, and the Procedure Presentation Score (PPS), which assessed video quality/educational content. Data on video characteristics, such as view count, publication date, and duration, were also collected. RESULTS Although YouTube videos reached more viewers, WebSurg videos had higher compliance with the 9 Commandments (WebSurg median score 8/9 vs. YouTube median score 5/9, p < 0.01). In addition, WebSurg videos had higher PPS scores (median: 8) than YouTube videos (median: 5) (p = 0.02). CONCLUSION When utilizing online video platforms for surgical training, institutional training platforms such as WebSurg should be preferred. When the videos included here were compared with YouTube in the light of the defined criteria; it was seen that YouTube videos were not of sufficient quality.
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Affiliation(s)
- Alisina Bulut
- Department of General Surgery, Marmara University Faculty of Medicine, Basıbuyuk Yolu No: 9 D:2, Maltepe, Istanbul, 34854, Turkey.
| | - Muhammed İkbal Akın
- Department of Gastrointestinal Surgery, Kosuyolu High Specialization Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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Satapathy P, Jena A, Gaidhane AM, Vadia N, Menon SV, Chennakesavulu K, Panigrahi R, Kaur M, Bushi G, Shabil M, Goyal M, Kumar H, Rani A, Ansar S, Sah S, Khatib MN, Goh KW, Jena D. Burden of inguinal, femoral, and abdominal hernias in India: A systematic analysis of prevalence, incidence, mortality, and DALYs from global burden of disease study 1990-2021 with projections to 2031. Hernia 2025; 29:158. [PMID: 40317332 DOI: 10.1007/s10029-025-03343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 04/07/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Hernias are a major health concern in India, with varying incidence and prevalence influenced by socio-demographic factors. Despite global advances in hernia management, regional disparities are evident within India. METHOD This analysis utilized data from the Global Burden of Disease (GBD) Study 2021 to examine inguinal, femoral, and abdominal hernias across India from 1990 to 2021, categorized by ICD-10 codes. Key metrics analyzed included prevalence, incidence, mortality, and Disability-Adjusted Life Years (DALYs), with age-standardized rates (ASRs). The Estimated Annual Percentage Change (EAPC) for incidence and mortality, Spearman correlation for assessing the relationship between Socio-Demographic Index (SDI) and hernia metrics, and ARIMA models for future trend projections were employed. RESULT Between 1990 and 2021, the age-standardized incidence rate (ASIR) of hernias in India decreased from 143.85 to 137.05 per 100,000, a reduction of 4.72%, despite a 46% increase in the absolute number of hernia cases due to population growth. Mortality rates significantly declined by 57.05%. DALYs also decreased from 98.01 to 43.51 per 100,000. Projections for 2031 indicate stabilization of incidence rates and an increase in prevalence. CONCLUSIONS Significant improvements in hernia management in India have been achieved over three decades, driven by advances in healthcare and socio-demographic progress. However, the rising number of cases and expected increase in prevalence highlight the need for enhanced healthcare strategies and resource allocation to manage the hernia burden effectively.
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Affiliation(s)
- Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Ashutosh Jena
- Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
| | - Abhay M Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, and Global Health Academy, Datta Meghe Institute of Higher Education, Wardha, India
| | - Nasir Vadia
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, Marwadi University Research Center, Marwadi University, Rajkot, 360003, Gujarat, India
| | - Soumya V Menon
- Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India
| | - Kattela Chennakesavulu
- Department of Chemistry, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Rajashree Panigrahi
- Department of Microbiology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to Be University), Bhubaneswar, Odisha, 751003, India
| | - Manpreet Kaur
- Department of Pharmacy, Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali, 140307, Punjab, India
| | - Ganesh Bushi
- Chitkara Centre for Research and Development, Chitkara University Institute of Engineering and Technology, Chitkara University, Solan, Himachal Pradesh, 174103, India
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Muhammed Shabil
- University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, 51001, Babil, Iraq
| | - Mayank Goyal
- IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, 462044, India
| | - Harish Kumar
- Tughlakabad Institutional Area, New Delhi Institute of Management, New Delhi, India
| | - Anju Rani
- Department of Microbiology, Graphic Era (Deemed to Be University), Clement Town, Dehradun, 248002, India
- Graphic Era Hill University, Clement Town, Dehradun, India
| | - Sabah Ansar
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, 11433, Riyadh, Saudi Arabia
| | - Sanjit Sah
- Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-Be-University), Pimpri, Pune, 411018, Maharashtra, India
- Department of Public Health Dentistry, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-Be-University), Pimpri, Pune, 411018, Maharashtra, India
- Department of Medicine, Korea Universtiy, Seoul, South Korea
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
- Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia
| | - Diptismita Jena
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, 140417, Punjab, India.
- Division of Research and Innovation, Uttaranchal University, Dehradun, India.
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English NC, Hood C, Corey B, Parmar AD. Natural history of groin hernias in women and factors leading to delay in repair: a single-institution study. Surg Endosc 2025; 39:3377-3385. [PMID: 40234333 PMCID: PMC12041139 DOI: 10.1007/s00464-025-11709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 03/31/2025] [Indexed: 04/17/2025]
Abstract
BACKGROUND The objective of this study was to describe the natural history of groin hernias in women at a high-volume tertiary medical center. Specifically, we abstracted the duration of symptoms prior to diagnosis, imaging modalities used, and operative findings. We hypothesized that females would experience a protracted preoperative clinical course. METHODS Our institutional hernia database was queried for elective groin hernia repairs from January 2018 to July 2023. Analyses were used to measure and describe demographics, clinical characteristics, and operative findings. In addition, patients' zip codes were linked to census track area deprivation index (ADI) values and a semi-qualitative inquiry was performed to explore reasons for the protracted preoperative clinical course. RESULTS Among 1331 patients, 8.4% were female. Majority were Caucasian (68.8%) and overweight (BMI 27.3 ± 5.8), averaging 61.2 years of age. Majority reported non-specific groin pain (73.8%) and an intermittent groin bulge (48.8%), with 40% experiencing symptoms for > 1 year. Patients averaged 1.2 clinic visits before seeing a surgeon. Indirect inguinal hernias were the most common (81.3%), followed by femoral (35%) and direct (26.3%). Sixty-three patients had preoperative imaging, including CT (56.8%), US (39.2%), and MRI (4.0%). The most common surgical approach was robotic (68.8%) followed by laparoscopic-TEP (22.5%). When stratified by duration of symptoms, ADI did not differ among our cohort (p = 0.497). Patient-related reasons for delaying surgery included interpersonal stressors (3.1%), symptoms not limiting ADLs (34.4%), and fear of mesh complications (3.1%). Providers advised against surgery due to malnutrition (3.1%), multiple prior repairs (9.4%), concomitant infection (3.1%), and severe ascites (6.3%). CONCLUSION Our study provides some insight into reasons for delay in inguinal hernia repair for women. While many reported symptoms for over a year, a minority sought treatment until they were ready to proceed with surgery. Future qualitative studies are needed to more thoroughly assess female's perspectives with groin hernias.
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Affiliation(s)
- Nathan C English
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35233, USA
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Caleb Hood
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35233, USA
| | - Britney Corey
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35233, USA
| | - Abhishek D Parmar
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35233, USA.
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Li L, Cui R, Ma W, Yao K. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia. Open Med (Wars) 2025; 20:20241066. [PMID: 40292257 PMCID: PMC12032990 DOI: 10.1515/med-2024-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 06/28/2024] [Accepted: 09/27/2024] [Indexed: 04/30/2025] Open
Abstract
Objective To evaluate the effect of serum IL-6, C-reactive protein (CRP), and matrix metalloproteinase-9 (MMP-9) levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia. Methods Clinical records of 42 patients with inguinal hernias who underwent modified preperitoneal Kugel repair were retrospectively analyzed. Serum IL-6, CRP, and MMP-9 were detected before surgery and after surgery. The patients were divided into the corresponding high-expression group and low-expression group. The basic data and clinical characteristics of patients were analyzed and compared, as well as postoperative indexes. Results In patients with inguinal hernia, serum IL-6, CRP, and MMP-9 increase first and then decrease after surgery, reaching the peak value around 24 or 48 h after surgery. Patients with high-expression of IL-6, CRP, and MMP-9 had longer hospital stays and time to return to normal activities, and were more likely to have chronic abdominal pain. In addition, high-expression of IL-6 and CRP had a higher probability of postoperative VAS values and wound infection, and high-expression of IL-6 and MMP-9 were also more likely to have wound healing injuries. Conclusions Serum IL-6, CRP, and MMP-9 levels in patients with inguinal hernia can affect the efficacy of modified preperitoneal Kugel repair and the prognosis of patients.
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Affiliation(s)
- Lifang Li
- Department of Gerneral Surgery, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Renjie Cui
- Department of Gerneral Surgery, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Wanli Ma
- Department of Gerneral Surgery, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Kunhou Yao
- Department of Gerneral Surgery, Huaihe Hospital of Henan University, No. 115 Ximen Street, Gulou District,, Kaifeng, 475000, China
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Hsieh CC, Dai JZ, Ni CC, Wei SY, Tsai MC, Chen PY, Fang L, Xie RH, Chen GY, Yin GC, Chen YC. Prevascularized Hydrogel Enhancing Innervation and Repair of Full-Thickness Volumetric Muscle Loss in Abdominal Wall Defects. Adv Healthc Mater 2025; 14:e2402433. [PMID: 40059482 DOI: 10.1002/adhm.202402433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 02/17/2025] [Indexed: 04/26/2025]
Abstract
Current materials for repairing abdominal peritoneal defects face rapid degradation, infection risk, insufficient vascular ingrowth, slow muscle regeneration, and suboptimal postoperative integration, often causing fibrotic healing and hindering volumetric muscle loss (VML) repair exceeding 30%. To address these issues, photo-cross-linkable gelatin hydrogels are combined with blood vessel-forming cells to reconstruct vascular networks, providing temporary nutrient and gas channels that support cell repair. By developing a polymer-chain propagation time technique, hydrogel properties are optimized, avoiding limitations of conventional light exposure. These gels guide blood-vessel formation in vitro and promote robust microvessel and neural development in vivo. Precise control of light exposure and propagation times balances cross-linking and degradation, fostering blood vessel growth and host motor neuron ingrowth. In 55% VML, these hydrogels enable full-thickness abdominal muscle regeneration, restoring up to 70% of lost muscle while mimicking healthy tissue's strength and structure. Achieving higher degradation rates and a vascular density exceeding 50 vessels/mm-2 is essential for functional muscle repair. These strategies effectively bridge current clinical gaps, advancing regenerative medicine. The ability to fine-tune degradation and stiffness underscores gelatin hydrogels' potential as cell carriers, allowing the reconstruction of temporary vascular and neural channels at injury sites and significantly enhancing muscle tissue regeneration.
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Affiliation(s)
- Chia-Chang Hsieh
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Jun-Zhi Dai
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Chun-Chuan Ni
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Shih-Yen Wei
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Min-Chun Tsai
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Po-Yu Chen
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Ling Fang
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
| | - Ren-Hao Xie
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
| | - Guan-Yu Chen
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, 300093, Taiwan
| | - Gung-Chian Yin
- National Synchrotron Radiation Research Center, Hsinchu, 300092, Taiwan
| | - Ying-Chieh Chen
- Department of Materials Science and Engineering, National Tsing-Hua University, Hsinchu, 300044, Taiwan
- College of Semiconductor Research, National Tsing-Hua University, Hsinchu, 300044, Taiwan
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Dufay M, Jimenez M, Casetta M, Chai F, Blanchemain N, Maton M, Cazaux F, Bellayer S, Degoutin S. Abdominal PP meshes coated with functional core-sheath biodegradable nanofibers with anticoagulant and antibacterial properties. BIOMATERIALS ADVANCES 2025; 169:214163. [PMID: 39756090 DOI: 10.1016/j.bioadv.2024.214163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/11/2024] [Accepted: 12/24/2024] [Indexed: 01/07/2025]
Abstract
Abdominal hernia repair is a common surgical procedure, involving in most cases the use of textile meshes providing a mechanical barrier to consolidate the damaged surrounding tissues and prevent the resurgence of the hernia. However, in more than half cases postoperative complications such as adhesions and infections occur at the surface of the mesh, leading to chronic pain for the patient and requiring the removal of the implant. One of the most promising strategies to reduce the risk of postoperative adhesions and infections is to add a physical barrier between the mesh and the abdominal walls. In this study, we propose a strategy to develop functional hernia meshes possessing anticoagulant and antibacterial activities depending on the side of the implant. Two bioactive polymers were synthetized: a polysulfonate (poly(2-acrylamido-2-methylpropane sulfonic acid), PAMPS) one for anticoagulant activity and a polymer bearing ternary amines (poly((2-tert-butylamino) ethyl methacrylate), PTBAEMA) for antibacterial activity. These polymers were used to produce core-sheath nanofibers thanks to coaxial electrospinning with poly(ɛ-caprolactone) (PCL) as core and the bioactive polymer as sheath. The electrospinning parameters were optimized in order to obtain defect-free nanofibrous coatings onto the mesh with improved stability in water. The core-sheath structure was investigated as well as the presence of the functional groups at the surface. The in vitro cytocompatibility, anticoagulant activity and antibacterial activity were evaluated and highlighted the high potential of these coatings for the simultaneous prevention of postoperative adhesions and infections.
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Affiliation(s)
- Malo Dufay
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France
| | - Maude Jimenez
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France
| | - Mathilde Casetta
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France
| | - Feng Chai
- Univ. Lille, Inserm, CHU Lille, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Nicolas Blanchemain
- Univ. Lille, Inserm, CHU Lille, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Mickael Maton
- Univ. Lille, Inserm, CHU Lille, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Frédéric Cazaux
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France
| | - Séverine Bellayer
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France
| | - Stéphanie Degoutin
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207 - UMET - Unité Matériaux et Transformations, F-59000 Lille, France.
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12
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Ki H, Koo S, Kang GH, Sul J, Park J. Nationwide big data analysis of inguinal hernia surgery trends in South Korea (2016-2022). Ann Surg Treat Res 2025; 108:211-218. [PMID: 40226173 PMCID: PMC11982445 DOI: 10.4174/astr.2025.108.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 11/28/2024] [Accepted: 12/29/2024] [Indexed: 04/15/2025] Open
Abstract
Purpose This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.
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Affiliation(s)
- Hyunjeong Ki
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seyoung Koo
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Gil Ho Kang
- Department of Surgery, Hansarang Hospital, Ansan, Korea
| | - Jiyoung Sul
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Junbeom Park
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
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13
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Varun R, Shaikh OH, Sagar P, Vijayakumar C, Balasubramanian G, Kumbhar US. Telescopic dissection versus balloon dissection during laparoscopic totally extraperitoneal inguinal hernia repair: A prospective randomised control trial. J Minim Access Surg 2025; 21:133-140. [PMID: 38726965 PMCID: PMC12054956 DOI: 10.4103/jmas.jmas_373_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 03/05/2024] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Totally extraperitoneal (TEP) repair involves creating a preperitoneal space. The preperitoneal space can be created by balloon or telescopic dissection (TD). Nevertheless, these techniques may have some complications. However, there are very few studies that compare these two techniques. This study aims to assess the impact and comprehensively compare the TD and balloon dissection (BD) methods in patients undergoing laparoscopic TEP inguinal hernia repair. PATIENTS AND METHODS This was a single-centre, double-blinded, prospective, randomised, controlled trial comparing BD and TD for the creation of the preperitoneal space. The primary end point was to compare the post-operative pain score, intraoperative complications and surgical site occurrence between the two groups. The secondary end point was to assess the impact of the dissection technique on operative time for the creation of extraperitoneal space during laparoscopic TEP inguinal hernia repair. RESULTS A total of 46 patients were included in the study (23 in each group). Baseline parameters were comparable between the groups. The total operative time between the groups (120 min vs. 160 min; P < 0.005) was statistically significant. The incidence of the peritoneal breach was statistically less in the BD group (43% vs. 13%; P < 0.005). Other short-term and long-term complications were less in the BD group but not statistically significant. CONCLUSIONS BD in TEP inguinal hernia repair reduces the operative time and peritoneal breach. When compared to TD in terms of operative time, routine use of BD can be proposed. It will be beneficial in the early part of the learning curve.
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Affiliation(s)
- Rajanna Varun
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Oseen Hajilal Shaikh
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prakash Sagar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Chellappa Vijayakumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gopal Balasubramanian
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Uday Shamrao Kumbhar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ambulatory inguinal hernia repair in Portugal - a multicenter prospective cohort study. Updates Surg 2025:10.1007/s13304-025-02084-6. [PMID: 40131709 DOI: 10.1007/s13304-025-02084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 01/07/2025] [Indexed: 03/27/2025]
Abstract
Ambulatory surgery is the recommended approach for elective inguinal hernia repair for most people. However, the relative use of this procedure in Portugal and its related outcomes are unknown. We aimed to assess complication rates in patients undergoing ambulatory and inpatient surgery. Prospective multicentric cohort study included consecutive patients undergoing elective inguinal hernia repair in mainland Portugal (October-December 2019). The primary outcome was the post-operative complication rate (any Clavien-Dindo grade) among patients undergoing ambulatory and inpatient surgery. A logistic regression analysis was performed to adjust for patient and disease-related co-variables. Eight hundred twenty-eight patients (89.1% of males) were included from thirty-three hospitals, of which seven hundred sixteen (86.4%) had unilateral hernias. Four hundred thirty-three (52.2%) were operated on as day cases and three hundred ninety-five (47.7%) with overnight stays. There were no significant differences in post-operative complication rate between patients undergoing ambulatory and overnight stay surgery, both in unadjusted (9.9% vs. 11.1%; p = 0.650) and adjusted (odds ratio: 1.08 [95% CI 0.66-1.76]) analyses. Ambulatory surgery was only performed in half of the patients, although this procedure is not associated with an increased risk of complications. These results should promote the expanded use of ambulatory surgery in patients eligible for elective inguinal hernia repair.
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15
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Zhang L, Chen J, Zhang YY, Liu L, Wang HD, Zhang YF, Sheng J, Hu QS, Liu ML, Yuan YL. Three-dimensional reconstruction under computed tomography and myopectineal orifice measurement under laparoscopy for quality control of inguinal hernia treatment. World J Gastrointest Endosc 2025; 17:104966. [PMID: 40125507 PMCID: PMC11923984 DOI: 10.4253/wjge.v17.i3.104966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 02/06/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Inguinal hernias are common after surgery. Tension-free repair is widely accepted as the main method for managing inguinal hernias. Adequate exposure, coverage, and repair of the myopectineal orifice (MPO) are necessary. However, due to differences in race and sex, people's body shapes vary. According to European guidelines, the patch should measure 10 cm × 15 cm. If any part of the MPO is dissected, injury to the nerves, vascular network, or organs may occur during surgery, thereby leading to inguinal discomfort, pain, and seroma formation after surgery. Therefore, accurate localization and measurement of the boundary of the MPO are crucial for selecting the optimal patch for inguinal hernia repair. AIM To compare the size of the MPO measured on three-dimensional multislice spiral computed tomography (CT) with that measured via laparoscopy and explore the relevant factors influencing the size of the MPO. METHODS Clinical data from 74 patients who underwent laparoscopic tension-free inguinal hernia repair at the General Surgery Department of the First Affiliated Hospital of Anhui University of Science and Technology between September 2022 and July 2024 were collected and analyzed retrospectively. Transabdominal preperitoneal was performed. Sixty-four males and 10 females, with an average age of 58.30 ± 12.32 years, were included. The clinical data of the patients were collected. The boundary of the MPO was measured on three-dimensional CT images before surgery and then again during transabdominal preperitoneal. All the preoperative and intraoperative data were analyzed via paired t-tests. A t-test was used for comparisons of age, body mass index, and sex between the groups. In the comparative analysis, a P value less than 0.05 indicated a significant difference. RESULTS The boundaries of the MPO on 3-dimensional CT images measured 7.05 ± 0.47 cm and 6.27 ± 0.61 cm, and the area of the MPO was 19.54 ± 3.33 cm2. The boundaries of the MPO during surgery were 7.18 ± 0.51 cm and 6.17 ± 0.40 cm. The errors were not statistically significant. However, the intraoperative BD (the width of the MPO, P = 0.024, P < 0.05) and preoperative AC (the length of the MPO, P = 0.045, P < 0.05) significantly differed according to sex. The AC and BD measurements before and during surgery were not significantly different according to age, body mass index, hernia side or hernia type (P > 0.05). CONCLUSION The application of this technology can aid in determining the most appropriate dissection range and patch size.
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Affiliation(s)
- Lei Zhang
- Hernia Center of the Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Jing Chen
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan 232001, Anhui Province, China
| | - Yu-Ying Zhang
- Hernia Center of the Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Lei Liu
- Hernia Center of the Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Han-Dan Wang
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan 232001, Anhui Province, China
| | - Ya-Fei Zhang
- School of Electrical and Information Engineering, Anhui University of Science and Technology, Huainan 232001, Anhui Province, China
| | - Jun Sheng
- Imaging Center, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Qiu-Shi Hu
- Hernia Center of the Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Ming-Liang Liu
- Imaging Center, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
| | - Yi-Lin Yuan
- Hernia Center of the Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan 232007, Anhui Province, China
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16
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Aragone L, Rosasco N, Gutierrez J, Croceri R, Medina P, Pirchi D. Complicated Inguinocrural Hernias: Laparoscopic Vs. Open Surgery in the Emergency Setting. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2025; 4:14408. [PMID: 40134504 PMCID: PMC11932831 DOI: 10.3389/jaws.2025.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 02/27/2025] [Indexed: 03/27/2025]
Abstract
Introduction The feasibility of laparoscopic treatment for inguinocrural-hernias (ICH) and its advantages over open techniques have already been demonstrated. Nonetheless, there is still no sufficient literature regarding laparoscopy for incarcerated or strangulated ICH in the emergency setting. Our primary outcome was to evaluate the feasibility and safety of laparoscopic surgery (LS) for complicated ICH by comparing outcomes to open surgery (OS). Methods A comparative retrospective study with prospective case registry was conducted. All patients who underwent ICH repair due to complicated hernias from January 2003 to December 2023 were analyzed and divided into groups according to the approach during surgery: OS (by Lichtenstein technique) or LS (by transabdominal preperitoneal approach). Demographic variables, hernia size and type, surgical time, length of stay, recurrence and other morbidities were compared between groups. Results A total of 8282 ICH were operated in the studied period, out of which 162 were included in the study due to incarceration or strangulation. Of these, 83 were treated by OS, while 79 underwent LS. LS showed a reduction in surgical time (70 min IQR60-103 vs. 117 min IQR100-120; p 0.03), length of stay (1.9 days ± 1.4 vs. 2.9 days ± 3.1; p 0.01) and total morbidities (6.3% vs, 16.8%; p 0.04), with a similar recurrence rate (1.2% vs. 1.2%; p1) when compared to OS group. Conclusion Laparoscopic surgery for the treatment of complicated inguinocrural-hernias is a feasible and safe approach. It allows the benefits of minimally invasive surgery, including shorter surgical time, shorter length of stay and fewer postoperative morbidities, without increasing recurrence rate compared to open surgery.
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Affiliation(s)
- Lucía Aragone
- Abdominal Wall Unit, General Surgery Department, British Hospital of Buenos Aires, Buenos Aires, Argentina
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17
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van de Pas MECM, Postema RR, Theeuwes HP, Klok JWA, Rahimi M, Verhoef C, Horeman T. A comparative study on trocar configurations and the use of steerable instruments in totally extraperitoneal inguinal hernia surgery training. Surg Endosc 2025; 39:2080-2090. [PMID: 39900862 PMCID: PMC11870937 DOI: 10.1007/s00464-025-11541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 01/08/2025] [Indexed: 02/05/2025]
Abstract
BACKGROUND Totally extraperitoneal (TEP) inguinal hernia surgery is a commonly performed but technically challenging procedure with a long learning curve. As TEP can be executed using two different trocar placements: a midline or a triangular configuration, the question remains which one is technically easier to master. METHODS In a multicenter crossover-study, medical students were randomised into two groups and executed tasks on a box trainer that measured time, volume and force parameters. Additionally, the study assessed whether the SATA instrument, a steerable laparoscopic instrument that articulates the instrument's tip, would reduce the difficulty of performing the tasks in the midline configuration. After training, all participants executed a first experiment using both trocar configurations, followed by a second experiment executed with steerable and non-steerable instruments in the midline configuration. Subjective and objective performances per condition and learning curves were assessed. RESULTS Participants were faster and showed lower peak forces in the triangulated configuration. Learning curve analysis showed a positive improvement in time and path length in the midline configuration. Although participants rated ergonomics and intuitiveness similarly between the instruments, they found the task easier with the SATA instruments, ranking the added value of the steering function as 5 out of 5. Objectively, time and path length showed no significant differences while exerted forces were lower when using conventional instruments. CONCLUSION Although the midline configuration is preferred in terms of comfort and posture, the findings indicate that, for inexperienced practitioners, performing TEP surgery in midline configuration is both subjectively and objectively more challenging, highlighting the need for extensive training to overcome its difficulties and possibly shorten its learning curve. Although instruments with additional steering functions were preferred over conventional instruments in the more challenging midline configuration, additional steering complexity did not result in better parameter outcomes, showing the need for more extensive training.
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Affiliation(s)
- M E C M van de Pas
- Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - R R Postema
- Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands
| | - H P Theeuwes
- Erasmus MC SkillsLab, Rotterdam, The Netherlands
- Department of Surgery, ETZ, Tilburg, The Netherlands
| | - J W A Klok
- Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands
| | - M Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Center, Amsterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Tim Horeman
- Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands.
- Amsterdam Skills Center, Amsterdam, The Netherlands.
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18
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Li ZW, Song M, Liu J, Jiang B, Hu W, Zheng X. Is the recurrence rate higher in obese patients undergoing inguinal hernia surgery? Hernia 2025; 29:107. [PMID: 40000506 DOI: 10.1007/s10029-025-03301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 02/16/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE This study aimed to evaluate whether obese patients undergoing inguinal hernia repair surgery have a higher recurrence rate and compare the clinical outcomes of obese and non-obese patients. MATERIALS AND METHODS The databases of PubMed, EMBASE, and Cochrane Library were used to search for eligible studies from inception to November 1, 2024. Mean difference (MD), Odds ratios (OR) and 95% confidence intervals (Cl) were pooled up to analyze. The Newcastle-Ottawa Scale (NOS) scores were used to evaluate the quality of the included studies. This study was performed with Stata (V.16.0) software. RESULTS A total of nine studies involving 56,833 patients were included in this study. By comparing the baseline information, we found that the obese group had Fewer older (MD=-0.08, I²=62.41%, 95%CI=-0.16 to -0.00, P = 0.04), higher BMI (MD = 2.45, I²=93.67%, 95%CI = 2.08 to 2.81, P < 0.01), more hypertension patients (OR = 1.32, I²=32.96%, 95%CI = 1.02 to 1.67, P = 0.04), more BPH (OR = 0.68, I²=0.00%, 95%CI = 0.49 to 0.94, P = 0.02) and more local anesthesia (OR = 0.82, I²=14.73%, 95%CI = 0.79 to 0.86, P < 0.01) than the none-obese group. In terms of postoperative outcomes, We found that the obese group had higher recurrence rate (OR = 1.27, I²=21.89%, 95%CI = 1.10 to 1.47, P < 0.01), more wound infection (OR = 1.43, I²=0.00%, 95%CI = 1.20 to 1.69, P < 0.01), and more overall complications (OR = 1.12, I²=28.20%, 95%CI = 1.05 to 1.20, P < 0.01). CONCLUSION Compared with the non-obese group, the obese group has a higher recurrence rate, more wound infections, and overall more complications.
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Affiliation(s)
- Zi-Wei Li
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Ming Song
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Jun Liu
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Bin Jiang
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Wei Hu
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China
| | - Xin Zheng
- Department of Hernia and Abdominal Wall Surgery & Pediatric Surgery, Wuhan Third Hospital, Tongren Hospital Affiliated to Wuhan University, Wuhan, 430000, China.
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Serrano Molina AM, Gutiérrez C, Carreño-Sáenz O, Pous-Serrano S. Laparoscopic approach to inguinal hernia with incarcerated ovary in a patient with endometrial neoplasia. BMJ Case Rep 2025; 18:e263421. [PMID: 40000041 DOI: 10.1136/bcr-2024-263421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2025] Open
Abstract
Ovarian inguinal herniation is a rare clinical entity. It can be safely managed laparoscopically, even in patients with concurrent gynaecological malignancies requiring radical hysterectomy.We present the case of a middle-aged woman admitted for severe anaemia and progressive weakness. Imaging revealed endometrial cancer and a right inguinal hernia containing an 8 cm lesion of indeterminate origin. MRI identified strangulated ovarian tissue within the hernia, and histopathology confirmed a low-grade endometrioid adenocarcinoma.The patient underwent a planned laparoscopic procedure, including radical hysterectomy, sentinel lymph node biopsy and simultaneous inguinal hernia repair. The hernia was repaired using the transabdominal preperitoneal approach after excision of the right adnexa, with polyvinylidene fluoride mesh fixation. The patient experienced an uneventful recovery and was discharged on the second postoperative day.Histopathological analysis confirmed low-grade endometrioid carcinoma with clear margins and metastasis in two lymph nodes, demonstrating the feasibility of managing both conditions concurrently.
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Affiliation(s)
| | - Carmen Gutiérrez
- General Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Omar Carreño-Sáenz
- Unit of Abdominal Wall Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Universidad de Valencia Facultad de Medicina y Odontología, Valencia, Spain
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20
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Schaffer O, Blich O, Yulevich A, Niazov E, Armon Y, Zmora O. The Impact of Surgical Repair on Restlessness in Infants with Non-Incarcerated Inguinal Hernias: A Prospective Study. J Clin Med 2025; 14:1105. [PMID: 40004636 PMCID: PMC11856464 DOI: 10.3390/jcm14041105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Revised: 01/30/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Pediatric inguinal hernias are usually described as asymptomatic unless they become incarcerated. Our aim was to evaluate possible restlessness associated with non-incarcerated inguinal hernias in infants. Methods: We performed a prospective multi-center cohort study that included infants, up to 18 months of age, with non-incarcerated inguinal hernias. Restlessness was evaluated by caregivers before ("Pre") and after ("Post") hernia repair using two scales, the soothability section of the Infant Behavioral Questionnaire (IBQ) and the Parents' Restlessness Score (PRS) on a 1-5 scale (5-highest degree of restlessness), and then compared to matched healthy controls. The change in restlessness after surgery was evaluated by Parents' Change in restlessness Score (PCS) and the difference between Pre- and Post-scores (Δ). A subgroup analysis for patients with Pre-PRS ≥ 3 was performed. Demographic and clinical characteristics were collected, and possible associations with levels of restlessness were evaluated. Results: Seventy-nine infants, median corrected age 2.5 (1.6-4.8) months, were included in this study during June 2022 to July 2024. Infants with inguinal hernias were found to suffer significant restlessness as compared to controls [Pre-PRS = 3 (2-4) vs. 2 (2-2), respectively, p < 0.001]. After hernia repair, PRS restlessness scores improved [ΔPRS = 1 (0-2)] to the level of controls (Post-PRS = 2 (1-3), p = 0.5). The difference in IBQ scores between hernia patients prior to repair and control patients was not statistically significant [3.2 (2.3-4.1) vs. 3.1 (2.3-4.1), respectively, p = 0.28], although both Post-PRS and Post-IBQ scores significantly improved as compared to Pre-PRS and Pre-IBQ scores [2 (1-3) and 2.8 (1.7-3.6) vs. 3 (2-4) and 3.2 (2.3-41), p < 0.001 and p = 0.005, respectively]. Fifty-two patients (66%) had Pre-PRS ≥ 3 and demonstrated a more pronounced improvement in restlessness following surgery [ΔPRS = 1.5 (1-2)]. Patients who had Emergency Department visits prior to hernia repair demonstrated both increased baseline restlessness and more pronounced improvement following repair as compared to patients with no visits (Pre-PRS = 3 (3-4) vs. 3 (2-3), p = 0.03; ΔPRS = 1.5 (1-2) vs. 0 (0-1), p < 0.01; ΔIBQ = 0.7 (0.02-1.45) vs. 0.12 (-0.5-1), p = 0.03). Conclusions: Non-incarcerated inguinal hernias in infants are associated with significant restlessness in most cases. Restlessness resolved after surgical repair.
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Affiliation(s)
- Ortal Schaffer
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel; (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
| | - Ori Blich
- Pediatric Surgery Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (O.B.); (Y.A.)
| | - Alon Yulevich
- Department of Pediatric Surgery, Ziv Medical Center, Safed 1311001, Israel;
| | - Eleonora Niazov
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel; (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
| | - Yaron Armon
- Pediatric Surgery Department, Shaare Zedek Medical Center, Jerusalem 9103102, Israel; (O.B.); (Y.A.)
| | - Osnat Zmora
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel; (O.S.); (E.N.)
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin 7073001, Israel
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21
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Spurzem GJ, Broderick RC, Ruiz-Cota P, Hollandsworth HM, Sandler BJ, Horgan S, Grunvald E, Jacobsen GR. GLP-1 receptor agonists are a transformative prehabilitation tool for weight loss in obese patients undergoing elective hernia repair. Surg Endosc 2025; 39:440-447. [PMID: 39369100 PMCID: PMC11666797 DOI: 10.1007/s00464-024-11308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 09/22/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Obesity is an independent risk factor for complications after abdominal hernia repair. Glucagon-like-peptide-1 (GLP-1) receptor agonists are gaining popularity as pharmacologic weight loss adjuncts and may help patients reach weight loss goals for surgery. We examine our early experience utilizing GLP-1 agonists versus lifestyle modifications alone to achieve weight loss in patients before elective hernia repair. METHODS This single-center, retrospective review identified obese patients who underwent elective hernia repair from 2014 to 2023. Patients were asked to achieve a BMI ≤ 33 kg/m2 before surgery. Patients who lost weight with GLP-1 therapy in addition to lifestyle changes were compared to a control cohort that achieved similar preoperative weight loss without GLP-1 therapy. Primary outcome was mean time from GLP-1 agonist initiation and initial surgery clinic visit to surgery. Secondary outcomes were 30-day morbidity, mortality, and reoperation rates, and hernia recurrence. RESULTS Forty-six patients with ventral/incisional, flank, umbilical, parastomal, inguinal, and hiatal hernias were identified (GLP-1 N = 24, control N = 22). 81.8% (N = 18) of controls had a ventral/incisional hernia, compared to 45.8% (N = 11) of GLP-1 patients (p = 0.03). Mean BMI at GLP-1 agonist initiation was similar to mean BMI at initial clinic visit for controls (38.1 ± 4.9 vs 38.2 ± 2.7 kg/m2, p = 0.66). Preoperative mean percentage total weight loss (14.9 ± 7.5 vs 12.4 ± 6.9 kg, p = 0.39) and mean BMI reduction (6.0 ± 3.8 vs 4.9 ± 2.3 kg/m2, p = 0.43) were similar between groups. The mean time from GLP-1 agonist initiation to surgery was significantly shorter than initial clinic visit to surgery for controls (6.3 ± 4.0 vs 14.7 ± 17.6 months, p = 0.03). There was no statistically significant difference in time from initial clinic visit to surgery between groups (7.6 ± 4.4 vs 14.7 ± 17.6 months, p = 0.06). There was no significant difference in 30-day morbidity between groups (8.3 vs 27.3%, p = 0.13). CONCLUSION GLP-1 agonists accelerate preoperative weight loss for obese hernia patients without negatively impacting postoperative outcomes.
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Affiliation(s)
- Graham J Spurzem
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA.
| | - Ryan C Broderick
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Patricia Ruiz-Cota
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Hannah M Hollandsworth
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Bryan J Sandler
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Santiago Horgan
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
| | - Eduardo Grunvald
- Division of General Internal Medicine, Bariatric and Metabolic Institute, University of California San Diego, San Diego, CA, USA
| | - Garth R Jacobsen
- Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA
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22
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Nazrah S, Rajesh S. Conversion of 2-dimensional to 3-dimensional mesh for resource-limited centres in developing countries. J Minim Access Surg 2025; 21:93-96. [PMID: 39718945 PMCID: PMC11838792 DOI: 10.4103/jmas.jmas_52_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 12/26/2024] Open
Abstract
BACKGROUND In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost. PATIENTS AND METHODS We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation. RESULTS AND CONCLUSIONS All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.
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Affiliation(s)
- Shaikh Nazrah
- Department of General Surgery, Shreeji Hospital, Bhilad-Valsad, Gujarat, India
| | - Shrivastava Rajesh
- Department of General Surgery, Shreeji Hospital, Bhilad-Valsad, Gujarat, India
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23
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Skepastianos G, Mallis P, Kostopoulos E, Michalopoulos E, Skepastianos V, Doudakmanis C, Palazi C, Tsourouflis G. Assessment of decellularization strategy and biocompatibility testing of full-thickness abdominal wall to produce a tissue-engineered graft. Biomed Mater Eng 2025; 36:43-53. [PMID: 39331089 DOI: 10.3233/bme-240144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Restoration of the abdominal wall defects due to herniation or other complications represents a challenging task of the reconstructive surgery. Synthetic grafts or crosslinked animal-derived grafts, are utilized, followed by significant adverse reactions. OBJECTIVE This study aimed to evaluate primarily the production of a decellularized abdominal wall scaffold and secondly its biocompatibility upon transplantation in an animal model. METHODS Full-thickness abdominal wall samples were harvested from Wistar Rats and then decellularized utilizing a three-cycle process. To evaluate the decellularization efficacy, histological, biochemical and biomechanical analyses were performed. The biocompatibility assessment involved the implantation of the produced scaffolds to Sprague Dawley rats. The grafts remained for a total period of 4 weeks, followed by immunohistochemistry for the detection of CD11b+, CD4+ and CD8+ cells. RESULTS Histological, biochemical and biomechanical results, indicated the production of compatible acellular full-thickness abdominal wall samples. After 4 weeks of implantation, a minor presence of immunity cells was observed. CONCLUSION The data of this study indicated the successful production of a full-thickness abdominal wall scaffold. Biologically derived full-thickness abdominal wall scaffolds may have greater potential in restoration of the abdominal wall defects, bringing them one step closer to their clinical utility.
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Affiliation(s)
- George Skepastianos
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, Piraeus, Greece
- Center of Experimental Surgery, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | | | | | | | - Christos Doudakmanis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, Athens, Greece
| | - Chrysoula Palazi
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, Piraeus, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, Athens, Greece
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24
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Rivero-Moreno Y, Goyal A, Redden-Chirinos S, Bulut H, Dominguez-Profeta R, Munnangi P, Shenoi J, Ganguly P, Blanc P, Alkadam K, Pouwels S, Taha S, Pascotto B, Azagra JS, Yang W, Garcia A, Morfin-Meza KD, Fuentes-Orozco C, González-Ojeda A, Suárez-Carreón LO, Marano L, Abou-Mrad A, Oviedo RJ. Clinical outcomes from robotic transabdominal preperitoneal inguinal hernia repair in patients under and over 70 years old: a single institution retrospective cohort study with a comprehensive systematic review on behalf of TROGSS - The Robotic Global Surgical Society. Aging Clin Exp Res 2024; 37:3. [PMID: 39718673 PMCID: PMC11668831 DOI: 10.1007/s40520-024-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 11/13/2024] [Indexed: 12/25/2024]
Abstract
AIM This study aimed to assess and compare outcomes of robotic inguinal hernia repair (RIHR) in patients under and over 70 years old, performed by a fellowship-trained robotic surgeon at a single institution. METHODS A retrospective analysis of patients undergoing robotic primary transabdominal preperitoneal inguinal hernia repair between 2020 and 2022 was conducted. Patients were categorized into two age groups: those under 70 years and 70 years and older. Data were collected through chart reviews with a mean follow-up of 30 days. Concurrently, a systematic review (SR) of relevant high-level literature was carried out. RESULTS Among the 37 patients studied, 75.7% (n = 28) were male, with a mean age of 64.8 years. Demographic features did not significantly differ based on age groups. Patients > 70 years had a higher incidence of reported complications (52.3% vs. 87.5%, p < 0.461). There were no differences in operative time or length of stay between the groups. In the SR, only 23.7% (n = 9) of studies provided age-related conclusions. Three studies identified age over 70 as a risk factor for postoperative complications, while two studies suggested that RIHR is feasible and safe in patients aged 80 years and older. CONCLUSION Patients over 70 years old demonstrated a higher incidence of complications compared to younger patients. However, current literature indicates that the robotic approach may offer a safe and minimally invasive option for inguinal hernia repair in both younger and older adults.
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Affiliation(s)
- Yeisson Rivero-Moreno
- Department of Surgery, Montefiore Medical Center, New York, USA
- Universidad de Oriente, Núcleo Anzoátegui, Venezuela
| | - Aman Goyal
- Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | | | - Halil Bulut
- Istanbul University Cerrahpasa, Istanbul, Turkey
| | | | - Pujita Munnangi
- Texas A&M University School of Medicine, 1020 Holcombe Blvd, Houston, TX, USA
| | - Jason Shenoi
- Texas A&M University School of Medicine, 1020 Holcombe Blvd, Houston, TX, USA
| | - Paulamy Ganguly
- School of Engineering Medicine, Texas A&M University, 1020 Holcombe Blvd, Houston, TX, USA
| | - Pierre Blanc
- Centre mutualiste de l'obésité, Clinique Chirurgicale Mutualiste de, Saint Etienne, France
| | | | - Sjaak Pouwels
- Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Herne, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Safwan Taha
- The Metabolic and Bariatric Surgery Centre (COEMBS), Mediclinic Hospital Airport Road, Abu Dhabi, United Arab Emirates
| | | | | | - Wah Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Andrea Garcia
- Unidad, De Investigación Biomédica 02, Hospital De Especialidades Del Centro Médico Nacional De Occidente, Guadalajara, Mexico
| | - Kathia Dayana Morfin-Meza
- Unidad, De Investigación Biomédica 02, Hospital De Especialidades Del Centro Médico Nacional De Occidente, Guadalajara, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad, De Investigación Biomédica 02, Hospital De Especialidades Del Centro Médico Nacional De Occidente, Guadalajara, Mexico
| | | | - Luis Osvaldo Suárez-Carreón
- UMAE Hospital de Especialidades del Centro Medico Nacional de Occidente, Guadalajara, Mexico
- University of Guadalajara, Guadalajara, Mexico
| | - Luigi Marano
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Viale Bracci 3, 53100, Siena, Italy.
- Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS, Akademia Medycznych I Spolecznych Nauk Stosowanych, 2 Lotnicza Street, 82-300, Elbląg, Poland.
- Department of General Surgery and Surgical Oncology, "Saint Wojciech" Hospital, "Nicolaus Copernicus" Health Center, Jana Pawła II 50, 80-462, Gdańsk, Poland.
| | - Adel Abou-Mrad
- Centre Hospitalier Régional et Universitaire d'Orleans, Orléans, France
| | - Rodolfo J Oviedo
- Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX, USA
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
- Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA
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25
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Aragone L, Pasquini MT, Croceri R, Medina P, Pirchi D. Self-gripping mesh in laparoscopic inguinal hernia repair: A comparative study about surgical time, post-operative pain and recurrence. J Minim Access Surg 2024:01413045-990000000-00109. [PMID: 39718940 DOI: 10.4103/jmas.jmas_62_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/01/2024] [Indexed: 12/26/2024] Open
Abstract
INTRODUCTION In laparoscopic inguinal hernia repair (LIHR), fixation means for meshes (FMMs) are commonly used to reduce hernia recurrence risk. Their use may result in post-operative pain (PP) and may even increase surgical time (ST). Recently, self-gripping meshes (SGMs) have been developed, which leave aside fixation devices; they could potentially reduce PP and even decrease ST. Our primary outcome was to compare ST, PP and recurrence rates in LIHR using SGM versus FMM. PATIENTS AND METHODS A comparative retrospective study with prospective case registry was conducted. All patients who underwent LIHR with transabdominal pre-peritoneal approach from January to December 2022 in a high-volume centre were analysed. Patients were divided into two groups according to the type of mesh used in surgery (SGM vs. FMM). Demographic variables, hernia type and size, mesh type and size, ST, PP, recurrence and other morbidities were compared between the groups. RESULTS A total of 411 LIHRs were performed during the period, of which 283 were included in the study. Of these, 234 patients were repaired with FMM and 49 with SGM. ST had a statistically significant reduction in the SGM group (P = 0.0004) with a mean time of 58.9 min (±13.6), compared to 68.1 min (±18.9) for the FMM group. A trend towards lower PP in the SGM group was noted (P = 0.08). No recurrences were found in the SGM group with a median follow-up of 18 months (interquartile range: 3). CONCLUSIONS SGMs have proven to be a safe, efficient and fast for LIHR in our series. They are a feasible alternative for LIHR, reducing ST and potentially reducing PP. Prospective randomised trials are needed to confirm this trend, along with a longer follow-up period to determine potential advantages in terms of recurrences.
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Affiliation(s)
- Lucía Aragone
- Department of General Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
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26
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Vasudeva KM, Thaker S, Gupta H. Beyond the hernia in groin ultrasound. ULTRASOUND (LEEDS, ENGLAND) 2024:1742271X241299241. [PMID: 39664863 PMCID: PMC11629357 DOI: 10.1177/1742271x241299241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/17/2024] [Indexed: 12/13/2024]
Abstract
Introduction Groin discomfort is one of the most common presenting complaints in health care and often requires ultrasound to detect hernias. However, such singular emphasis leads to over diagnosing hernia and other significant aetiologies in and around the groin are overlooked. Topic description The article elaborates on the key areas a sonographer needs to focus on and presents a range of conditions responsible for groin pain other than hernia. Discussion In addition to evaluating for hernia, a groin ultrasound should evaluate structures in the inguinal canal, the adductor muscles and symphyseal region, the superficial inguinal lymph nodes, the femoral neurovascular bundle, the hip joint with periarticular regions and the structures in the right iliac fossa. Conclusion Sonographers must have a methodical approach, a good knowledge of normal anatomy and pathologies and a comprehensive understanding of the various types of groin abnormalities for a thorough examination.
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Affiliation(s)
- Karthik M Vasudeva
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Siddharth Thaker
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harun Gupta
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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27
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Calomino N, Poto GE, Carbone L, Micheletti G, Gjoka M, Giovine G, Sepe B, Bagnacci G, Piccioni SA, Cuomo R, Adani GL, Marrelli D. Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study. Am J Surg 2024; 238:115950. [PMID: 39265512 DOI: 10.1016/j.amjsurg.2024.115950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 08/17/2024] [Accepted: 09/03/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34-36 g/m2) and heavy-weight polypropylene (HW-PP, 95 g/m2) meshes. METHODS Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications. RESULTS Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 % and 39.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities. CONCLUSION 1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.
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Affiliation(s)
- Natale Calomino
- Kidney Transplant Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Gianmario Edoardo Poto
- Surgical Oncology Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ludovico Carbone
- Surgical Oncology Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giorgio Micheletti
- Kidney Transplant Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mattheus Gjoka
- Surgical Oncology Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gennaro Giovine
- Unit of General Surgery, University of Naples, Naples, Italy
| | - Benito Sepe
- Unit of General Surgery, University of Naples, Naples, Italy
| | - Giulio Bagnacci
- Unit of Diagnostic Imaging, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Stefania Angela Piccioni
- Surgical Oncology Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gian Luigi Adani
- Kidney Transplant Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniele Marrelli
- Surgical Oncology Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Siena, Italy
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Wu Q, Shi H, Song H, Peng X, Yang J, Gu Y. Application of machine learning algorithms to predict postoperative surgical site infections and surgical site occurrences following inguinal hernia surgery. Hernia 2024; 28:2343-2354. [PMID: 39287831 DOI: 10.1007/s10029-024-03167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/03/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE This study aimed to develop, validate, and evaluate machine learning (ML) algorithms for predicting Surgical site infections (SSI) and surgical site occurrences (SSO) after elective open inguinal hernia surgery. METHODS A cohort of 491 patients who underwent elective open inguinal hernia surgery at Fudan University Affiliated Huadong Hospital between December 2019 and December 2020 was enrolled. To create a strong prediction model, we employed five ML methods: generalized linear model, random forest (RF), support vector machines, neural network, and gradient boosting machine. Based on the best performing model, we devised online calculators to facilitate clinicians' access to a linear predictor for patients. The receiver operating characteristic curve was utilized to evaluate the model's discriminatory capability and predictive accuracy. RESULTS The incidence rates of SSI and SSO were 4.68% and 13.44%, respectively. Four variables (diabetes, recurrence, antibiotic prophylaxis, and duration of surgery) were identified for SSI prediction, while four variables (diabetes, size of hernias, albumin levels, and antibiotic prophylaxis) were included for SSO prediction. In the test set, the RF model showed the best predictive ability (SSI: area under the curve (AUC) = 0.849, sensitivity = 0.769, specificity = 0.769, and accuracy = 0.769; SSO: AUC = 0.740, sensitivity = 0.513, specificity = 0.821, and accuracy = 0.667). Online calculators have been developed to assess patients' risk of SSI ( https://wuqian17.shinyapps.io/predictionSSI/ ) and SSO ( https://wuqian17.shinyapps.io/predictionSSO/ ) after surgery. CONCLUSIONS This study developed a prediction model for SSI/SSO using ML methods. It holds the potential to facilitate the selection of appropriate treatment options following elective open inguinal hernia surgery.
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Affiliation(s)
- Qian Wu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Hekai Shi
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Heng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Xiaoyu Peng
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China.
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Gantner L, Mignot H, Pochhammer J, Grieder F, Breitenstein S. Robotic minimally invasive inguinal hernia repair with the Dexter robotic system™: A prospective multicenter clinical investigation. Surg Endosc 2024; 38:7647-7655. [PMID: 39542890 PMCID: PMC11615000 DOI: 10.1007/s00464-024-11361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 10/11/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) has been established with various robotic platforms. The Dexter robotic system is an open platform consisting of a sterile surgeon's console, two robotic instrument arms, and one robotic endoscope arm. This study aimed to confirm the perioperative and early postoperative safety and clinical performance of the Dexter system in patients undergoing primary transperitoneal inguinal hernia repair. METHODS The primary objectives of this multicenter study conducted at three centers in France, Germany, and Switzerland were to document the successful completion of rTAPP procedures and the occurrence of serious adverse events (Clavien-Dindo grades III-V), device-related events up to 30 days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems. RESULTS 50 patients with a median age of 62.5 years (IQR 51.0-72.0) and BMI of 25.1 kg/cm2 (IQR 23.5-28.7), respectively, underwent inguinal hernia repair (33 unilateral, 17 bilateral). All surgeries were successfully completed using three standard laparoscopy trocars. There were no conversions to open surgery, intraoperative complications or device deficiencies. The median skin-to-skin operative time was 50 min (IQR 45-60) for unilateral hernias and 96 min (IQR 84-105) for bilateral hernias. The median console time was 30 min (IQR 26-41) for unilateral and 66 min (IQR 60-77) for bilateral hernias. Twenty-six patients were discharged on the day of surgery, and 22 on postoperative day 1. CONCLUSION This study confirmed the use of the Dexter system in rTAPP was feasible and safe in multicenter cohorts, with operative times consistent with the literature on other robotic platforms. Our data demonstrated the accessibility of this new robotic approach, even when adopted by surgeons new to robotics. The Dexter system emerged as a valuable device in the hernia repair toolkit for both experienced robotic surgeons and those new to the field.
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Affiliation(s)
- Lukas Gantner
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
| | - Hubert Mignot
- Department of General Surgery, Centre Hospitalier de Saintes, Saintes, France
| | - Julius Pochhammer
- Clinic for General, Visceral, Thoracic, Transplant and Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Felix Grieder
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
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Wang H, Wang X. Laparoscopic Versus Open Hernia Repair for Indirect Inguinal Hernia in Adolescents: A Retrospective Cohort Study. J INVEST SURG 2024; 37:2427382. [PMID: 39551479 DOI: 10.1080/08941939.2024.2427382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 10/17/2024] [Accepted: 11/01/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND AND PURPOSE The optimal surgical approach for inguinal hernia (IH) repair in adolescents has not been established. This study aimed to analyze and compare the perioperative results and long-term outcomes of adolescent patients with IH treated with laparoscopic (LHR) versus open hernia repair (OHR). METHODS This study retrospectively reviewed the clinicopathological data of adolescent patients with IH who underwent LHR or OHR as initial treatment from March 2012 to February 2018 at Xinxiang Central Hospital. Clinicopathological factors associated with the prognosis of patients were identified using univariate and multivariate Cox regression analysis. Recurrence-free survival (RFS) curves between different cohorts of patients were generated using the Kaplan-Meier method and compared using the log-rank test. Propensity score matching (PSM) analysis was used to match patients of the LHR and OHR groups in a 1:1 ratio. RESULTS Adolescent patients with IH were enrolled, including 243 patients in the LHR group and 252 patients in the OHR group. After PSM, 189 patients were matched in each of the study group. Compared with the OHR group, the LHR group had a shorter hospitalization, less blood loss, fewer overall postoperative complications and lower rates of recurrence and chronic pain. The LHR group had a significantly better RFS than the OHR group before and after PSM. CONCLUSIONS Laparoscopic inguinal hernia repair for adolescent patients with IH can be safely performed with favorable perioperative and long-term outcomes.
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Affiliation(s)
- Haipeng Wang
- Department of General Surgery, Xinxiang Central Hospital, Xinxiang City, Henan Province, P.R. China
| | - Xiaolei Wang
- Department of General Surgery, Xinxiang Central Hospital, Xinxiang City, Henan Province, P.R. China
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Sharma K, Koul A, Puri G, Rathore YS, Chrungoo RK. Comparison of modified tumescent and conventional laparoscopic transabdominal pre-peritoneal repair in the patients of inguinal hernia: A randomised control trial. J Minim Access Surg 2024:01413045-990000000-00095. [PMID: 39611555 DOI: 10.4103/jmas.jmas_99_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/30/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION Inguinal hernia surgery, a common procedure worldwide, continues to develop to achieve minimal access and tension-free repairs. However, a universally accepted technique has yet to be developed. Our study introduces a new approach, a modified tumescent transabdominal pre-peritoneal (TAPP), to a low-cost setting. We then compare its safety and efficacy with the conventional TAPP, providing a new perspective on hernia repair methods. PATIENTS AND METHODS The study was conducted between April 2016 and September 2017 at the department of surgery in a medical college in Jammu. Sixty patients were randomly assigned to either the conventional TAPP group or the tumescent TAPP group using computer-generated randomisation. In the tumescent group, we carefully administered a tumescent solution into the pre-peritoneal space after creating pneumoperitoneum and then compared the effectiveness and safety of the two procedures. RESULTS Our study revealed significant differences in various aspects between the two groups. In the conventional group, 16.7% of patients experienced challenging peritoneal flap dissection, while none in the tumescent group faced this issue. In addition, none of the patients in the tumescent group had an intraoperative haemorrhage. The conventional group had a mean operating time of 100.4 ± 11.21 min. On the other hand, the tumescent group had a significantly shorter mean operating time of 84 ± 13.47 min. The complication rates were 16.7% in the tumescent group and 30% in the conventional group. After the surgery, 13.3% of patients in the conventional group reported persistent pain, compared to only one patient in the tumescent group, which was statistically significant. CONCLUSION Our study demonstrates that tumescent TAPP can overcome the challenges of conventional TAPP surgery, offering practical benefits such as reduced bleeding, easier dissection, decreased post-operative pain and shorter operating time. Administering tumescent solution before TAPP repair of inguinal hernia provides technical and clinical advantages, suggesting the potential for shorter surgeries and a quicker learning curve.
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Affiliation(s)
- Kanika Sharma
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - Avinash Koul
- Department of Surgery, Fortis Noida, Noida, Uttar Pradesh, India
| | - Gopal Puri
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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Rasador ACD, da Silveira CAB, Lech GE, de Lima BV, Lima DL, Malcher F. The missed diagnosis of femoral hernias in females undergoing inguinal hernia repair - A systematic review and proportional meta-analysis. Hernia 2024; 29:17. [PMID: 39549170 DOI: 10.1007/s10029-024-03196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 10/13/2024] [Indexed: 11/18/2024]
Abstract
BACKGROUND Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women. METHODS PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software. RESULTS From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89). CONCLUSIONS Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH.
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Affiliation(s)
| | | | - Gabriele Eckerdt Lech
- Pontifical Catholic University of Rio Grande do Sul, 6681 Ipiranga Ave, Porto Alegre, RS, 90619-900, Brazil
| | - Bruno Veronez de Lima
- University of the City of São Paulo, Cesário Galeno St, Tatuapé, SP, 05403-000, Brazil
| | - Diego Laurentino Lima
- Department of Surgery, Montefiore Medical Center, 1825 Eastchester Rd, New York, NY, 10641, USA.
| | - Flavio Malcher
- Division of General Surgery, NYU Langone Health, NYC, New York, NY, USA
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Şenol Z, Ertürk T, Cemel H, Yıldırak K, Yamaç DM, Kızıltoprak N, Genç S, İşçeviren B, Karaaslan A, Çalık GC, Terzi ED, Karadağ M, Güleç B. Assessment of Three Distinct Approaches to Postoperative Pain in Laparoscopic Inguinal Hernia Repair, a Randomized Prospective Study. J Laparoendosc Adv Surg Tech A 2024; 34:1021-1025. [PMID: 39167474 DOI: 10.1089/lap.2024.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups (P > .05). Procedure duration was found to be significantly longer in IINB group compared with others (p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o (P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o (p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.
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Affiliation(s)
- Zafer Şenol
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Tuna Ertürk
- Department of Anesthesia, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Haron Cemel
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Kadir Yıldırak
- Department of General Surgery, Ümraniye Training and Research Hospital, Istanbul, Turkiye
| | - Dilek Metin Yamaç
- Department of Anesthesia, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Nurhilal Kızıltoprak
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Salih Genç
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Bora İşçeviren
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Atahan Karaaslan
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Gamze Ceylan Çalık
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Elif Didem Terzi
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Merve Karadağ
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
| | - Bülent Güleç
- Department of General Surgery, Health Sciences University Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkiye
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Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024; 76:2603-2610. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
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Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
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Yu H, Qian J, Dong Y, Yu T, Zeng Y, Shen Q. Preoperative CT findings predict the development of metachronous contralateral inguinal hernia after unilateral inguinal hernia repair: a single-center retrospective cohort study. Hernia 2024; 28:1925-1934. [PMID: 39085515 DOI: 10.1007/s10029-024-03123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To identify potential clinical and preoperative CT risk factors that can predict the development of metachronous contralateral inguinal hernia (MCIH) after unilateral inguinal hernia repair (IHR). METHODS This study included unilateral inguinal hernia patients seen from 2016 to 2019 who underwent CT and subsequent IHR and had at least five years of follow-up. Preoperative CT scans were retrospectively reviewed for the presence of asymmetric spermatic cord fat and weakness of the transversalis fascia. The correlations of each CT feature and other clinical characteristics with the development of MCIH were calculated. The Kaplan-Meier model and multiple logistic regression were used to evaluate the associations among CT features, clinical variables and MCIH. RESULTS A total of 677 male patients aged > 40 years were included in the study cohort. After more than 5 years of follow-up, 162 patients developed MCIH, representing an incidence of 23.9%. Patients with radical prostatectomy or peritoneal dialysis [P < 0.0001, HR 4.189 (95% CI 2.369 to 7.406)], primary left-sided IHR [P = 0.0032, HR 1.626 (95% CI 1.177 to 2.244)], and direct, femoral or pantaloon hernias were predisposed to MCIH. Asymmetric spermatic cord fat [P = 0.0002, HR 1.203 (95% CI 0.8785 to 1.648)] and weakness of the transversalis fascia [P < 0.0001, HR 7.914 (95% CI 5.666 to 11.05)] on preoperative CT were also identified as risk facts and demonstrated to be independent predictive factors for MCIH development. CONCLUSION Asymmetric spermatic cord fat and weakness of the transversalis fascia were predictive factors for MCIH development. For decision making regarding prophylactic contralateral IHR at the time of index surgery, preoperative CT findings as well as clinical characteristics should be considered.
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Affiliation(s)
- Hang Yu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Jiajie Qian
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Yang Dong
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Tang Yu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Ying Zeng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Qianyun Shen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, Zhejiang Province, 310003, China.
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Ge Y, Zhou Y, Liu J, Shen W, Gu H, Cheng G. A nomogram prediction model for postoperative seroma/hematoma in elderly subjects after TAPP. Hernia 2024; 28:1961-1967. [PMID: 39177908 DOI: 10.1007/s10029-024-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Formation of seroma/hematoma is one of the most common postoperative complications following laparoscopic inguinal hernia repair. This study aimed to identify risk factors associated with seroma/hematoma and construct a prediction model. METHODS Elderly subjects undergoing laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP) were included in this study. The observation endpoint was set as the occurrence of seroma/hematoma within 3 months after TAPP surgery. Independent risk factors were identified through preliminary univariate screening and binary logistic regression analysis. These risk factors were then used to construct a nomogram predictive model using R software. RESULTS A total of 330 patients were included in the analysis, of which 51 developed seroma/hematoma, resulting in an incidence rate of 15.5%. Obesity (OR: 3.54, 95%CI: 1.45-8.66, P = 0.006), antithrombotic drug use (OR: 2.73, 95%CI: 1.06-7.03, P = 0.037), C-reactive protein (CRP) ≥ 8 (OR: 2.72, 95%CI: 1.04-7.10, P = 0.041, albumin/fibrinogen ratio (AFR) < 7.85 (OR: 2.99, 95%CI: 1.28-7.00, P = 0.012), and lymphocyte/monocyte ratio (LMR) < 4.05 (OR: 12.62, 95%CI: 5.69-28.01, P < 0.001) were five independent risk factors for seroma/hematoma. The nomogram model has well predictive value for seroma/hematoma, with an AUC of 0.879. CONCLUSIONS The nomogram model based on obesity, antithrombotic drug, CRP, AFR, and LMR has a proved good predictive value and it has potential in clinical practice.
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Affiliation(s)
- Yongxiang Ge
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China
| | - Yang Zhou
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China
| | - Jian Liu
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China
| | - Weijian Shen
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China
| | - Hailiang Gu
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China
| | - Guochang Cheng
- Department of Hernia and Pediatric Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou Clinical Medical School of Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China.
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Shibuya A, Isobe Y, Nishihara Y, Matsumoto S, Nagayasu T, Matsumoto K. Development and validation of a high-quality simulator with exchangeable peritoneum for transabdominal preperitoneal laparoscopic inguinal hernia repair. Asian J Endosc Surg 2024; 17:e13362. [PMID: 39045770 DOI: 10.1111/ases.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Practical simulation training with proper haptic feedback and the fragility of the human body is required to overcome the long learning curve associated with laparoscopic inguinal hernia repair (LIHR). However, few hernia models accurately reflect the texture and fragility of the human body. Therefore, in this study, we developed a novel model for transabdominal preperitoneal (TAPP) LIHR training and evaluated its validity. METHODS We developed a high-quality mock peritoneum with a hydrated polyvinyl alcohol layer and a unique two-way crossing cellulose fiber layer. To complete the simulation, the peritoneum was adhered to a urethane foam inguinal base with surgical landmarks. Participants could perform all the procedures required for the TAPP LIHR. Twenty-four surgeons performed TAPP LIHR simulation using a novel simulator. Their opinions were rated on a 5-point Likert scale. Additionally, 6 surgical residents and 10 surgical experts performed the procedure. Their performance was evaluated using the TAPP checklist score and procedure time. RESULTS Most participants strongly agreed that the TAPP LIHR simulator with an exchangeable peritoneum model was useful. The participants agreed on the model fidelity for tactile sensation, forceps handling, and humanlike anatomy. In comparisons between surgical residents and experts, the experts had significantly higher scores (10.6 vs. 17.2, p < 0.05) and shorter procedure times (92.3 vs. 55.9 min; p < .05) than did surgical residents. CONCLUSIONS We developed a high-quality exchangeable peritoneal model that mimics the human peritoneum's texture and fragility. This model enhances laparoscopic simulation training, potentially shortening TAPP LIHR learning curves.
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Affiliation(s)
- Ayako Shibuya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Surgery, National Hospital Organization (NHO) Tokyo Medical Center, Tokyo, Japan
| | - Yoh Isobe
- Research Center for Clinical Medicine, International University of Health and Welfare, Tokyo, Japan
| | | | - Sumio Matsumoto
- Department of Surgery, National Hospital Organization (NHO) Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Fair L, Leeds SG, Bokhari SH, Esteva S, Mathews T, Ogola GO, Ward MA, Aladegbami B. Achieving fascial closure with preoperative botulinum toxin injections in abdominal wall reconstruction: outcomes from a high-volume center. Updates Surg 2024; 76:2421-2428. [PMID: 38507174 DOI: 10.1007/s13304-024-01802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA.
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Syed Harris Bokhari
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | | | - Tanner Mathews
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald O Ogola
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
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Romano G, Di Buono G, Rodolico V, Romano G, Barletta G, Zanghì G, Calò PG, Buscemi S, Agrusa A. The DySLOH Study: Comparative Evaluation of the Results between the ProFlor and Lichtenstein Techniques for Open Inguinal Hernia Repair-A Randomized Controlled Trial. J Clin Med 2024; 13:5530. [PMID: 39337017 PMCID: PMC11432422 DOI: 10.3390/jcm13185530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/12/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Background: The Lichtenstein open anterior approach with static flat meshes, the most popular inguinal hernia repair technique, has raised concerns regarding mesh fixation, defect patency, and poor quality biological response. To address these issues, the 3D dynamic ProFlor scaffold promoting a fixation-free hernia defect obliteration has been developed as an alternative. Methods: The results of open inguinal hernia repair with the ProFlor approach compared with those of the Lichtenstein repair were evaluated. Results: In a time frame of 24 months, two cohorts of patients were enrolled, 95 in the ProFlor group and 93 in the Lichtenstein group. ProFlor demonstrated superior outcomes compared to the Lichtenstein technique, with shorter procedure times, decreased intraoperative complications, and lower rates of postoperative complications. Additionally, ProFlor provided enhanced postoperative pain relief, a faster return to daily activities, and no long-term discomfort. No chronic pain was reported in the ProFlor group and 11.8% reported chronic pain in the Lichtenstein group. Conclusions: The results highlight the need to reevaluate the conventional Lichtenstein approach and align it with recent scientific progress. Further consideration of the evolving understanding of inguinal pathophysiology and groin protrusion genesis is crucial for advancing surgical techniques.
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Affiliation(s)
- Giorgio Romano
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Di Buono
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
| | - Vito Rodolico
- Department PROMISE, Section Pathological Anatomy, University of Palermo, 90127 Palermo, Italy
| | - Giorgio Romano
- Postgraduate School of General Surgery, University of Palermo, 90127 Palermo, Italy
| | - Gabriele Barletta
- Postgraduate School of General Surgery, University of Palermo, 90127 Palermo, Italy
| | - Guido Zanghì
- Department of General Surgery, University of Catania, 95124 Catania, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 95124 Cagliari, Italy
| | - Salvatore Buscemi
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
| | - Antonino Agrusa
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
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Mainprize M, Svendrovski A, Spencer Netto FAC, Katz J. Matching males and females undergoing non mesh primary unilateral inguinal hernia repair: evaluating sex differences in preoperative and acute postoperative pain. Updates Surg 2024; 76:1983-1990. [PMID: 38480641 DOI: 10.1007/s13304-024-01792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/24/2024] [Indexed: 10/06/2024]
Abstract
PURPOSE The objective was to compare pain and related psychological factors during the preoperative and acute postoperative period between male and female patients, who underwent non mesh primary unilateral inguinal hernia repair. METHODS After ethics approval, informed consent was obtained, and data were collected. Male and female participants were compared by manually matching one-to-one on 10 variables. Descriptive statistics (mean ± standard deviation and frequency) as well as numerical rating scales from 0 to 10 were used. Comparison tests were performed using Chi-square or Fisher's Exact test for categorical data and independent samples t-test or non-parametric equivalent tests for numerical scores. p < 0.05 is reported as statistically significant. To control type I error, Bonferroni correction was used. RESULTS 72 participants with 36 matched pairs were included. Sex differences were found for operation length (p = .006), side of operation (p = .002), and hernia type (p = .013). Significant differences between the sexes were not found at the preoperative or postoperative time for resilience, pain interference or pain severity related measures, postoperative hernia pain incidence, pain catastrophizing, depression and anxiety symptoms, or return to normal activities. CONCLUSION When controlling for known confounders and using a conservative Type I error rate, pain and related factors between the sexes did not differ significantly.
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Affiliation(s)
- Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 7N2, Canada.
| | | | | | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
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Berardo A, Bonaldi L, Stecco C, Fontanella CG. Biomechanical properties of the human superficial fascia: Site-specific variability and anisotropy of abdominal and thoracic regions. J Mech Behav Biomed Mater 2024; 157:106637. [PMID: 38914036 DOI: 10.1016/j.jmbbm.2024.106637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Superficial fascia is a fibrofatty tissue found throughout the body. Initially described in relation to hernias, it has only recently received attention from the scientific community due to new evidence on its role in force transmission and structural integrity of the body. Considering initial difficulties in its anatomical identification, to date, a characterization of the superficial fascia through mechanical tests is still lacking. The mechanical properties of human superficial fasciae of abdominal and thoracic districts (back) of different subjects (n = 4) were then investigated, focusing on anisotropy and viscoelasticity. Experimental tests were performed on samples taken in two perpendicular directions according to body planes (cranio-caudal and latero-medial axes). Data collected from two different uniaxial tensile protocols, failure (i.e., ultimate tensile strength and strain at break, Young's modulus and toughness) and stress-relaxation (i.e., residual stress), were processed and then grouped for statistical analysis. Failure tests confirmed tissue anisotropy, revealing the stiffer nature of the latero-medial direction compared to the cranio-caudal one, for both the districts (with a ratio of the respective Young's moduli close to 2). Furthermore, the thoracic region exhibited significantly greater strength and resultant Young's modulus compared to the abdomen (with greater results along the latero-medial direction, such as 6.13 ± 3.11 MPa versus 0.85 ± 0.39 MPa and 24.87 ± 15.23 MPa versus 3.19 ± 1.62 MPa, respectively). On the contrary, both regions displayed similar strain at break (varying between 38 and 47%), with no clear dependence from the loading directions. Stress-relaxation tests highlighted the viscous behavior of the superficial fascia, with no significant differences in the stress decay between directions and districts (35-38% of residual stress after 300 s). All these collected results represent the starting point for a more in-depth knowledge of the mechanical characterization of the superficial fascia, which can have direct implications in the design, implementation, and effectiveness of site-specific treatments.
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Affiliation(s)
- Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy
| | - Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy.
| | - Carla Stecco
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121, Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Industrial Engineering, University of Padova, 35131, Padova, Italy
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Abuassi M, Joulani W, Sammodi E, Eftaiha M, Obed A. Composite Mesh in Incisional Hernia Repair: Unprecedented Gastric Penetration and Gastrocutaneous Fistula Formation. ACG Case Rep J 2024; 11:e01475. [PMID: 39301458 PMCID: PMC11412696 DOI: 10.14309/crj.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/15/2024] [Indexed: 09/22/2024] Open
Abstract
Hernia repair frequently employs surgical mesh. However, potential complications exist, including mesh migration into adjacent organs, leading to serious outcomes such as enteric fistulas. We report an unprecedented case of composite mesh leading to gastric penetration and subsequent gastrocutaneous fistula formation, identified during endoscopic investigation as a foreign body. A 70-year-old man who underwent right hemicolectomy and incisional hernia repair using composite mesh presented in with symptoms of intestinal obstruction and a small bowel content leak. Following these complications, a small bowel resection was performed, and an ileostomy was created. During an endoscopic investigation, the composite mesh used in the hernia repair during the ileostomy creation was found as a foreign body penetrating the gastric antral area, causing a gastrocutaneous fistula. An exploratory laparotomy was successfully carried out. This case highlights the need to consider mesh-related complications and advocates for research into prevention and management of such adverse outcomes.
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Affiliation(s)
- Mohammad Abuassi
- Internal Medicine Department, College of Medicine, University of Central Florida, Gainesville, FL
| | - Walid Joulani
- Department of Hepatology, Gastroenterology and Hepatobiliary/Transplant Unit, Jordan Hospital, Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Emad Sammodi
- Department of Hepatology, Gastroenterology and Hepatobiliary/Transplant Unit, Jordan Hospital, Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Mohamed Eftaiha
- Department of Hepatology, Gastroenterology and Hepatobiliary/Transplant Unit, Jordan Hospital, Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Aiman Obed
- Department of Hepatology, Gastroenterology and Hepatobiliary/Transplant Unit, Jordan Hospital, Ibn Sina University for Medical Sciences, Amman, Jordan
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Wu JM, Yeh CC, Wei N, Tsai HH, Tseng SM, Chan KC, Chen KH. Increased age and the volume of intraoperative fluid administered predict urinary retention after elective inguinal herniorrhaphy. Perioper Med (Lond) 2024; 13:90. [PMID: 39160619 PMCID: PMC11331662 DOI: 10.1186/s13741-024-00446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Inguinal hernia repair (IHR) is a common surgical procedure worldwide. Although IHR can be performed by the minimally invasive method, which accelerates recovery, postoperative urinary retention (POUR) remains a common complication that significantly impacts patients. Thus, it is essential to identify the risk factors associated with POUR to diminish its negative impact. METHODS We conducted a single-center retrospective review of elective IHR from 2018 to 2021. POUR was defined as the postoperative use of straight catheter or placement of an indwelling catheter to relieve the symptoms. Adjusted multivariate regression analysis was performed to address the associations of clinicodemographic, surgical, and intraoperative factors with POUR. RESULTS A total of 946 subjects were included in the analysis after excluding cases of emergent surgery, recurrent hernia, or concomitant operations. The median age was 68.4 years, and 92.0% of the patients were male. Twenty-three (2.4%) patients developed POUR. In univariate analysis, POUR in comparison with non-POUR was significantly associated with increased age (72.2 versus 68.3 years, P = 0.012), a greater volume of intraoperative fluid administered (500 versus 400 ml, P = 0.040), and the diagnosis with benign prostate hypertrophy (34.8% versus 16.9%, P = 0.025). In the multivariate model, both increased age (odds ratio [OR] 1.04, 95% CI 1.01-1.08; P = 0.049) and a greater volume of intraoperative fluid administered (OR 1.12 per 100-mL increase, 95% CI 1.01-1.27; P = 0.047) were significantly associated with the occurrence of POUR. CONCLUSIONS We found that increased age and a greater volume of intraoperative fluid administered were significantly associated with the occurrence of POUR. Limiting the administration of intraoperative fluid may prevent POUR. From the perspective of practical implications, specific guidelines or clinical pathways should be implemented for fluid management and patient assessment.
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Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC
| | - Chi-Chuan Yeh
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC
| | - Nathan Wei
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC
| | - Hsing-Hua Tsai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC
| | - Shang-Ming Tseng
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC.
| | - Kuo-Hsin Chen
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
- Division of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, ROC.
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Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Martínez-López P, Fernandes N, Bel R, López-Cano M. Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different? Hernia 2024; 28:1355-1363. [PMID: 38704470 PMCID: PMC11297094 DOI: 10.1007/s10029-024-03050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair. METHODS This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications. RESULTS A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications. CONCLUSIONS Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.
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Affiliation(s)
- V Rodrigues-Gonçalves
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain.
| | - M Verdaguer-Tremolosa
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - P Martínez-López
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - N Fernandes
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - R Bel
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - M López-Cano
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
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Yang G, Tung KLM, Tumtavitikul S, Li MKW. A new groin hernia classification with clinical relevance. Hernia 2024; 28:1169-1179. [PMID: 38662243 DOI: 10.1007/s10029-024-03000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups. METHOD A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation. RESULT This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients. CONCLUSION This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.
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Affiliation(s)
- George Yang
- Hong Kong Adventist Hospital, Stubbs Road, Hong Kong, China.
| | | | | | - M K W Li
- Hong Kong Sanatorium & Hospital, 2 Village Road, Happy valley, Hong Kong, China
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Rai L, Raza D, Ong CS, Naqi A, Iftikhar N, Awais G, Alam R, Siddiqui SS, Shamsi G, Lodhi N. Evaluation of Open Rives-Stoppa and Lichtenstein Repair Methods for Bilateral Inguinal Hernias: A Single-Centre Comparative Analysis. Cureus 2024; 16:e67946. [PMID: 39328621 PMCID: PMC11426406 DOI: 10.7759/cureus.67946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Aim The purpose of the study is to compare the two common open surgical methods for bilateral inguinal hernias: bilateral Lichtenstein repair and Rives-Stoppa repair. It evaluates their benefits, drawbacks, and outcomes to improve the management of bilateral inguinal hernias and enhance patient care and results. Background Abdominal wall hernias are prevalent in the surgical field, and they occur when intra-abdominal organs protrude through weakened or torn regions in the abdominal wall. The Lichtenstein repair, also known as the tension-free mesh repair, is one of the most widely used techniques that involves placing a synthetic mesh over the hernia defect to reinforce the abdominal wall. The Rives-Stoppa technique takes the posterior approach, which involves placing a large mesh in the preperitoneal space, which provides broad coverage of the potential hernia sites. Method This retrospective study included 86 male patients from the Department of General Surgery at Indus Health Network, Karachi, Pakistan. Data were collected up to three months post-operation for all open bilateral inguinal hernia repairs performed between January 2017 and April 2021. The patients were divided into two groups: group A underwent Lichtenstein repair, while group B underwent Rives-Stoppa repair. The procedures were performed by different surgeons and surgical trainees under direct supervision. Results Regarding post-operative complications (scrotal swelling, epididymo-orchitis, seroma formation, ipsilateral testicular swelling, surgical site infection, erectile dysfunction, wound dehiscence, fever, hydrocele, sensory abnormality, hernia recurrence in 3 months, post-operative pain in 14 days), there was no significant difference observed between the two groups. There were two recurrences within three months after Lichtenstein repair and one recurrence after Stoppa repair, but no statistical difference was demonstrated. Conclusion Statistically, both the Lichtenstein repair and the Rives-Stoppa repair demonstrated similar outcomes. However, the Rives-Stoppa repair offers distinct advantages for bilateral inguinal hernia repair, making it a preferable option in many cases as this approach utilises a single midline incision, simultaneously facilitating access to both hernial sites. This method ensures complete coverage of the myopectineal orifices bilaterally, addressing all potential hernia sites in the lower abdomen. These features collectively contribute to the technique's efficacy in managing bilateral hernias.
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Affiliation(s)
- Lajpat Rai
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
- Department of General Surgery, Ysbyty Gwynedd Hospital, Bangor, GBR
| | - Danial Raza
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Chon Sum Ong
- Department of General Surgery, Ysbyty Gwynedd Hospital, Bangor, GBR
| | - Ali Naqi
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Nazish Iftikhar
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Ghina Awais
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Rutaba Alam
- Department of General Surgery, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Sheeraz S Siddiqui
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Ghina Shamsi
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
| | - Nazia Lodhi
- Department of General Surgery, Indus Hospital and Health Network, Karachi, PAK
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Andresen K, Rosenberg J. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev 2024; 7:CD004703. [PMID: 38963034 PMCID: PMC11223180 DOI: 10.1002/14651858.cd004703.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND An inguinal hernia occurs when part of the intestine protrudes through the abdominal muscles. In adults, this common condition is much more likely in men than in women. Inguinal hernia can be monitored by 'watchful waiting', but if symptoms persist or worsen, surgery is usually required, which can be open or laparoscopic. Laparoscopic (keyhole) repair of inguinal hernias in adults is generally performed using either the transabdominal preperitoneal (TAPP) or the totally extraperitoneal (TEP) method. Both methods include the use of mesh placed in front of the peritoneal lining of the abdominal wall, but for the TAPP technique, the abdominal cavity needs to be entered to place the mesh, and for the TEP technique, the whole procedure is done on the outside of the peritoneal lining of the abdominall wall. Whether one method is superior to the other has not been established, and there is debate about their relative benefits and harms. An advantage of TEP is its avoidance of the abdominal cavity; the downside is that it requires a steeper learning curve for clinicians. TAPP is considered simpler and makes it possible to inspect the contralateral side, but TAPP may have a higher risk of visceral injury compared to TEP. This is an update of a Cochrane review first published in 2005. OBJECTIVES To compare the benefits and harms of laparoscopic TAPP technique versus laparoscopic TEP technique for inguinal hernia repair in adults. SEARCH METHODS On 25 October 2022, the authors searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); and Ovid Embase, for published randomised controlled trials. To identify studies in progress, we searched ClinicalTrials.gov and the WHO International Clinical Trial Registry Platform (ICTRP). SELECTION CRITERIA All prospective randomised, quasi-randomised, and cluster-randomised trials that compared the laparoscopic TAPP technique with the laparoscopic TEP technique for inguinal hernia repair in adults were eligible for inclusion. We included studies that involved a mix of different types of groin hernia if we could extract data for the inguinal hernias. Studies may have also included a group of participants receiving hernia repair by open surgery, but these groups were not included in our review. DATA COLLECTION AND ANALYSIS Both review authors independently evaluated trial eligibility, extracted data from included studies, and assessed the risk of bias in the included studies. The review's primary outcomes were serious adverse events, chronic pain (persisting for at least six months after surgery), and hernia recurrence. We also assessed a variety of secondary outcomes at perioperative, early postoperative, and late postoperative time points. We performed statistical analyses using the random-effects model, and expressed the results as odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for key outcomes as high, moderate, low or very low. MAIN RESULTS We included 23 studies in this review update, which randomised 1156 people to TAPP and 1110 people to TEP, all requiring repair of inguinal hernias. Study sample sizes varied from 40 to 316 participants. The vast majority of study participants were male. We judged most studies to be at 'high' or 'unclear' risk of bias. Our judgements of the certainty of the evidence were low or very low for all outcomes we assessed. There may be little to no difference between TAPP and TEP laparoscopic techniques for serious adverse events (0.4% versus 0.7%; OR 0.58, 95% CI 0.15 to 2.32, P = 0.45, I2 = 0%; 19 studies, 1735 participants; low certainty of evidence); and hernia recurrence (1.2% versus 1.1%; OR 1.14, 95% CI 0.49 to 2.62, P = 0.97, I2 = 0%; 17 studies, 1712 participants; low certainty of evidence). The evidence is very uncertain about the effects of TAPP versus TEP techniques on chronic pain (OR 0.62, 95% CI 0.20 to 1.97, P = 0.68, I2 = 0%; 6 studies, 860 participants; very low certainty of evidence). In terms of secondary outcomes, the evidence is very uncertain for TAPP versus TEP techniques for perioperative visceral and vascular injury (15 studies, 1523 participants; very low certainty of evidence), and for haematoma or seroma during the early (≤ 30 days) postoperative phase (OR 0.86, 95% CI 0.54 to 1.37, P = 0.3861, I2 = 0%; 15 studies, 1423 participants; very low certainty of evidence). TEP technique may carry a higher risk of conversion to another hernia repair method (either TAPP technique or open surgery) when compared to TAPP (2.5% versus 0.7%; OR 0.28, 95% CI 0.09 to 0.84, P = 0.02, I2 = 0%; 13 studies, 1178 participants; low certainty of evidence). Only two studies (474 participants) reported quality of life in the late (> 30 days) postoperative phase; overall, there was an improvement in quality of life from the pre- to post-operative assessment, but the evidence suggests little to no difference between the techniques (low certainty of evidence). AUTHORS' CONCLUSIONS This review update found that there may be little to no difference between the TAPP and TEP techniques for serious adverse events, hernia recurrence, or chronic pain (low- to very-low-certainty evidence). Decisions about which method to use will most likely reflect surgeon and patient preference until high-certainty evidence becomes available. There may be a higher risk of needing to convert from TEP to TAPP or open surgery when compared to the risk of needing to convert from TAPP to open surgery (low-certainty evidence). If surgeons opt for TEP as their standard laparoscopic method, they could consider having a strategy for how to handle the potential need for conversion. This might include proficiency in the TAPP approach or having informed the patient about the risk of conversion to open surgery. For surgeons or surgical departments, the choice of a laparoscopic technique should involve shared decision-making with patients and their families or carers. Future research could focus on patient-reported outcomes, such as quality of life.
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Affiliation(s)
- Kristoffer Andresen
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, University of Copenhagen, Herlev Hospital, Herlev, Denmark
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Almunifi A, Alshamrani OA, AlMehrij SM, Alsamhan AF, Althewaikh AM, Alowaysi AS, Zahid HO, Aldeghaither S, Mohamed EY. The Prevalence, Awareness, and Associated Risk Factors of Inguinal Hernia Among the Adult Population in Saudi Arabia. Cureus 2024; 16:e65570. [PMID: 39192899 PMCID: PMC11348653 DOI: 10.7759/cureus.65570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/29/2024] Open
Abstract
PURPOSE Inguinal hernias lead to several potentially fatal complications such as strangulation. Assessing the prevalence, risk factors, and beliefs of a population is essential to develop appropriate preventive strategies. This study investigated the prevalence, risk factors, and awareness of inguinal hernia in the adult population of Saudi Arabia. METHODS This cross-sectional study enrolled 461 adults aged between 18 and 60 years after excluding those aged <18 and >60 years. This study was conducted in five regions of Saudi Arabia (north, west, central, south, and east). A pre-tested questionnaire was used to collect data on the prevalence, perception, and awareness of the participants. Multivariate regression analysis was used to identify risk factors for inguinal hernia. RESULTS The study revealed that most participants were men n=262 (56.8%), aged between 18 and 25 years n=241 (52.3%), were single n=278 (60.3%), had a bachelor's degree n=225 (48.8%) and earned less than 50,000 Saudi Riyals annually n=285 (61.8%). Most participants resided in urban areas n=366 (79.4%) with their parents n=230 (49.9%). The prevalence of inguinal hernias in adults was low (5.2%). Our results indicated a significant association between family history of inguinal hernia, chronic cough, bronchial asthma, smoking, and inguinal hernia (p < 0.001). Young adults and undergraduates displayed significantly low awareness of inguinal hernias (p < 0.001). CONCLUSION Family history of inguinal hernia, chronic cough, bronchial asthma, and smoking were factors associated with inguinal hernia. Low awareness levels were observed among young undergraduates, with a moderate overall level of awareness.
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Affiliation(s)
- Abdullah Almunifi
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | - Osama A Alshamrani
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | - Shahd M AlMehrij
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Abdullah F Alsamhan
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | | | - Abdullah S Alowaysi
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | - Hussain O Zahid
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Saud Aldeghaither
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SAU
| | - Elsadig Y Mohamed
- Department of Basic Medical Sciences, College of Medicine, Majmaah University, Majmaah, SAU
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Santos I, F. F. Simões J, Dias CC, Sampaio Alves M, Azevedo J, Cunha M, Alagoa João A, Nobre JG, Picciochi M, Sampaio Soares A, Vieira B, Peyroteo M, On behalf of PT Surg. Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study. ACTA MEDICA PORT 2024; 37:507-517. [PMID: 38950617 DOI: 10.20344/amp.20277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/08/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Evidence about the advantage of Lichtenstein's repair, the guidelines' recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques. METHODS Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications. RESULTS Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein's repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84). CONCLUSION The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.
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Nosheen S, Mukhtar H, Haider S, Khan R, Sharif F. Tissue engineered multifunctional chitosan-modified polypropylene hernia mesh loaded with bioactive phyto-extracts. Int J Biol Macromol 2024; 271:132282. [PMID: 38750855 DOI: 10.1016/j.ijbiomac.2024.132282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/07/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
Surface modified tissue engineered polypropylene / PP hernia meshes were fabricated by incorporating Bacterial cellulose / BC and chitosan / CS and phytochemical extracts. Under current practice, hernia and other traumatic injuries to the abdominal organs are clinically treated with surgical meshes. Often the foreign body reaction and infections result in relapse in patients which dictates additional reparative surgical procedures and pain. To improve the outcome of clinical restorative procedures new biomaterials with improved characteristics are required. The functionalized meshes were physically and chemically characterized using SEM, mechanical testing, FTIR and XRD. The antimicrobial activity was qualitatively and quantitatively tested using E. coli and S. aureus strains of bacteria. In vitro biocompatibility and wound healing effect of the modified meshes were performed using NIH3T3 fibroblast cell lines. Furthermore, tissue engineering potential of the meshes was evaluated using confocal fluorescent microscopy. In vivo implantation of the meshes was performed in male wistar rats for 21 days. Therefore, PP meshes with sustained drug delivery system augmented with anti-inflammatory and anti-microbial characteristics were developed. The coatings hereby not only increased the tensile strength of meshes but also prevented the modified meshes from causing infection. Current study resulted in CS-BC bioactive PP meshes loaded with phytochemicals which showed anti-inflammatory, antibacterial and wound healing potential. These meshes can be valuable to lessen the post-surgical complications of implanted PP mesh and thus reduce rejection and recurrence.
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Affiliation(s)
- Sadaf Nosheen
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan, 54000; Dr. Ikram-Ul-Haq Institute of Industrial Biotechnology (IIB), GC University, Katchery Road, Lahore, Pakistan, 54000
| | - Hamid Mukhtar
- Dr. Ikram-Ul-Haq Institute of Industrial Biotechnology (IIB), GC University, Katchery Road, Lahore, Pakistan, 54000
| | - Sajjad Haider
- Chemical Engineering Department, College of Engineering, King Saud University, P.O.Box 800, Riyadh 11421, Saudi Arabia
| | - Rawaiz Khan
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Faiza Sharif
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan, 54000; Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield, Broad Lane, Sheffield, UK.
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