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Laparoscopic Transabdominal Preperitoneal Mesh Hernioplasty: A Medical College Experience  [PDF]
Mushtaq Chalkoo, Mujahid Ahmad Mir, Hilal Makhdoomi
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.72015
Abstract: Objectives: To determine the feasibility and patient’s outcome of laparoscopic transabdominal preperitoneal mesh hernioplasty for inguinal hernias. Patients and Methods: This study was carried out from March 2011 to April 2014. A total of 130 patients underwent laparoscopic transabdominal preperitoneal mesh hernioplasty (TAPP) for uncomplicated inguinal hernia. Of this, 10 patients presenting with bilateral inguinal hernias were operated in the single sitting. A 15 cm × 12 cm polypropylene mesh was used in all cases. Operative morbidity, postoperative pain, seroma formation, evidence of superficial infection, chronic groin pain and hernia recurrence were noted. The majority of the patients were discharged within 24 hours and follow-up was done at 1 week, 1 month, and 6 months. Results: 130 patients presenting with uncomplicated inguinal hernias were operated over a period of three years in the department of surgery, Govt. Medical College Srinagar. The mean age of the patients was 39.18 years (range: 18 - 70 years). The median duration of operation was 48.5 minutes (range: 18 - 120 minutes). None of the procedure was converted to open inguinal hernia repair. Postoperative pain was observed in 9.23% of the cases and was easily controlled by oral analgesics. Six patients (4.62%) developed seroma, out of which one required aspiration while others settled conservatively. Two patients (1.54%) developed wound infection and one patient (0.77%) had recurrence. None of the patients developed scrotal hematoma or neuralgia. Return to normal activity after TAPP repair was found to be after a median of 16.1 days. Conclusion: Transabdominal preperitoneal repair for inguinal hernia using proline mesh may be a safe and effective procedure with low morbidity, early return to normal activity and with a very low recurrence after six months follow-up.
Se debe fijar la malla durante una herniorrafia inguinal? Should mesh prosthesis be fixed in inguinal herniorraphy?
Luis Carlos Domínguez,álvaro Sanabria,Neil Valentín Vega,Camilo Osorio
Revista Colombiana de Cirugía , 2012,
Abstract: Introducción. La fijación de la malla durante una herniorrafia inguinal ha sido recomendada rutinariamente. La información disponible es controversial. En este estudio se hace una revisión crítica de la literatura científica, evaluando la efectividad clínica de esta intervención en cirugía laparoscópica y abierta (técnica de Lichtenstein). Métodos. Se hizo una búsqueda de la literatura científica siguiendo la metodología BET (Best Evidence Topic), para identificar artículos que compararan fijar contra no fijar la malla durante una herniorrafia inguinal. Los artículos se revisaron según los criterios de apreciación de la Journal of the American Medical Association (JAMA). Se extrajeron los datos de la efectividad de la intervención y se analizaron resultados primarios como reproducción, dolor posoperatorio, infección, seroma y hematoma. Se analizaron como resultados secundarios costo, tiempo de estancia hospitalaria, retorno laboral y tiempo quirúrgico. Resultados. Se encontraron una revisión sistemática de la literatura científica y nueve estudios de asignación aleatoria. En herniorrafia totalmente extraperitoneal, transabdominal preperitoneal y abierta, no existe diferencia en la frecuencia de reproducción, infección, seroma ni hematoma. La presencia de dolor posoperatorio disminuye tardíamente cuando no se fija la malla, tanto en herniorrafia abierta como laparoscópica. En herniorrafia laparoscópica el tiempo de incapacidad no disminuye si se fija la malla. Fijar la malla incrementa el costo y el tiempo quirúrgico. Conclusiones. La fijación de la malla puede omitirse en herniorrafia laparoscópica totalmente extraperitoneal, en la transabdominal preperitoneal y en la abierta por vía anterior (Lichtenstein). La principal ventaja de no fijar la malla, documentada en los estudios disponibles, tiene que ver con la reducción del dolor posoperatorio crónico, sin que exista diferencia en la tasa de reproducción. No hay información disponible sobre esta intervención en otros tipos de herniorrafia abierta, como la preperitoneal (Nyhus). Introduction / aims: Mesh fixation in groin hernia repair has been recommended routinely; however there is pertinent controversial information. In this study we review the clinical effectiveness of the intervention in open (Lichtenstein repair) and laparoscopic repair. Methods: We used a Best Bets methodology to identify clinical trials comparing mesh fixation versus no mesh fixation during inguinal herniorraphy. Studies were evaluated according with JAMA criteria. Information about clinical effectiveness was extracted from artic
The Professional Medical Journal , 2011,
Abstract: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show thatthe use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk ofinfection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. StudyDesign: Descriptive Study. Period: Oct 2009 to Jun 2010. Setting: Shalamar Hospital, Lahore. Materials and Methods: Over a period of 9months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct andcystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at oneweek and six weeks after discharge from hospital. Results: There was no clinical evidence of surgical site infection or leak from appendicularstump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. Conclusions: This study shows that clipscan be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is veryconvenient, an easy, safe, and cost-effective procedure.
Single-incision trans-abdominal preperitoneal mesh hernioplasty  [cached]
Roy Prabal,De Anushtup
Journal of Minimal Access Surgery , 2011,
Abstract: Single-incision laparoscopy is being used to carry out a wide variety of laparoscopic operations since its introduction in 2007. Various case reports and studies have demonstrated the safety and feasibility of single-incision laparoscopic transabdominal preperitoneal (TAPP) and totally extra-peritoneal mesh hernioplasty. However, till date, its apparent advantages have been mainly cosmetic and related to patient satisfaction. We have been performing single-incision laparoscopic TAPP mesh hernioplasty since June 2009 using conventional laparoscopic instruments. Here, we describe our technique that is aimed at standardising the method.
Rectus sheath abscess after laparoscopic appendicectomy  [cached]
Golash Vishwanath
Journal of Minimal Access Surgery , 2007,
Abstract: Port site wound infection, abdominal wall hematoma and intraabdominal abscess formation has been reported after laparoscopic appendicectomy. We describe here a rectus sheath abscess which occurred three weeks after the laparoscopic appendicectomy. It was most likely the result of secondary infection of the rectus sheath hematoma due to bleeding into the rectus sheath from damage to the inferior epigastric arteries or a direct tear of the rectus muscle. As far as we are aware this complication has not been reported after laparoscopic appendicectomy.
Laparoscopic versus open appendicectomy: An Indian perspective  [cached]
De Utpal
Journal of Minimal Access Surgery , 2005,
Abstract: BACKGROUND: Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is scant. This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis. MATERIALS AND METHODS: The study group consisted of two hundred and seventy nine patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendicectomy (LA) and one hundred seventy nine patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost in terms of their medians. The Mann-Whitney statistics (T) were calculated and because of large samples, the normal deviate test (Z) was used. RESULTS: Of the hundred patients, six patients (6%) had the procedure converted to open surgery. The rate of infections and overall complications (LA: 15%, OA: 31.8%, P < 0.001) were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA, 5 days after OA, P < 0.0001) than after OA. The operating time was shorter {OA: 25 min (median), LA: 28 min (median), 0.01< P < 0.05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. CONCLUSION: Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same. LA is also associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.
The comparison of anterior preperitoneal mesh and Lichtenstein mesh techniques in inguinal hernia repair  [PDF]
Ahmet Nuray Turhan,Selin Kapan,Serkan Fatih ?pek,Sinan Hatipo?lu
Medical Journal of Bakirk?y , 2005,
Abstract: Aim: Inguinal hernia repair is currently one of the most common operations in general surgery. In this prospective randomized study we compared the novel technique of anterior preperitoneal mesh repair with Lichtenstein mesh repair. Material and methods: Between January 2004 and December 2004 inguinal hernia repair was performed in 188 cases, under general or spinal anesthesia. The two methods were compared regarding operation time, postoperative pain via visual analogue scores (VAS) on the 1st, 7th, 30th and 90th days postoperatively, mean hospital stay, mean period for returning to daily activities, early complication and recurrence rates. The parameters were evaluated by Anova: single variate and Chi-Square (Fischer’s exact test) tests and p<0.05 was accepted to be statistically significant. Results: Forty-two of the cases had bilateral hernia and the male to female ratio was 172/16. According to Nyhus Classification 26 cases had Type II hernia, 72 cases had Type III a hernia, 117 cases had Type III b hernia and the remaining 15 cases had Type IV hernia. Anterior preperitoneal mesh repair was performed in 104 cases and Lichtenstein mesh repair was performed in the remaining 84 cases. Mean age of the patients was 50.38 ± 1.16 (18-85). Mean follow up period was 8.40 ± 0.27 (3-15) months. Early complication and recurrence rates were 22/104 (21.15%) and 1/104 (0.9%) in cases with anterior preperitoneal mesh repair and 12/84 (14.28%) and 2/84 (2.3%) in cases with Lichtenstein repair respectively. Main complications were wound site infection and hematoma. When the two techniques were compared regarding mean time of operation, VAS, mean hospital stay, mean time for returning to daily activities, early complication and recurrence rates, VAS of postoperative 7th day in the Lichtenstein group was found to be significantly lower (p=0.01) whereas time for returning to daily activities was significantly shorter in the anterior preperitoneal mesh repair group (p=0.001). Early complication and recurrence rates were found to be similar in both groups. Conclusion: The anterior preperitoneal mesh repair had similar results with Lichtenstein mesh repair regarding postoperative pain, mean hospital stay, early complication and recurrence rates. The advantage of a significantly shorter period for returning to daily activities make this novel technique a safe, easy and reliable alternative in open hernia surgery.
Herniorrafia preperitoneal anterior abierta con malla en una capa Open anterior preperitoneal mesh herniorrhaphy in one layer
Jaime Gutiérrez
Revista Colombiana de Cirugía , 2007,
Abstract: El objetivo de este trabajo es presentar una técnica quirúrgica abierta de herniorrafia con malla por vía preperitoneal y demostrar ventajas como poca incapacidad posoperatoria, dolor leve, costo bajo y recidiva muy poca. Se realiza un estudio prospectivo desde octubre de 2000 hasta octubre de 2005, período en el cual se intervinieron 255 hernias de la ingle. La disección y colocación preperitoneal de la malla proporciona una zona de mayor protección. Fijar la malla impide una de las causas de la recidiva como es la migración. Una malla en un solo plano es tan efectiva y mucho más económica que una malla tridimensional. This paper’s objective is to present an open mesh herniorrhaphy surgical technique by preperitoneal approach and to demonstrate its advantages, such as less postoperative incapacity, lesser pain, low cost, and a very low recurrence rate. A prospective study that included 255 patients with groin hernias operated on during period October 2000-October 2005 was undertaken. The dissection and preperitoneal placement of the mesh provides a grater degree of protection. Fixation of the mesh prevents migration, which is one of the main causes of recurrence. A one-plane mesh is as effective as a three-dimensional mesh.
Delayed Mesh Infection: A Rare Complication of Laparoscopic Inguinal Hernia Repair (TEP—Totally Extra-Peritoneal Repair)  [PDF]
Anand Kumar Yadav, Vivek Bindal, Vinod Kumar Jangra, Zuber Khan, Shahnawaz Ahangar, Vikram Sharanappa, Mukund Khetan, Suviraj John, Sudhir Kalhan, Parveen Bhatia
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.710061
Abstract: Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.
Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia  [PDF]
Po Ching Cathy Ng, George Pei Cheung Yang, Michael Ka Wah Li
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.46A007

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.

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