Value Analysis of Methods of Inguinal Hernia Repair

Glasgow, Robert E.; Mulvihill, Sean J.; Pettit, Jacob; Young, Jeffrey; Smith, Brigitte K.; Vargo, Daniel; Ray, David M.; Finlayson, Samuel R.G.

doi:10.1097/sla.0000000000005063

Cited by 7 publications

(3 citation statements)

References 23 publications

(58 reference statements)

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“…Importantly, as healthcare spending in the USA continues to rise, there has been a lack of demonstrable improvement in quality of care and outcomes [ 40 ]. With inguinal hernia repairs, the trend toward laparoscopic, and now robotic, approaches increases cost without value added [ 41 ]. The tendency to employ newer, more expensive technology and devices without evidence of superiority further adds to this burden.…”

Section: Discussionmentioning

confidence: 99%

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Woo,

Ellis,

Maskal

et al. 2024

Surg Endosc

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Introduction Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. Methods This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. Results A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). Conclusion Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.

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Section: Discussionmentioning

confidence: 99%

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Woo,

Ellis,

Maskal

et al. 2024

Surg Endosc

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“…[6–8] The only definitive modality for such conditions is surgical repair, also known as inguinal hernia repair (IHR). [9–13]…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] The only definitive modality for such conditions is surgical repair, also known as inguinal hernia repair (IHR). [9][10][11][12][13] IHR is often performed under general, regional, or local anesthesia. [14][15][16] Spinal anesthesia (SA) is commonly used to manage IHR.…”

Section: Introductionmentioning

confidence: 99%

Regional block anesthesia for adult patients with inguinal hernia repair: A systematic review

Zhang

Zeng

et al. 2022

Medicine

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Background: Inguinal hernia repair (IHR) is a common surgical technique performed under regional block anesthesia (RBA). Although previous clinical trials have explored the effectiveness and safety of RBA for IHR, no systematic review has investigated its effectiveness and safety in adult patients with IHR.Methods: This systematic review searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, Wangfang, and VIP) from their inception to July 1, 2022. We included all potential randomized controlled trials that focused on the effects and safety of RBA in adult patients with IHR. Outcomes included operative time, total rescue analgesics, numerical rating scale at 24 hours, occurrence rate of nausea and vomiting, and occurrence rate of urinary retention (ORUCR).Results: Five randomized controlled trials, involving 347 patients with IHR, were included in this study. Meta-analysis results showed that no significant differences were identified on operative time (MD = −0.20; fixed 95% confidence interval [CI], −3.87, 3.47; P = .92; I² = 0%), total rescue analgesics (MD = −8.90; fixed 95% CI, −20.36, 2.56; P = .13; I² = 28%), and occurrence rate of nausea and vomiting (MD = 0.39; fixed 95% CI, 0.13, 1.16; P = .09; I² = 0%) between 2 types of anesthesias. However, significant differences were detected in the numerical rating scale at 24 hours (MD = −1.53; random 95% CI, −2.35, −0.71; P < .001; I² = 75%) and ORUCR (MD = 0.20; fixed 95% CI, 0.05, 0.80; P = .02; I² = 0%) between the 2 management groups. Conclusion:The results of this study demonstrated that IHR patients with RBA benefit more from post-surgery pain relief at 24h and a decrease in the ORUCR than those with CSA.Abbreviations: CI = confidence interval, IH = inguinal hernia, IHR = inguinal hernia repair, MD = mean difference, NRS at 24 hours = numerical rating scale at 24 hours, NV = occurrence rate of nausea and vomiting, ORUCR = occurrence rate of urinary retention, OT = operative time, RBA = regional block anesthesia, RCTs = randomized controlled trials, SA = spinal anesthesia, TRA = total rescue analgesics.

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Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis

de’Angelis,

Schena,

Moszkowicz

et al. 2023

Surg Endosc

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Value Analysis of Methods of Inguinal Hernia Repair

Cited by 7 publications

References 23 publications

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Regional block anesthesia for adult patients with inguinal hernia repair: A systematic review

Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis

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