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ABSTRACT BACKGROUND: Regarding postoperative pain, it remains unclear whether non-fixation of the polypropylene prosthesis in transabdominal preperitoneal inguinal hernia repair produces the same outcomes as mesh fixation with glue or tackers. In addition, hernia recurrence is another aspect to be assessed in the comparison between non-fixation and mesh-fixation techniques (tackers and glue). AIMS: This study aimed to evaluate the incidence, quality of pain, and recurrence in patients undergoing laparoscopic inguinal hernioplasty (transabdominal preperitoneal) technique, comparing the fixation of the mesh with tackers versus with glue versus without fixation. METHODS: This is a prospective, double-blind study in which 63 patients presenting with primary unilateral inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal hernia repair and were randomized into three groups: no mesh fixation (n=21), mesh tacked (n=21), and mesh fixed with fibrin glue (n=21). Patients also responded to questionnaires in order to assess pain and pain quality and were followed up for 2 years. RESULTS: Neither mesh-fixation nor non-fixation techniques were found to affect postoperative chronic pain (p=0.535), but patients undergoing tacker fixation reported more pain descriptors (p=0.0021) and a higher pain index (p=0.002) on the McGill scale in the first 15 postoperative days (T0 and T1). No hernia recurrences were observed. CONCLUSIONS: Both mesh-fixation techniques (tackers and glue) used with the transabdominal preperitoneal approach did not influence the onset of inguinodynia, but tacker fixation was more likely to increase patient sensitivity to pain. Mesh placement without fixation produced the same pain and recurrence outcomes as mesh-fixation techniques. Also, no recurrence was observed in patients without mesh fixation in this study. Consequently, it has become an alternative therapy deserving consideration for hernia repair.
RESUMO RACIONAL: Em relação à inguinodinia, há que se perguntar se a não fixação da tela pela técnica da hernioplastia inguinal videolaparoscópica transbadominal pré-peritoneal teria os mesmos resultados em relação à fixação de telas com cola ou grampos. Além disso, a recorrência de hérnia é outro aspecto a ser avaliado na comparação entre as técnicas de não fixação e de fixação com tela (grampos e cola). OBJETIVOS: Avaliar a incidência, qualidade da dor e recorrência em pacientes submetidos à técnica de hernioplastia inguinal laparoscópica (transbadominal pré-peritoneal), comparando a fixação da tela com grampos vs. com cola vs. sem fixação. MÉTODOS: Este é um trabalho prospectivo, duplo-cego, em que 63 doentes portadores de hérnia inguinal submetidos à hernioplastia inguinal videolaparoscópica pela técnica transbadominal pré-peritoneal foram randomizados em três grupos: no primeiro a tela não foi fixada; no segundo foi fixada por grampos; e no terceiro foi fixada com cola. Estes pacientes foram submetidos a questionários para avaliação de dor, sendo acompanhados por dois anos. RESULTADOS: O método de fixação da tela, assim como a não fixação dela não interferiu no aparecimento da dor crônica pela Escala Visual Analógica; porém, os que foram submetidos à fixação por grampos tiveram mais descritores e índice de dor pela escala de McGill. Não foram observadas recidivas herniárias. CONCLUSÕES: O método de fixação da tela na técnica transbadominal pré-peritoneal não influencia no aparecimento da inguinodinia. A não fixação teve os mesmos resultados em termos de dor e recidiva, tornando-se alternativa terapêutica a ser considerada, pois não acarretou recidivas.
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ABSTRACT Purpose: To develop a reproducible training program model covering the steps of the extended totally extraperitoneal approach (e-tep) technique for correction of ventral or incisional hernia repair. Methods: Training sessions with surgeons in the laboratory using both porcine specimens and a new ethylene vinyl acetate (EVA) model simulating the operative steps of the e-tep technique. Students were interviewed and asked to answer a questionnaire pre and post the sessions to assess their performance and evaluated the course and model. Results: A total of 25 trained abdominal wall surgeons was evaluated at the end of the course. It was obtained a 100% satisfaction score of the training, as well as increased confidence levels up to 9 and 10 in all technical aspects of the surgery, having 96% of the surgeons performed a surgery under supervision of the proctors after the course. Conclusions: This training model is simple, effective, low cost, and replicable in guidance on the beginning of e-tep technique adoption, and performance. As a result, surgeons can get more confident and more able to perform surgeries employing this technique.