Table 4 - uploaded by Hans Glise
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To evaluate the influence of the laparoscopic technique in hernia repair regarding time to full recovery and return to work, complications, recurrence rate, and economic aspects.
Several studies have shown advantages in terms of less pain and faster recovery after laparoscopic hernia repair, whereas others have not, and the cost-effectiveness has b...
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Context 2
... significant center effect (p 0.05) was found for this variable, but there were no signs of a treatment-by-center interaction effect-in other words, the pattern of treatment effect was similar in all centers. After 7 days, 26.5% of the patients in the TAPP group were back at work, compared with 15.5% (p 0.03) in the open mesh group and 9.3% (p 0.001) in the conventional group (see Table 4). At the 8-week visit, 98.6% in the TAPP group, 96.7% in the open group, and 99.2% in the conventional group were back at work (p n.s.). ...
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Methods:
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Citations
... Laparoscopic hernia repair has been reported since 1990 and later become the standard treatment nowadays [2] [3]. Many studies showed comparable recurrence rates between laparoscopic and open hernia repair (2.7% vs. 3.1%, respectively) [3][4][5]. Moreover, the laparoscopic method had a lower incidence of wound infection, chronic pain, and a shorter time to return to work than the open method about 1% vs. 2.7%, 9.4% vs. 18.8%, and 14.8 vs. 21.4 ...
... Moreover, the laparoscopic method had a lower incidence of wound infection, chronic pain, and a shorter time to return to work than the open method about 1% vs. 2.7%, 9.4% vs. 18.8%, and 14.8 vs. 21.4 days, respectively [3][4][5][6]. Laparoscopic repair consists of 2 important techniques, transabdominal preperitoneal (TAPP), and total extraperitoneal (TEP), there are differences in approaching aspects, but the results of those techniques showed no difference in recurrence rate, complications rate, and chronic pain [3,[6][7][8] Hence, sexual dysfunction is a major important outcome after inguinal hernia repair and effect to patient's quality of life. Some previous studies suggested the causes related of male infertility might occur from iatrogenic injury, mesh fibrotic scar, or inguinal hernia repairs [9,10]. ...
Purpose
Sexual dysfunction after inguinal hernia complication is considered rare. However, its consequences impact on quality of life inevitably. Laparoscopic and open inguinal hernia repair may be comparable in terms of recurrent rate, overall complications, and chronic pain. Therefore, its complication is still questionable between these approaches. In this study, we compared sexual dysfunction and related complications between laparoscopic and open inguinal hernia repair.
Methods
Systematic review and meta-analysis of randomized controlled trials (RCTs) studies were performed to compare laparoscopic and open inguinal hernia repair. Risk ratio (RR) and 95% confidence intervals (95% CI) were used as pooled effect size measures.
Result
Thirty RCTs (12,022 patients) were included. Overall, 6014 (50.02%) underwent laparoscopic hernia repair, and 6008 (49.98%) underwent open hernia repair. Laparoscopic approach provided non-significance benefit on pain during sexual activity (RR 0.57; 95% CI 0.18, 1.76), Vas deferens injury (RR 0.46; 95% CI 0.13, 1.63), orchitis (RR 0.84; CI 0.61,1.17), scrotal hematoma (RR 0.99; CI 0.62,1.60), and testicular atrophy (RR 0.46; CI 0.17,1.20). Meanwhile, the open inguinal hernia approach seems to perform better for cord seroma complications and testicular pain.
Conclusion
There is no advantage of laparoscopic inguinal hernia repair over an open approach concerning sexual dysfunction. On the contrary, there is an increasing risk of cord seroma after laparoscopic inguinal hernia repair with statistical significance.
... Does the laparoscopic surgery provide us the ideal procedure or comes closer to such advantages along with cost is the question yet to answered comprehensively. (12) As the hernia repair is the most commonly performed general surgery a signicant reduction in the cost of these procedures by laparoscopic methods can have a signicant economic impact on the society with the benets of minimal access surgery. (13,14) Though our experience is short one in laparoscopic surgery but it showed a signicant variation in operating time in favor of open mesh hernioplasty. ...
... Much of the extra cost is attributed to the longer duration of the surgical procedure, which can be expected to decrease with increasing experience. This extra cost is to be compensated by reducing the loss of working days (12).The reduction in duration of return to normal activity is in line with the published randomized studies (26)(27)(28)(29)(30)(31)(32)(33)(34)(35).However some studies have gone against this observation of favorable shortening with laparoscopic technique (23,(36)(37)(38) In present study return to normal domestic and routine work was sooner after laparoscopic repairs. This nding was universal in reported trials in either TEP or TAPP repairs as compared with open repairs (39) The postoperative follow up was shorter in our study hence it will be too earlier to comment on the results of recurrence though we had one long term complication after 22 months who needed re-exploration for bowel obstruction following bilateral TAPP repair. ...
... A definite cause could not be ascertained. Similar findings have been reported from a Swedish SCUR hernia study [ 15 ]. Apart from pain the other complication pattern varied among the different groups with seroma formation being most common. ...
Objective: To compare tension-free open mesh hernioplasty with total extra-peritoneal (TEP) laparoscopic hernia repair.Design: A prospective comparative study of 120 patients with inguinal hernias.Setting:.Results: The laparoscopic method took significantly more time than the open procedure (p <0.01). Intra-operative and immediate postoperative complications were more frequent in the laparoscopic group, although rates of long-term complications were similar in the two groups. Duration of hospital stay (p <0.01) and recurrence rate (6.67%) were significantly higher after laparoscopic repair. Pain scores showed significantly more pain for the laparoscopic group (p <0.01). The mean cost per patient for laparoscopic repair was higher.Conclusion: The open technique is still superior to the laparoscopic technique for mesh repair of groin hernias in a developing country like India.
... Similarly, multiple other studies, including The SCUR Hernia Repair Study, which compared 613 patients randomized to open suture repair, open preperitoneal mesh repair, and laparoscopic TAPP repair, 17 Payne et al.'s prospective trial of 100 patients randomized to laparoscopic TAPP or open tension-free repairs using a polypropylene mesh, 18 and further citations within the EHS and International guidelines 14,15 support the laparoscopic advantage of quicker recovery and thus shorter hospital stays. The quicker recovery and the reduced complications in turn reduce the total hospital costs for laparoscopic inguinal hernia repair when compared to open. ...
Background:
Inguinal hernia repair is one of the more common procedures performed in the United States. The optimal surgical approach, however, remains controversial. We aimed to compare the postoperative outcomes and costs between laparoscopic and open inpatient inguinal hernia repairs in a national cohort.
Materials and Methods:
We performed a retrospective analysis of the National Inpatient Sample during the period 2009-2015. Adult patients (≥18 years old) undergoing laparoscopic and open inguinal hernia repair were included. Multivariable logistic, generalized logistic, and linear regression were used to assess the effect of the laparoscopic approach on postoperative complications, mortality, length of stay, and hospital charges.
Results:
A total of 41,937 patients undergoing open inguinal hernia repair (N = 36,575) and laparoscopic inguinal hernia repair (N = 5282) were included. Patients undergoing laparoscopic inguinal hernia repair were less likely to have postoperative wound complications (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41-0.98), infection (OR: 0.34, 95% CI: 0.27-0.42), bleeding (OR: 0.72, 95% CI: 0.63-0.82), cardiac failure (OR: 0.72, 95% CI: 0.64-0.82), renal failure (OR: 0.54, 95% CI: 0.47-0.62), respiratory failure (OR: 0.70, 95% CI: 0.58-0.85), and inpatient mortality (OR: 0.27, 95% CI: 0.17-0.40). On average, the laparoscopic approach reduced length of stay by 1.28 days (95% CI: -1.58 to -1.18), and decreased hospital costs by $2400 (95% CI: -$4700 to -$700).
Conclusion:
Laparoscopic hernia repair is associated with significantly lower rates of postoperative morbidity and mortality, shorter length of hospital stays, and lower hospital costs for inpatient repairs. The laparoscopic approach should be encouraged for the management of appropriate patients with inpatient inguinal hernias.
... [4,6,7] Seventy percent presented with an indirect hernia, comparable to other studies. [8,9] The mean operating time in the laparoscopic group was 73.45 min and in the open mesh repair group, 30.88 min with a significant P value, similar to other studies, [10][11][12] highlighting the steep learning curve in laparoscopic hernia repair. ...
... The procedure requires several missed workdays, mainly due to postoperative pain and discomfort. [19,20] Thus, it is important to choose techniques associated with better recovery and less postoperative pain, with faster return to activities. Male patients predominated in both groups in our study, consistent with the inguinal hernia epidemiology data for Brazil. ...
PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh fixed with staples on postoperative pain in patients undergoing videolaparoscopic inguinal herniorrhaphy by the transabdominal preperitoneal (TAPP) technique.
MATERIALS AND METHODS: The study analyzed data from 52 patients (46 males, mean age 54.9 years, 51.9% right-sided hernias) who underwent TAPP. They were operated on consecutively and randomly in two groups of 26 patients each: Group 1 with self-gripping mesh and Group 2 with endoscopic tacker-fixed prolene mesh. Each patient's postoperative pain was recorded twice using a visual analog scale (VAS) at 6 and 24 h after the surgery. Patients were followed up to 10 months after the surgery.
RESULTS: The median VAS score at 6 h for all patients was 3. The median score at 24 h was 1. The median VAS scores of the two groups were different at 6 h: In Group 1, the median score was 2, whereas in Group 2, it was 3 (P = 0.053). At 24 h, there was no difference between the groups, with a median score of 1 in both (P = 0.277).
CONCLUSION: There was no statistically significant difference between groups according to postoperative pain (after 6 h and after 24 h). Studies with larger samples are needed to compare self-gripping mesh with tacker fixation in laparoscopic inguinal hernia repairs. The technique performed was safe and reproducible, with a low complication rate, early patient discharge, and good postoperative recovery.
... However, the laparoscopic approach for unilateral primary IH appears to be more expensive than the open mesh repair; hence, not encouraged in routine practice in the early studies. [12,13] However, recent guidelines recommend a laparoscopic approach for unilateral IH when adequate facilities and expertise are available. [3] However, it may not be able to offer laparoscopic approach for most of the patients with unilateral IH, where the resources are limited in publicly funded hospitals. ...
OBJECTIVE: The aim of this study is to elucidate the guideline conformity and to analyze the surgical techniques, outcomes, and the use of devices and consumables for the first 100 cases of laparoscopic inguinal hernia (IH) repair performed during an institutional hernia programme (IHP) in a single surgical center.
METHODS: This is a retrospective review of the first consecutive 100 cases of laparoscopic IH repair performed during IHP. Patient's demographic, operation techniques, the use of devices and consumables, and outcomes are reviewed.
RESULTS: A total of 185 IHs were laparoscopically repaired in 100 male patients with a mean age of 37.86 (range: 24–68) years from May 2015 to April 2019. Common indications for laparoscopic IH repair are bilateral IH (n = 85) and recurrences after the previous open repair (n = 11). A total extraperitoneal repair (TEP) was performed in 96 patients, and transabdominal preperitoneal repair was performed in four patients. The mean operation time was 35.97 (range: 10–90 min). Electrosurgical energy, surgical suction, and laparoscopic scissors were used in seven, four, and six patients, respectively. All the surgeries performed with low-cost standard polypropylene meshes. Surgical takers used in seven patients to anchor the mesh (n = 6) and close the peritoneal defect (n = 1). Conversion to open procedure was required in a single patient. The single hematoma was the only complication encountered. Seven patients developed unilateral recurrences after TEP repair for bilateral IH during the mean follow-up period of 2 years and 3 months. All the patients were discharged within 23 h of the surgery.
CONCLUSIONS: This study shows a higher level of guideline conformity of the laparoscopic IH repair with acceptable level of recurrence while using a minimum number of costly devices and consumables.
... et al (2%), Spitz et al (1.5%) and Liem et al (1%) and less than in the study of Cohen et al (6%).10,13,20 There were 3 (15%) cases of hematoma formation in open Lichtenstein group. ...
Background: The purpose of the study was to observe the differences between the two methods of inguinal hernia repair in terms of operative time, postoperative pain, need for analgesia, hospital stay and postoperative complications.Methods: This prospective study conducted in the department of Surgery, IGMC Shimla, included 40 patients of inguinal hernia who were randomized to TEP and Lichtenstein tension free mesh hernioplasty groups randomly. After thorough clinical examination, whereas all patients with unilateral incomplete inguinal hernia fit for laparoscopic surgery were included in the present study, those with bilateral inguinal hernia, unwilling for laparoscopic surgery or who had complicated and recurrent inguinal hernia, poor cardiopulmonary reserve or were immunocompromised were excluded from the study.Results: Laparoscopic TEP is significantly lengthier procedure than open Lichtenstein repair especially in the learning phase as the mean operative time of TEP repair was 75.6 minutes and that of open Lichtenstein repair was 54 minutes. Not only postoperative pain recorded by using VAS was significantly less in the in the first 4 postoperative hours there was significantly less consumption of post-operative analgesic in TEP as compared to Lichtenstein group. No major complications in either group but only minor complications were observed in TEP group.Conclusions: TEP can be recommended to those desiring better cosmetic results and early return to work as TEP was found to be associated with less pain in the first 4 hours after surgery.
... Even the complications in endoscopic inguinal hernia surgery are more dangerous and more frequent compared to those in open surgery; they could be avoided especially in experienced hands [33]. The complication rate for laparoscopic repair of inguinal hernia ranges from less than 3% to as high as 20% [34]. ...
... La hernioplastia de Lichtenstein es considerada la técnica de elección para el tratamiento de las hernias inguinales [1][2][3][4][5] . Sin embargo, numerosos estudios han demostrado que el abordaje laparoscópico presenta superioridad en un menor dolor y tiempo de recuperación postoperatoria, con una reincorporación más temprana a la actividad cotidiana [6][7][8][9][10] . Existen difi cultades para comparar correctamente ambas técnicas, debido a los sesgos de evaluar pacientes diferentes en variables subjetivas durante el posoperatorio inmediato 11 . ...
RESUMEN Existen controversias sobre las diferencias entre abordaje convencional y lapa-roscópico. El objetivo del estudio es comparar el grado de satisfacción de pa-cientes intervenidos inicialmente de hernioplastia inguinal abierta (técnica de Lichtenstein) y luego laparoscópicamente del lado contralateral (técnica TAPP) con un seguimiento de 10 años. Se excluyeron los pacientes mayores a 85 años para evitar sesgos de memoria y aquellos que presentaron complicaciones qui-rúrgicas, hernias inguino-escrotales o recidivas herniarias. Se objetivó el grado de satisfacción a través de una encuesta comparando la última intervención en relación con la primera, utilizando 5 grados: 1) mucho mejor, 2) mejor, 3) igual, 4) peor y 5) mucho peor. Del total de 62 pacientes registrados, se excluyeron 32. De los 30 pacientes evaluados, 26 refi rieron un mayor grado de satisfacción con respecto a la técnica laparoscópica (20, mucho mejor; 6, mejor), mientras que los 4 restantes manifestaron igual satisfacción con ambas técnicas. ABSTRACT There is controversy about the differences between conventional and laparos-copic approach. The aim of this study is to compare satisfaction of patients initially operated of inguinal conventional hernioplasty (Lichtenstein procedure) and then of a laparoscopic contralateral hernioplasty (TAPP procedure) with a follow-up of 10 years. There were excluded those patients older than 85 years old to avoid biases of comparison and those who presented postoperative complications, inguinal-escrotal hernias or hernia recurrence. We compared degree of satisfaction in both procedures using a 5 steps scale: 1. Much better, 2. Better, 3. Equal, 4. Worse and 5. Much worse. Of the total of 62 registered patients , 32 were excluded. Of 30 evaluated patients, 26 presented a better rates of satisfaction with the laparoscopic technique (20 much better, 6 Better), whereas 4 patients demonstrated equal rates of satisfaction with both techniques. Fronteras en Medicina 2015;10(2):55-58 La hernioplastia de Lichtenstein es considerada la téc-nica de elección para el tratamiento de las hernias in-guinales 1-5. Sin embargo, numerosos estudios han de-mostrado que el abordaje laparoscópico presenta supe-rioridad en un menor dolor y tiempo de recuperación postoperatoria, con una reincorporación más tempra-na a la actividad cotidiana 6-10. Existen difi cultades para comparar correctamente ambas técnicas, debido a los sesgos de evaluar pacientes diferentes en variables sub-jetivas durante el posoperatorio inmediato 11. No hay publicaciones que analicen resultados de in-tervenciones bilaterales en el mismo individuo uti-lizando ambas técnicas, lo que constituiría la mejor forma de comparación. Si bien existen pacientes ope-rados previamente con cirugía convencional que son sometidos luego a una intervención laparoscópica, se desconoce en estos el grado de satisfacción a lar-go plazo. Surge el interrogante: ¿cuál es la real magnitud de es-tas diferencias? En condiciones posoperatorias norma-les, sin complicaciones, ¿qué ocurriría al comparar pa-cientes operados, en dos momentos diferentes, con am-bas técnicas? Objetivo Evaluar el grado de satisfacción de pacientes interve-nidos inicialmente de hernioplastia inguinal abierta y luego sometidos a la reparación laparoscópica del lado contralateral.
