Does primary closure of direct inguinal hernia defect during laparoscopic mesh repair reduce the risk of early recurrence?

Ng, A.; Lin, Jiun-Nong; Ching, Siok Siong; Lee, J; Wong, Andrew Siang Yih

doi:10.1007/s10029-020-02257-9

Cited by 10 publications

(4 citation statements)

References 14 publications

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“…Four (1.3%) patients with seroma required puncture. To reduce the incidence of seroma formation and recurrence, a method of suturing the hernia defect in medial hernias has been reported; 23,24 however, its effectiveness remains uncertain. Kudsi et al reported that defect plication did not appear to reduce post‐operative pain, seroma incidence, or recurrence 23 .…”

Section: Discussionmentioning

confidence: 99%

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

Okamoto,

Misawa,

Shimada

et al. 2023

Asian J Endoscop Surgery

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IntroductionWe aimed to evaluate the safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in 12 pioneering hospitals in Japan.MethodsClinical data of patients who underwent robotic‐assisted transabdominal preperitoneal repair between September 1, 2016, and December 31, 2021 were collected. Primary outcome measures were intra‐operative adverse events and post‐operative complications, whereas secondary outcomes were surgical outcomes, including chronic pain, recurrence, and learning curve.ResultsIn total, 307 patients were included. One case of inferior epigastric arterial injury was reported; no cases of bowel or bladder injury were reported. Thirty‐five seromas were observed, including four (1.3%) cases that required aspiration. The median operative time of a unilateral case was 108 minutes (interquartile range: 89.8–125.5), and post‐operative pain was rated 1 (interquartile range: 0–2) on the numerical rating scale. In complicated cases, such as recurrent inguinal hernias and robotic‐assisted radical prostatectomy‐associated hernias, dissection and suture were safely achieved, and no complications were observed, except for non‐symptomatic seroma. All patients underwent robotic procedures, and there was no chronic post‐operative inguinal pain, although one case of hernia recurrence was reported. Regarding the learning curve, plateau performance was achieved after 7–10 cases in terms of operative time (P < .001).ConclusionRobotic‐assisted transabdominal preperitoneal repair can be safely introduced in Japan. Regardless of the involvement of many surgeons, the mastery of robotic techniques was achieved relatively quickly. The advantage of robotic technology such as wristed instruments may expand the application of minimally invasive hernia repair for complicated cases.

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Section: Discussionmentioning

confidence: 99%

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

Okamoto,

Misawa,

Shimada

et al. 2023

Asian J Endoscop Surgery

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“…In another prospective study by Usmani et al [12] comparing direct defect closure in MII and MIII inguinal hernias by barbed non-resorbable suture versus non-closure in TEP and TAPP repair demonstrated a statistically significant reduction not only in seroma formation (12.6% vs. 6.4%, P = 0.045) but also in recurrence (4.4% vs. 0.9%, P = 0.036) after a follow-up of at least 9 months.…”

Section: Seromamentioning

confidence: 93%

“…The advantage of direct defect closure in prevention of recurrence was also reported in a retrospective study by Ng et al [13] in TAPP and TEP repair using interrupted non-resorbable single sutures for MII and MIII inguinal hernias with a 6.4% recurrence rate in the non-closure group vs. 0% in the closure group after 1 year. In both studies [12,13] , besides the defect closure, mesh fixation was performed by resorbable tacker.…”

Section: Seromamentioning

confidence: 99%

Is mesh fixation in TAPP and TEP still necessary?

Fortelny¹

2021

MIS

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One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century. Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker. Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate. Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained. On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should be used.

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“…With great pleasure, we read study in the recent issue of Hernia, Ng AY et al reported a retrospectively study comparing the outcomes of defect closure and non-closure [7], with no surprise, three cases of recurrences were observed in the non-closure group with mean duration of recurrence of 4.7 months, interestingly, the author reported a higher seroma formation rate in the defect closure group (17.9% vs. 2.1%, p = 0.025), and the author stated that, they did not invert "the apex of the sac" when performing defect closure, however, this step of the apex of the latex transversalis fascia inverting is the important step of in our initially reported technique, although it is a little bit technical challenging, it is very effective to eradicate the direct cavity and prevent seroma formation [4]. In addition, the author misused the term of "the apex of sac" [7], which may cause readers' confusion, actually, the term of "transversalis fascia (IF)" should be used, since the sac was already reduced into preperitoneal cavity, and in direct hernia development, the IF becomes thin and weak.…”

mentioning

confidence: 99%

More work should be done in laparo-endoscopic direct hernia repair

2020

Hernia

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Does primary closure of direct inguinal hernia defect during laparoscopic mesh repair reduce the risk of early recurrence?

Cited by 10 publications

References 14 publications

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

Is mesh fixation in TAPP and TEP still necessary?

More work should be done in laparo-endoscopic direct hernia repair

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