Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair

Abstract

IntroductionSurgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases. MethodsPatients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period. ResultsTwenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months. ConclusionhLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.

Analysis of influencing factors of complications after laparoscopic inguinal hernia repair: An observational study

“…In the Guidelines for the Diagnosis and Treatment of Inguinal Hernia in Adults in 2018, an inguinal hernia is defined as the degeneration of the transversus abdominis muscle in the weak area of the groin to form a defect in the brachiocephalic layer, which ultimately progresses to a hernia sac, and the hernia contents (mostly small bowel, followed by the greater omentum) are mostly formed by the entry of abdominal organs and tissues into the hernia sac, and the hernia content protrudes from the region of the inguinal defect onto the surface of the body, and the forming mass or bulge is referred to as an inguinal hernia. [ 11 , 12 ] Diagnosis of inguinal hernia is relatively simple, and sometimes a definitive diagnosis can be made simply based on the patient’s medical history and physical examination, but initial physical examination is difficult to determine the type of inguinal hernia in a patient. [ 13 ] At present, the treatment measures of inguinal hernia with a definite diagnosis include surgical treatment and conservative treatment, but surgical treatment is the most effective treatment for inguinal hernia; except for special patients (infants and children < 1 year old, elderly patients who are difficult to tolerate surgery, and those who are difficult to carry out surgery for concurrent illnesses), it is recommended to carry out surgery at an early stage, so as to avoid the subsequent progression of intestinal obstruction or intestinal necrosis.…”

Bone anchor as fixation method for abdominal wall reconstruction. A case report about a ten times recurred inguinal hernia

“…The correct dissection of the hernia sac, as well as an active search for all the compartments that could develop a hernia defect, are both of huge importance. On the other hand, late recurrence is secondary to factors intrinsic to the patient [ [4] , [5] , [6] , [7] ].…”

“…Previous studies that describe mesh sustenance to bone anchors have shown difficulty to do the overlap mesh size to the abdominal wall defect, as it happens to lumbar and supra pubic hernias [ 3 , 7 ].…”