Laparoscopic Inguinal Herniorrhaphy Results of a Multicenter Trial

ABSTRACT ABSTRACT ABSTRACTNeedlescopic techniques have been used recently in repairing inguinal hernias (IH), which has made this type of surgery more feasible and less invasive. The technique is being developed further. The objective of this study is to describe and assess the results that can be achieved by using a new simplified techinque (Reverdin needle, RN) in needlescopic inguinal herniorrhaphy (NH) in children. All patients with symptomatic IH confirmed by clinical examination were subjected to elective needlescopic herniorrhaphy. One-hundred and fifty patients with 186 groin hernias, from two hospitals in Egypt and Saudi Arabia, in the period from October 1999 to May 2002, were assinged to NH using RN. The RN was used to insert a purse-string suture around the internal inguinal ring (IIR) to be tied extracorporeally. A total of 186 IH defects in 150 children were repaired successfully. There were 130 males and 20 females with a mean age of 20.58+21 months (range 8-96 months). Right-sided IH was present in 86 patients (57.33%); among these patients, an opened IIR was found and repaired in 12 cases (8%). Left-sided IH was present in 30 cases (20%), bilateral hernia in 19 cases (12.67%), and recurrent IH in 20 cases (10%). The mean duration of surgery was 8.7+1.18 min for unilateral and 12.35+2 min for bilateral hernia repair. No intra or postoperative complications. The mean hospital stay was 7.79+1.28 h. The new technique had all the advantages of needlescopic herniorrhaphy in children (less invasive, less pain, short hospital stay) combined with the advantages of reduced operating time, simplicity, and feasibility. It may be preferable for the intracorporeal suturing and knot tying. However, it needs longterm follow up.

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“…[2], [8], [13], [14] In the present study, no single case of recurrence was seen at 1-year follow-up and the scars were almost invisible.…”

Section: Discussionmentioning

confidence: 59%

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Shalaby

Fawy

Soliman

et al. 2005

J Indian Assoc Pediatr Surg

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“…Many of these complications are directly related to lack of thorough knowledge of surgical anatomy or improper technique [7,8]. The complication rates after laparoscopic hernioplasty vary from 5% to 13%, but the definition of complications differs widely among studies [9,10]. Severe bleeding usually due to vascular injury of iliac vessels and generally occurs because the using of staples during mesh fixation [11].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

Lasheen¹,

Tolba²,

Mohamed³

et al. 2013

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Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.

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“…19 TAPP and TEP usually involves fixation of mesh, however many studies challenging the mesh fixation in TEP are being published. 22 There are two most common methods of fixing mesh using fibrin glue (Tissucol) and tackers.…”

Section: Contentmentioning

confidence: 99%

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Shinde¹

2009

WJOLS

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Background: Laparoscopic fixation of meshes prior to their fibrous incorporation should be reliable to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture, tack and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data showing that fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP.Methods: A literature search was performed using medline and the search Google, Springer link and Highwire press. The following search terms were used: Laparoscopic hernia mesh, Fibrin glue, and Tackers. 2293 citations were found in total.Selected papers were screened for further references. Criteria for selection of literature were the number of cases (excluded if less than 80), methods of analysis (statistical or nonstatistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (specialized institution for laparoscopic surgery).Results: Mesh fixation has always invited lots of interest amongst surgeons and instrument companies due to the wide range of postoperative complications each of them caused. TAPP and TEP usually involves fixation of mesh, however many studies challenging the mesh fixation in TEP are being published. There are two most common methods of fixing mesh using fibrin glue (Tissucol) and tackers. Fibrin sealant possesses both mechanical strength and elasticity. Overall, data from previous studies, shows that mesh stability with fibrin sealant fixation is at least equivalent to suture fixation, indicating that fibrin sealant could be considered the fixation method of choice in inguinal hernia repair. This new method of mesh fixation is obviously potentially less harmful than stapling the mesh and can help reduce the risk of chronic postoperative pain at a comparative or even lower cost than a stapling device. Conclusions:Fibrin glue gives an adequate mesh fixation with a less chance of chronic postoperative pain. It appears to be an alternative to staples and may help reduce the postoperative pain problems after hernia repair. All methods give the same results in terms of recurrence rate, hospital stay, and costs; but with better results in terms of postoperative pain, seromas, and trocar-related trauma. However the use of fibrin glue needs extensive study, as the anatomical dissection and inguinal region preparation have to be carefully performed, and the mesh size has to be adequate; peritoneum closure with a running suture is more time consuming. Large randomized trials and longer follow-up are required to demonstrate the advantages of either technique.

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Laparoscopic Inguinal Herniorrhaphy Results of a Multicenter Trial

Cited by 335 publications

References 15 publications

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Needlescopic inguinal herniorrhaphy in children - A new simplified technique

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

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