Meta-analysis of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery

Prassas, Dimitrios; Rolfs, Thomas; Knoefel, Wolfram Trudo; Krieg, Andreas

doi:10.1002/bjs.11140

Cited by 9 publications

(11 citation statements)

References 19 publications

(46 reference statements)

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“…TEP repair is a relative contraindication for patients who have had lower abdominal surgery because access to the preperitoneal space and safe dissection may be difficult because of scar tissue from previous surgeries. 1,10,15,22 There 10 Elshof et al 23 reported a 9.8% conversion rate in TEP surgery for right inguinal hernia in patients who underwent open appendectomy. Lau and colleagues found a conversion rate of 4.3% and a PT rate of 56.5% in patients who underwent open appendectomy.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Karabulut

Dönmez

Şahbaz

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. Materials and Methods: We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. Results: The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. Conclusion: Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Karabulut

Dönmez

Şahbaz

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The chances of peritoneal tear become higher in case of preexisting scarring as a result of lower abdominal surgery, a factor that has been shown to generally result to a worse outcome in general, compared to cases with a virgin pre-peritoneal envelope. [24] Cases with previous lower abdominal surgery were excluded in 3 of the meta-analyzed RCTs. [13][14][15] The second most common intraoperative morbidity reported was major bleeding.…”

Section: Discussionmentioning

confidence: 99%

Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials

Prassas

Rolfs²,

Vaghiri

et al. 2022

Medicine

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Background:The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques.Methods: A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by metaanalysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated.Results: Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = −0.23; 95% CI [−0.41, −0.06]; P = .01; 4 studies; I 2 = 9). For the remaining primary and secondary endpoints, intra-and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups.Conclusions: Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.Abbreviations: CI = confidence interval, OR = odds ratio, RCT = randomized controlled trial, SMD = standard mean difference, STEP = single-port totally extraperitoneal hernia repair, TEP = totally extraperitoneal hernia repair.

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“…Several studies have proposed simultaneous inguinal hernia repair and prostatectomy through two different independent surgical cuts and not using the retroperitoneal mesh. 12–16 An inguinal hernia repair concomitant with prostatectomy was firstly reported by McDonald and Huggins, however this was performed with two separate incisions, with the hernia defect repaired through the inguinal approach. 17–19 After that, the Pfannenstiel-Kerr incision or pubic incision, that allows access to the abdomen, was suggested for the hernia repair meanwhile performing a simple prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

New technique of inguinal hernia repair during prostatectomy

Talebpour

Khatami

Aghaii

et al. 2020

Journal of Clinical Urology

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Background: Several benefits of inguinal hernia repair concurrent with simple prostatectomy have been proposed recently. For the first time we represent this surgery in the form of retroperitoneal mesh insertion without an additional surgical cut for the inguinal hernia repair. Methods: We selected 19 patients for this trial of a new surgery method. The simple prostatectomy was performed and from the same surgical cut the hernia sac recognized. Two methods of prostatectomy surgery were undertaken: Millin’s and Freyer’s prostatectomy. The retroperitoneal insertion of monofilament polypropylene was undertaken for hernia repair. Results: All patients were prospectively followed for three years for clinical outcomes and hernia recurrence. No complications after surgery, including wound infection, pelvic collections, sepsis and recurrence of the hernia were seen. Conclusions: Our new retroperitoneal mesh insertion technique is safe, effective and simultaneously practical with simple prostatectomy. This new method is strongly recommended to other surgeons, since it has beneficial results with no noteworthy raise in operative duration or further complications.

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Meta-analysis of totally extraperitoneal inguinal hernia repair in patients with previous lower abdominal surgery

Cited by 9 publications

References 19 publications

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials

New technique of inguinal hernia repair during prostatectomy

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