Strengths and weaknesses of laparoscopic and open mesh inguinal hernia repair: A randomized controlled experimental study

Abstract

There are no objective data available on the relative strengths of inguinal hernia repairs. The aim of this randomized controlled study was to measure th force required to disrupt laparoscopic and open mesh repairs in a porcine model. Eleven pigs had inguinal hernia repair following randomization to an open mesh group (n = 5) or a transabdominal preperitoneal laparoscopic group (n = 6). Four weeks after operation the pigs were killed and the pelvic girdles were mounted in a test jig on a mechanical testing machine. The applied disruption forces were measured and recorded. Mean(s.d.) force required to disrupt the normal inguinal canal (n = 11) was 68.6(30.1) N with no difference between groups. The open mesh repair required 110.3(41.4) N and the laparoscopic mesh 220.0(95.2) N. Both open and laparoscopic mesh repairs were stronger than the normal side (P < 0.03). The laparoscopic mesh repair was stronger than the open mesh repair (P = 0.04). This model provides a standardized method for mechanically testing inguinal hernia repairs in pigs. It confirms that both open and laparoscopic mesh hernia repairs are stronger than the non-herniated normal side at 4 weeks after operation. Laparoscopic mesh repair is stronger than open mesh repair. The weakest points of the repairs correlate well with those identified in clinical reports.

Endoscopic Inguinal Hernia Repair in Comparison with Shouldice and Lichtenstein Repair

“…Thirty-three randomized controlled trials with a total of 5,053 random patients were used for the evaluation [11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45]. Due to the separate publication of partial aspects [40, 45]and late results [11, 12, 14, 18], a total of 36 publications was analyzed.…”

“…number of study centers, exclusion criteria), the number of cases (11–928) and follow-up times (0–72 months). One study was an animal experiment [30]with mechanical strain tests. Operation times and morbidity were investigated in more than 80% of the studies, whereas other parameters such as lung function or metabolic factors were only analyzed in isolated trials.…”

Horseshoe-Shaped Marlex Mesh for the Treatment of Pelvic Floor Prolapse

“…Most importantly we are able to use a sheet to anchor the pelvic organs with a physiological support similar to the normal anatomical support namely the tendineous arc and specialized parts of the endopelvic fascia including the pubocervical and the uterosacral-cardinal ligaments [6]. …”

“…Polypropylene Marlex mesh is frequently used to repair inguinal and incisional hernias and for the suspension of vaginal vault prolapse [4, 5, 6]. It seems logical, therefore, to use it as a genitourinary and rectal support and as a substitute for the pelvic fascia.…”

Laparoskopische transperitoneale Hernioplastik (TAPP) – Effektivität und Gefahren

“…Das im Rahmen der endoskopischen Reparation als Basis notwendige Prinzip der spannungsfreien Rekonstruktion ist bereits seit langem durch die Ergebnisse von Amid et al [9] fu È r die gleichnamige konventionelle, anteriore Onlay-Technik bekannt. Im Unterschied zu dieser Operationsform wird bei der endoskopischen Technik sowohl eine widerstandsfa Èhigere [10] als auch eine durch den minimalen Zugang schmerza È rmere Rekonstruktion erzielt. Die in verschiedenen randomisierten Untersuchungen nachgewiesene raschere postoperative Erholung [11] hat eindeutige Konsequenzen fu È r eine Verku È rzung der postoperativen Arbeitsunfa È higkeitsdauer.…”