Safety and Efficiency of Laparoscopic Femoral Hernia Repair with Preserved Uterine Round Ligament

Guo, Mingxiao; Chen, Dongfeng; Zhang, Haifeng; Chen, Lu

doi:10.29271/jcpsp.2019.10.932

Cited by 6 publications

(12 citation statements)

References 15 publications

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“…Emergency operations due to incarceration strangulation, intestinal obstruction and other complications are associated with expressive morbidity and mortality 7 , 8 , 10 . A multitude of surgical operations have been employed to treat femoral hernias, including open inguinal or femoral access, laparoscopic procedures, use of mesh or plugs and closure of the femoral canal 3 - 5 , 14 , 15 , 17 . In the last decade, laparoscopic access became the preferable access to treat groin hernia for most surgeons 17 , 20 , 32 .…”

Section: Introductionmentioning

confidence: 99%

Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

Coelho

Hajar

Moreira

et al. 2021

ABCD, arq. bras. cir. dig.

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Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter’s hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

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Section: Introductionmentioning

confidence: 99%

Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

Coelho

Hajar

Moreira

et al. 2021

ABCD, arq. bras. cir. dig.

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“…After reading the title and abstract, 171 studies were excluded, leaving 21 studies, and after reading the full text again, 12 studies were excluded, of which 5 were excluded because the full text was not available, 3 studies did not report the required results, 2 were letters or comments, and 2 did not report sufficient data. In the end, we included 9 studies published between 2015 and 2023 [ 13 – 21 ], including 6 non-randomized controlled studies [ 13 , 15 , 17 – 19 , 21 ] and 3 randomized controlled studies [ 14 , 16 , 20 ]. The 9 studies included 1104 patients, 578 of whom had the URL preserved and 526 of whom had the URL transected.…”

Section: Resultsmentioning

confidence: 99%

“…Data on age from 7 studies, including 984 patients (528 preservation group and 465 division group) [ 14 – 16 , 18 – 21 ], with high heterogeneity, and were analyzed using a random-effects model (I 2 = 95%, P < 0.00001). There was no significant difference in age between the preservation group and the division group (MD-6.58, 95% CI − 13.41 to 0.24; P = 0.06; Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis

Zhong,

Zhang,

Zhong

et al. 2024

Hernia

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Purpose The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females. Methods We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. Results Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI − 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI − 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI − 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable. Conclusion In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.

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“…Luk et al 26 found that for female patients undergoing TEP, there was no significant difference in clinical outcomes between those with a transected round ligament and those with a preserved ligament. However, Guo et al 27 found that preserving the round ligament during TAPP can significantly reduce the incidence of postoperative uterine prolapse; however, there was no significant difference in the incidence of postoperative pain, seroma, or recurrence rate. In this study, we transected the round ligament of the uterus into 360 hernias and preserved the remaining 254 sides.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Inguinal Hernia Repair for Female Patients: Experience from a High-volume Center in 20 years

Lu,

Zhao,

Yue

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Although laparoscopic inguinal hernia repair (LIHR) is widely performed worldwide, few studies have focused on the procedure in female patients. This study investigated the characteristics and outcomes of female patients with inguinal hernias who underwent LIHR. Materials and Methods: This study retrospectively analyzed the data of 7380 patients with inguinal hernia admitted to the General Surgery Department of Ruijin Hospital and underwent LIHR from January 2001 to December 2020. The clinical characteristics, surgical outcomes, and complications were assessed. Results: In total, 572 female patients were enrolled in this study. The proportion of femoral hernias in female patients was higher in women than in male patients (17.4% vs. 0.3%, respectively). Mesothelial cysts of the round uterine ligament (MCURL) were noted in 74 patients. The mean age of patients with MCURL was lower than that of patients without MCURL (46.4 vs. 55.6, P=0.018). Seventy cases (93.3%) of MCURL were resected laparoscopically, and 5 cases were resected through an auxiliary small incision. The round ligament was cut off in 335 patients and preserved in 237. No significant differences were observed in the number of hospitalization days, recurrence rates, or complications between the transection and preservation groups. None of the cases were converted to laparotomy, and no recurrence was noted during follow-up. Conclusion: LIHR is safe and feasible in female patients. Treatment of femoral hernia, MCURL, and the round ligament of the uterus should be carefully considered during LIHR in female patients.

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Safety and Efficiency of Laparoscopic Femoral Hernia Repair with Preserved Uterine Round Ligament

Abstract: Objective: To evaluate the efficiency and safety of the transabdominal preperitoneal (TAPP) technique with or without preserved uterine round ligament for the repair of femoral hernias (FHs), on the female patients treated at a single centre.

Cited by 6 publications

References 15 publications

Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis

Laparoscopic Inguinal Hernia Repair for Female Patients: Experience from a High-volume Center in 20 years

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