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An Experience of Short-Term Results of Laparoscopic Inguinal Hernioplasty Using 3D Mesh in a Developing Country  [PDF]
Iqbal Saleem Mir, Alfer Ah Nafae, Aijaz Ahmed Malyar, Muntakhab Nafae, Yawar Watali, Mudasir Farooq, Shahnawaz Bashir Bhat, Sheikh Viqar
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.61010
Background: The experience of short term results of laparoscopic inguinal hernia repair using 3D mesh in a developing country is reviewed. Methods: From January 2012 to February 2014, 53 patients underwent laparoscopic inguinal hernioplasty. A retrospective case series of 53 consecutive patients undergoing TEP/TAPP by a single surgical team was followed prospectively with a focused physical examination and interview. 4 out of 53 patients had recurrent hernia following open repairs and 49 had primary hernias. Data collected included operative time, intraoperative bleeding, intraoperative difficulties, immediate postoperative pain, chronic groin pain, recurrence, sensory disturbance, activity or occupational limitation and personal satisfaction. Results: All the patients were male aged 32 to 75 years with a mean age of 53.5 years. Mean operative time was 37.4 minutes; intraoperative dissection, blood loss were less; and immediate postoperative pain was negligible as assessed by VAS. There was no mortality or major morbidity. Mean follow-up was 12 months (2 to 18 months). Follow-up was completed by interview and physical examination. Hernia was not found to recur during the follow up period. Chronic pain occurred in 2 patients (3.7%), which was mild in nature. Ninety-seven percent of patients were satisfied with their repair and would or had recommended TEP/TAPP to others using 3D Mesh. Conclusions: Short-term results of TEP/TAPP hernia repair using 3D mesh demonstrated to be an effective and safe procedure with low prevalence of chronic pain that is generally of a mild, infrequent nature. It was also concurred that there is decrease in operative time. Manipulation of mesh was significantly reduced. Intraoperative bleeding and use of post operative analgesia was reduced considerably. There was no recurrence, however the cost of the mesh increased the overall cost of the procedure acting as a limiting factor in a developing country.
Hernioplastia inguinal de Rutkow y Robbins, sin recurrencias Rutkow y Robbins' inguinal hernioplasty without recurrences  [cached]
Bárbaro de Armas Pérez,Oscar Duménigo Arias
Revista Cubana de Cirugía , 2008,
Abstract: INTRODUCCIóN. La universalización del uso de las bioprótesis y sus actuales pioneros Lichtenstein, Gilbert, Rutkow y Robbins, están logrando vencer lo que hasta hoy ha sido el fantasma de la cirugía herniaria: las recurrencias. Las técnicas a base de tapón de malla ya tienen más de 20 a os de evaluación y son ampliamente aceptadas por la mayoría de los cirujanos. MéTODOS. Se estudiaron 34 pacientes afectos de hernia inguinal a los cuales se les realizó hernioplastia de Rutkow y Robbins entre enero del 2001 y diciembre del 2004. Con el objetivo de determinar la efectividad de dicha técnica, se analizaron las variables: edad, sexo, lado y variedad de hernia, tiempo de hospitalización y anestesia, material protésico utilizado, complicaciones posoperatorias y recurrencias. RESULTADOS. La muestra estuvo constituida mayormente por hombres, con un promedio de edad de 56 a os. Predominaron las hernias del lado derecho, de los tipos 2 y 3 según la clasificación de Gilbert modificada por Rutkow y Robbins, de etiología primaria en el 82,35 % de los casos. El 79,41 % de los pacientes se operó de forma ambulatoria, mayormente con anestesia espinal y el material protésico más empleado fue el polipropileno. El índice de complicaciones fue del 14,74 % y hasta la fecha no han existido recurrencias. CONCLUSIONES. Los resultados obtenidos con la técnica de Rutkow y Robbins son alentadores, con baja morbilidad y sin recurrencias. INTRODUCTION. The universalization of the use of bioprostheses and its pioneers Lichtenstein, Gilbert, Rutkow and Robbins are being able to overcome what has been the ghost of hernial surgery: recurrences. The techniques based on mesh plug have been evaluated for more than 20 years and are widely accepted by most of the surgeons. METHODS. 334 patients with inguinal hernia that had undergone Rutkow y Robbins' hernioplasty from January 2001 to December 2004 were studied. The following variables were analyzed in order to determine the effectiveness of this technique: sex, age, side and variety of hernia, time of hospitalization and anesthesia, prosthetic material used, postoperative complications and recurrences. RESULTS. The sample included mostly males with an average age of 56 years old. It was observed a predominance of type 2 and 3 hernias on the right side according to Gilbert's classification modified by Rutkow y Robbins. They were of primary etiology in 82,35 % of the cases. 79.41 % of the patients underwent ambulatory surgery, mostly with spinal anesthesia and the most used prosthetic material was polypropylene. The index of complications wa
Laparoscopic hernioplasty by Eyeglass-Shaped Mesh in 54 patients with bilateral inguinal hernia
Talebpour M,Yagoobi A,Zargar M
Tehran University Medical Journal , 2007,
Abstract: Background: Laparoscopic hernioplasty is a standard technique with increasing interest of patients and surgeons. Bilateral hernioplasty can be performed by laparoscopy as well. The aim of this study is to show laparoscopic bilateral hernioplasty is an acceptable method and use of eye-shaped mesh getting the best result.Methods: In 54 cases with bilateral inguinal hernia, under general anesthesia laparos-copic reconstruction with eye-shaped prolene mesh performed. All cases of recurrent, big, direct, indirect and femoral hernia were entered in the study.Results: Seven of 54 cases were female. Four cases (male) had direct hernia, four female had femoral hernia and remaining of the study group had indirect form. Direct hernia 4 case (male), femoral hernia 4 (female) and remaining were indirect hernia. Operation performed without any complications in all cases. In 12 cases sac of hernia was too much enlarged so technique of bridge at the base of sac used. In five cases diameter of defect was more than 2 centimeter. In three of them defect repaired by suture before mesh insertion. Postoperative complications were seroma at distal of mesh in 23 cases (absorbed during 3 weeks spontaneously), reaction to mesh in one case (mesh and protack removed after 3 months of operation. Conservative management was ineffective and anterior repair performed), recurrence in one case (after 2 months of operation due to displacement of mesh in big direct hernia). Post operative hospital stay was 1.3 day (mean time). Painless movement and mobilization was obvious after 48 hours.Conclusion: Laparoscopic bilateral hernioplasty using eye-shaped prolene mesh is an acceptable method with good results especially in indirect hernia. In direct hernia, repair of defect by suturing and fixation of mesh is preferred.
The Professional Medical Journal , 2009,
Abstract: Incisional hernia is a common complication of abdominal surgery and an important source of morbidity. It may be repaired using open suture, open mesh or laparoscopic mesh techniques. Objectives: To examine the results of open mesh repair using “sublay technique” of hernioplasty. Setting: Surgical Unit-I, Department of Surgery at Allied Hospital, a tertiary care teaching hospital affiliated with Punjab Medical College, Faisalabad. Patient & Methods: Sixty patients (male:16, female:44) were operated for incisional hernia. Open mesh repair was done. Polypropylene mesh was placed over closed posterior rectus sheath layer and over the rectus abdominis, were available. Anterior rectus sheath was closed in front of the implanted mesh. All the patients received injectable third generation cephalosporin for 48hrs postoperatively. Postoperative recovery in terms of seroma formation, wound infection, intraabdominal adhesions leading to intestinal obstruction, enterocutaneous fistula formation and recurrence were the main factors noted and analyzed statistically. Results: Mean postoperative hospital stay was 03 days. Only one patient developed wound infection. None of the patients developed seroma formation, intestinal obstruction or enterocutaneous fistula. Maximum follow up till this study is 14 months. No recurrence has been reported so far. Conclusions: Open mesh repair using “sublay technique” does not carry risk of enterocutaneous fistula, carries low risk of seroma formation and wound infection. Proper technique is not associated with recurrence.
Comparison of superficial surgical site infection following use of diathermyand scalpel for making skin incision in inguinal hernioplasty
Q Ali, K Siddique, S Mirza, A Malik
Nigerian Journal of Clinical Practice , 2009,
Abstract: The method of making surgical incision remains a complex problem. Although controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rate or postoperative pain is reportedwith the use ofDiathermy. However, the fear of excessive scarring and poorwound healing has curtailed itswidespread use for skin incision. The objective of the study is to compare superficial surgical site infection (SSSI) in diathermy and scalpel skin incision in inguinal hernioplasty. Quasi experimental study. Study was conducted at Surgical Unit II, Holy Family Hospital. Rawalpindi from1 Jan. 2008 to 30 September. 2008. Atotal of 80 patients who presented with inguinal hernias were included in the study. Patientswere divided in two groups. Group1: In 40 patients skin incisionwasmadewithDiathermy,Group 2: The other 40 had skin incisionwith scalpel. Themean age of patients in the intervention group (Group 1)was 50 years while in the control group (Group 2) itwas 46 years. 48% patients in Group 1 and 55% in the Group 2 had indirect inguinal hernias. SSSI was noted in 12.5% cases in Group 1 whereas in Group 2 it was 17.5% but this difference was not found to be statistically significant (p value=0.378). The use of diathermy for making skin incisions is as safe as scalpel and there is no significant difference amongst both regardingwound infection.
Effective rectus sheath canal: does it affect total extraperitoneal approach for inguinal mesh hernioplasty?  [cached]
Maulana Mohammad Ansari
Journal of Experimental and Integrative Medicine , 2013, DOI: 10.5455/jeim.071212.br.012
Abstract: Objectives: This study aimed to compare the effects of the 1st port placement at two different levels below umbilicus during the total extraperitoneal (TEP) laparoscopic repair of inguinal hernia and to check the hypothesis that shorter effective rectus sheath canal would facilitate the TEP procedure. Methods: Eighteen adult males underwent TEP repair for uncomplicated primary inguinal hernia in one year. First (optical) port was placed 1 cm and 2.5 cm below the umblicus in the two groups (I and II, respectively). Effective rectus sheath canal (ERSC) was measured. Primary outcome measures (endoscopic vision, ease of the procedure and operating time) were compared between the two groups. Results: ERSC (mean ± SD) was found 3.24 ± 0.41 and 2.08 ± 0.27 cm in group I (n = 7) and group II (n = 11), respectively (P < 0.05). Endoscopic vision was found significantly better in group II compared to group I; visual analogue score (VAS) 8.82 ± 0.41 vs 4.57 ± 0.45, respectively (P < 0.05). Procedure was found significantly easier in group II compared to group I (VAS 8.91 ± 0.44 vs 5.5 ± 0.65; P < 0.05). Operating time was found significantly lower in group II compared to group I (1.83 ± 0.3 vs 2.71 ± 0.42 h; P < 0.05). Conclusions: Shorter effective rectus sheath canal of ≤ 2 cm greatly facilitates the TEP hernioplasty in terms of endoscopic vision, ease of the procedure and operating time, and is highly recommended, especially for the beginners. [J Exp Integr Med 2013; 3(1): 73-76]
Evaluation of Post Operative Analgesic Efficacy of Intramuscular Pethidine, Compared to Indometacin and Diclofenac Na Suppositories in Unilateral Inguinal Hernioplasty Patients  [PDF]
Biezhan Arya,Ali-Akbar Abdollahi,Mohammad-Jafar Golalipour,Kazem Kazemnezhad
Journal of Medical Sciences , 2007,
Abstract: We compared analgesic effects of intramuscular pethidine to diclofenac sodium and indometacin suppositories. This study is a semiexperimental clinical trial study over 55 patients of 17 to 60 years old who had undergone unilateral inguinal hernioplasty. These patients divided into 3 groups incidentally the first group including 17 patients who received 100 mg indometacin suppository every 8 h to relief postoperative pain. The second group of 18 patients who received 100 mg Diclofenac Na suppository every 8 h and the third group including 20 patients who received 0.5 mg kgG1 body weight pethidine intramuscularly every 8 h and the first dose of each drug started 2 h after termination of operation. The severity of pain was checked by Visual Analogue Scale (VSA) method every 2 h for 24 h. Mean pain severity checked and compared in 6 h intervals. Mean pain severity and standard deviation in the first 24 h were 23"12 for indometacin and 27"12 for pethidine and 31"9 for diclofenac Na groups respectively. There is no meaningful difference in pain relief during the first post op day. We concluded that Indometacin and diclofenac Na suppositories are good substitutes of intramuscular pethidine to relief post op pain during the first post op day.
Local anesthetic agents along with hyaluronidase for inguinal hernia block provides excellent analgesia: a double blind study  [cached]
Asmita V. Chaudhari,Vipul P. Chaudhari
International Journal of Basic & Clinical Pharmacology , 2013, DOI: 10.5455/2319-2003.ijbcp20130822
Abstract: Background: Inguinal hernia block is cost effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether hyaluronidase along with local anesthetic agent provides good analgesia for hernia block. The aim was to evaluate the effectiveness of hyaluronidase along with local anesthetic agents for inguinal hernia block in patients undergoing inguinal hernioplasty. Methods: 50 patients ASA grade I and II, age above 18 years, undergoing inguinal hernioplasty were randomized into two groups. Group A received inguinal hernia block with local anesthetic agents without hyaluronidase and Group B received inguinal hernia block with hyaluronidase and local anesthetic agents. Both groups received premedication 10 minutes before induction in the form of inj. Fentanyl, Midazolam, Ranitidine and Ondansetron Results: In Group B, out of 25 patients only 4 patients required intraoperative analgesia while in group A 16 patients required intraoperative analgesia. Post operative pain was assessed for 24 hours using the pain rating scale. The mean duration of analgesia was significantly longer in group B (16.16±6.8780 hrs) compared to group A (7.32±2.5285 hrs); pain score was compared between the two groups. Group B had lower pain scores than group A which was statistically significant (P<0.05). Conclusion: It concludes that hyaluronidase with local anesthetic agent for inguinal hernia block provides excellent intraoperative analgesia and also prolongs the post operative analgesia. [Int J Basic Clin Pharmacol 2013; 2(4.000): 466-469]
Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty
Bárbaro Agustín Armas Pérez,Evelio Salvador Reyes Balseiro,Oscar Duménigo Areas,Orlando René González Menocal
Revista Cubana de Cirugía , 2009,
Abstract: INTRODUCCIóN. La hernioplastia inguinal bilateral libre de tensión de Lichtenstein es una posibilidad real de tratamiento en pacientes con hernia inguinal bilateral. Este método es en esencia menos costoso para el paciente, la institución y la economía en general, y permite una reincorporación rápida a la sociedad, por lo cual en el presente estudio se presentaron los resultados de este protocolo de tratamiento, con la finalidad de evaluar su efectividad. MéTODOS. Se realizó un estudio descriptivo transversal con los primeros 38 pacientes operados con la técnica de Lichtenstein mediante anestesia local (técnica combinada de Braun y de Shleider). Los pacientes fueron operados de forma ambulatoria entre enero de 2001 y diciembre del 2007. Se dio el alta en la tarde, si la operación fue en la ma ana; y al amanecer del día siguiente, si se operó en la tarde, con el objetivo de evitar la equimosis declive con la movilización precoz. RESULTADOS. Cuatro de los pacientes presentaban hernias recurrentes. El material protésico más empleado fue el polipropileno (86,9 %). Las complicaciones alcanzaron el 9,1 % (referidas no a los 38 pacientes, sino a las 76 hernioplastias); y después de un seguimiento que osciló entre 1 y 36 meses, se presentó un rechazo al material protésico (1,3 %) y una recidiva (1,3 %). CONCLUSIONES. Se concluyó que este procedimiento es aplicable a las hernias bilaterales, ya que el estrés, los costos institucionales y las molestias del paciente se reducen, con lo cual demuestra su eficacia. INTRODUCTION. Lichtenstein's tension free bilateral inguinal hernioplasty is a real possibility for treating patients with bilateral inguinal hernia. This method is essentially less expensive for the patient, the institution and the economy in general, and it allows a fast reincorporation to society. Therefore, the results of this treatment protocol were included in the present study aimed at evaluating its effectiveness. METHODS. A descriptive cross-sectional study was conducted among the first 38 patients operated on by Lichtenstein's technique with local anesthesia (Braun and Sheleider's combined technique). The patients underwent ambulatory surgery between January 2001 and December 2007. The patients operated on in the morning were discharged in the afternoon, whereas those operated in the afternoon were discharged next morning in order to prevent the ecchymosis with the early mobilization. RESULTS. Four of the patients had recurrent hernias. The most used prosthetic material was polypropilene (86.9 %). The complications accounted for 9.1 % (referred n
Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia
Lima Neto, Edgar Valente de;Goldenberg, Alberto;Jucá, Mário Jorge;
Acta Cirurgica Brasileira , 2007, DOI: 10.1590/S0102-86502007000400007
Abstract: purpose: to evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. methods: this was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types iii a and iii b according to the nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the lichtenstein technique. the patients were evaluated using doppler ultrasound before the operation and selectively at the third and sixth months after the operation. the variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. results: no statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). conclusion: no alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis.
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