Femoral hernia: uncommon, but associated with potentially severe complications / Hérnia femoral: incomum, mas associada a complicações potencialmente graves

ABSTRACT 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.

RESUMO Racional: Embora o acesso laparoscópico esteja se tornando o tratamento preferencial para a hérnia femoral, poucos são os estudos sobre esse importante assunto. Objetivo: Avaliar os resultados do acesso laparoscópico totalmente extraperitoneal no tratamento da hérnia femoral. Métodos: Os dados de 62 pacientes com hérnia femoral que foram submetidos a herniorrafia foram revisados ​​retrospectivamente. O diagnóstico foi estabelecido por exames clínicos e/ou de imagem em 55 pacientes e por achados laparoscópicos em sete. Resultados: Havia 55 (88,7%) mulheres e 7 (11,3%) homens, com proporção feminino/masculino de 8: 1. A média de idade foi de 58,9±15,9 anos (22-92). A maioria (n=53, 85,5%) apresentava hérnia única e o restante (n=9, 14,5%) bilaterais, perfazendo um total de 71 hérnias femorais operadas. Operações prévias no abdome inferior foram registradas em 21 (33,9%) pacientes. A conversão para procedimento pré-peritoneal transabdominal laparoscópico foi realizada em quatro (6,5%). Herniorrafia aberta foi necessária em dois pacientes (3,2%), um com fístula enterocutânea espontânea na região da virilha (hérnia de Richter) e o outro com perfuração incidental do intestino delgado adjacente que ocorreu durante a dissecção do saco herniário. Não houve mortalidade. Conclusão: A hérnia femoral é incomum e pode estar associada a complicações potencialmente graves. A maioria das hérnias femorais pode ser tratada com sucesso através do acesso laparoscópico totalmente extraperitoneal, com baixas taxas de conversão e complicações.

Clinical comparative analysis of Laparoscopic transabdominal preperitoneal repair and path tension -free ;hernioplasty in the treatment of recurrent inguinal hernia in adults / 中国基层医药

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP)and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults,and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia.Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time,intraoperative bleeding volume,postoperative hospitalization time,cost of hospitalization,postoperative complications,early postoperative pain and the recurrence of hernia were compared between the two groups.Results All patients were successfully completed surgery.The operation time of TAPP group (47.2 ±9.4)min was significantly shorter than (73.1 ±10.4)min of Lichtenstein group (t=-2.503,P=0.034).The median amount of bleeding during operation of TAPP group was 40(15 -110)ml,which was significantly less than 73(11 -130)ml in Lichtenstein group (t=-6.018,P=0.000). Postoperative hospital stay of TAPP group[(6.5 ±1.4)d]was shorter than (8.2 ±1.6)d of the Lichtenstein group (t=-2.613,P=0.028).Early postoperative pain score of TAPP group[(1.8 ±1.2)points]was better than (2.9 ± 1.4)points in Lichtenstein group (t=-7.006,P=0.000),the difference was statistically significant.However,the hospitalization cost of TAPP group[(8 842.8 ±415.2)yuan]was higher than (6 676.9 ±327.6)yuan of the Lichtenstein group,the difference was statistically significant(t=6.782,P<0.05).In TAPP group,2 cases had complications after operation,which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months,1 case of recurrence in Lichtenstein group,the recurrence rate was 3.8%.There was no recurrence in the TAPP group.Conclusion TAPP has the advantages of short operation time,less bleeding,rapid postoperative recovery,less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults.

Retorno ao trabalho após herniorrafia inguinal convencional com prótese e sem prótese,por videolaparoscopia / Return to work activities after conventional inguinal hernia repair with prosthesis or not, and by laparoscopy

Este estudo tem como objetivos avaliar e comparar o tempo de afastamento das atividades laborais necessário para a recuperação de pacientes submetidos à hernioplastia inguinal por via convencional ? com prótese ou não, por via laparoscópica. Foi realizada revisão da literatura e análise de resultados de diversos artigos que tratam do tema. As médias ponderadas referentes a herniorrafias por inguinotomia foram comparadas com as de herniorrafias laparoscópicas. Observou-se redução de 39% no tempo para que os pacientes submetidos a cirurgia laparoscópica retornassem às atividades laborais quando comparados àqueles operados com a técnica convencional.

The objective of this study is to evaluate and compare the time away from work for the recovery of patients who have undergone inguinal hernioplasty by conventional technique ? with or without use of synthetic prosthesis, to that needed by those who have been submitted tolaparoscopic herniorrhaphy. A literature review and analysis of the results from several articles on the subject were conducted. Weighted averages related to open hernia repair were compared with data from laparoscopic hernia repair. Patients who had undergone laparoscopic surgery needed 39% less time to return to work, as compared with those submitted to theconventional technique.

Laparoscopic Totally Extraperitoneal Hernia Repair for Inguinal Hernia Patients: Results of 92 Cases / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.

The Incidence of the Occult Contralateral Hernia in Patients Undergoing Total Extraperitoneal (TEP) Repair of a Left Inguinal Hernia / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.

The Comparative Analysis between Laparoscopic Total Extraperitoneal Repair and Open Tissue Repair: Initial Experience of a Single Institute

PURPOSE: Laparoscopic herniorrhaphy has been recognized as one of the treatment options for inguinal hernia. This study compared the short-term results of two methods of repair: totally extraperitoneal (TEP) repair and open tissue based repair. METHODS: A retrospective review was conducted on all patients who underwent laparoscopic TEP repair (LH, 105 cases) and open repair (OH, 57 cases) at our hospital between September 2007 and December 2008. Posterior wall repairs in open technique follow as McVay (25 cases) and Bassini (32 cases). Demographic data, operation time, perioperative complications, consumption of analgesics, and hospital stay were compared. RESULTS: There was no significant difference in relation to patient characteristics; age, gender, BMI, medical and surgical history and hernia type. Also, there was no difference of operation time for both groups. Patients in the LH group consumed fewer analgesics (P=0.002). Intraoperative complications occurred more frequently in the LH group (P=0.036) but postoperative complications were similar. Hospital stay was shorter in LH (P<0.001). There was no difference of recurrence between LH group and OH group for 16 months. CONCLUSION: Laparoscopic TEP repair shows similar postoperative complications and recurrences and with less postoperative pain and hospital stay, compared with open tissue based hernia repair. However, further study with longer follow up data is necessary.

The Comparative Analysis between Laparoscopic Inguinal Herniorrhaphy and Open Inguinal Herniorrhaphy

PURPOSE: Published evidence comparing laparoscopic and open herniorraphy is contraversial. Laparoscopic surgery has became or is being tried as a standard in most of abdominal surgery due to its advantages. But disadvantages of laparoscopic surgery include the need for general anethesia, a problem particularly in over increasingly aged population, limit its more use. This study aimed to investigate the availability and indication of both laparoscopic and open herniorraphy. METHODS: The records and data of 85 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=20) or open herniorrhaphy (n=65), with similiar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to totallly extraperitoneal approach (TEP) repair and open herniorrhaphy to Bassini repair and Lichtenstein repair. As statistical method, the one way Anova Tests and Post Hoc Tests was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site, complication rate, or recurrence rate in both group. The laparoscopic group has a shorter mean postoperative hospital day than open group. However there was no statistical significance. Postoperative analgesic administration is significantly decreased in mesh applied group. CONCLUSION: The advantages of laparoscopic herniorrhaphy is not revealed in all patients. Indications for laparoscopic herniorrhaphy are being restricted to recurrent, bilateral hernia. Patient selection has been stepped up. Thus elderly patients and patients with significant morbidity who may well require monitoring after procedure are being advised to undergo open tension free repair with local anethesia. These recommendation apply similarly young patients with small, simple primary defects. After studying more cases, a reevaluation must be done concerning the advantage of both laparoscopic and open herniorraphy.

A Clinical Review of the Advantages of Laparoscopic Inguinal Herniorrhaphy

PURPOSE: Laparoscopic surgery has became or is being tried as a standard procedure in most of abdominal surgeries due to the advantages of little postoperative pain, shortened of hospital stay, early return to daily life, the cosmetic effect etc. In this article, we examine the availability of laparoscopic herniorrhaphy through a clinical review of patients who had undergone by laparoscopic or conventional herniorrhaphy. METHODS: The records and data of 137 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=57) or conventional herniorrhaphy (n=80), with similar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to transabdominal preperitoneal repair and conventional herniorrhaphy to Bassini's or Ferguson's repair. As statistical method, the Chi-square and T-test was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site and type of hernia, complication rate, or recurrence rate in both group. The laparoscopic group had a longer mean operative time (87.3 vs 68.6 min) and less frequent postoperative analgesic use (49.1 vs 72.6%) as compared to the conventional group. However there was no statistical significance. The laparoscopic group had a significantly shorter mean postoperative hospital day (3.6 vs 7.8 days) and the mean period of return to work (6.2 vs 15.2 days) as compared to the conventional group. CONCLUSION: Laparoscopic herniorrhaphy is thought to be becoming the preferred operative procedure for young patients with a flourishing social activity particularly due to its shortening of the postoperative hospital stay and facilitating the early return to work. There is a need for the complication and recurrence rate to be reestimated following a sufficient and strict follow up. After studying more cases, a reevaluation must be done concerning the advantage of laparoscopic herniorrhaphy.

Laparoscopic closure of the internal ring and high ligation of the hernial sac in children with indirect inguinal hernia / 中国微创外科杂志

Objective To discuss the feasibility of laparoscopic closure of the internal ring and high ligation of the hernial sac in children with indirect inguinal hernia.Methods Laparoscopic closure of the internal ring and high ligation of the hernial sac was conducted in 21 children with indirect inguinal from January 2003 to December 2004 in this hospital.A 5-mm 30? laparoscope was introduced through the umbilicus.The internal ring and the posterior crus(PC) on the side of hernia were identified.A 3-mm dissection forceps was placed on the midline between the umbilicus and pubic symphysis.At the skin projection of the internal ring on the side of hernia,a round-tip needle with 3-0 Prolene suture grasped by a regular needle holder was passed directly into the abdominal cavity to suture the posterior crus and then penetrate out of the abdomen via the roof of the internal ring through the musculoaponeurotic arch of the transversus abdominis.Then the Prolene suture was cut off,and passed by using the Endoclose device into the extraperitoneal cavity at the skin projection of the internal ring.The dissection was continued from without outward around the sac to encircle the neck and an extracorporeal high circumferential ligation of the sac was finished.Results The operation was successfully completed in all the 21 cases.The operating time was 16~50 min(mean,32.9 min),the postoperative duration in hospital was 1~2 d,and the time to normal activity,1~4 d(mean,1.4 d),respectively.No postoperative bleeding,hematoma of scrotum,or incisional infection occurred.Follow-up checkups in the 21 cases for 1~24 months(mean,15 months) showed no recurrence.Conclusions Laparoscopic closure of the internal ring and high ligation of the hernial sac is a novel,feasible,reliable and effective herniorrhaphy for the treatment of pediatric indirect inguinal hernia.

Effects of two anesthetic methods on stress reactions during peri-operative period of laparoscopic herniorrhaphy in children / 中国微创外科杂志

0.05),while were significantly increased in the Group G(P0.05) while remarkably increased in the Group G(P

Laparoscopic Inguinal Herniorraphy with an Extracorporea Suturing Needle

This report describes an innovative and effective application of the extracorporeal suturing needle (ESN) to perform a laparoscopic inguinal herniorraphy. Between 1/1/96 and 12/31/96, we treated 23 patients with inguinal hernia using this suturing needle uniquely designed by Nahm-gun Oh. This new technique and device allow sutures to be made in the tissues near the floor of the internal inguinal canal without exposing the area while the movement of the ESN is observed with a laparoscopic camera. In 16 patients, the internal inguinal ring was ligated and fixed medially to the fascial root of the inferior epigastric vessels and to laterally the internal oblique muscle, using the ESN. In 5 patients with large inguinal hernias, the sutures were placed to force the inguinal canal with intraperitoneal onlay mesh fixation to the fascia, using the ESN, causing a narrowing of the internal inguinal canal. In 2 patients with inguinal hernias, the peritoneum of the internal inguinal ring was closed and laterally fixed to the internal oblique muscle by using the ESN. The ESN has been used successfully in 96% of the patients with inguinal hernias. One patient had a recurrence of the hernia. No permanent complications were seen in the patients involved in this study. Some transient postoperative complications included groin pain (21%), urinary retention (13%), and abdominal wall hematoma (9%). In four patients (17%), contralateral inguinal hernias were discovered during their operations and were corrected using the same procedures. We conclude that the extracorporeal suturing needle was safely and effectively used in laparoscopic inguinal herniorrhaphies and should be considered for use in laparoscopic herniorrhaphies and other laparoscopic surgeries.