A comparative study on the effects of transabdominal preperitoneal hernia repair and open hernia repair surgery in the treatment of adult inguinal hernia / 中国综合临床

Objective To evaluate the clinical outcomes of different stages of transabdominal preperitoneal hernia repair (TAPP) and open hernia repair surgery (Rutkow) in treating adult inguinal hernia.Methods The clinical data of patients with inguinal hernia undergoing hernia repair(TAPP,TAPP Ⅰ group:56 patients administered TAPP during January 2003 to December 2005 ; TAPP Ⅱ group:76 patients administered TAPP during January to December 2010) and Rutkow hernia-ring filling (Rutkow group:78 patients administered Rutkow during January 2003 and December 2005) were analyzed retrospectively.Clinical indexes and effective indicators were observed to compare the treatment effects of the operation procedures,including duration of surgery,post-operation hospital stay,post-operation leaving bed time,post-operation free activity time,hospitalization costs,time of beginning taking food,and complications.Results The TAPP Ⅱ group had significantly shorter average length of stay,time of beginning taking food,post-operation leaving bed time and post-operation free activity time than the other two groups (average length of stay:(2.6 ± 1.6) d vs.(4.1 ±2.6) d vs.(4.2 ± 1.9) d; time of beginning taking food:(8.6 ± 3.1) h vs.(22.2 ± 3.8) h vs.(20.7 ± 3.2)h;post-operation leaving bed time:(4.6 ±2.2) h vs.(18.3 ±2.3) h vs (20.5 ±3.1) h;Post-operation free activity time:(8.6 ± 2.9) d vs.(15.2 ± 3.3) d vs.(17.1 ± 3.8) d ; P ＜ 0.05).There were no significant differences between TAPP Ⅰ and Rutkow groups on average length of stay,time of beginning taking food,postoperation leaving bed time and post-operation free activity time (P ＞ 0.05).TAPP Ⅰ group had significantly longer duration of operation than the other two groups ((113.3 ± 18.6) min vs.(50.4 ± 11.8) min vs.(48.6 ± 12.1) min,P ＜ 0.05).There was no difference on surgery duration between Rutkow and TAPP Ⅱ groups (P ＞ 0.05).No difference was observed regarding rates of postoperative complications and recurrence (P ＞ 0.05).Conclusion With the advancement of technology,TAPP shows more advantages compared to traditional herniorrhaphy,such as minimal trauma,fewer complications and shorter duration of operation and lower recurrence rate.TAPP is an excellent hernia repair for inguinal hernia.

The Comparison of Laparoscopic and Open Incisional and Ventral Hernia Repairs / 대한내시경복강경외과학회지

PURPOSE: We performed a prospective study for the purpose of analyzing and comparing outcomes after laparoscopic and open incisional hernia repairs. METHODS: Open incisional hernia repair with Rives-Stoppa method was performed on 35 patients between April 2003 and March 2008. Laparoscopic incisional hernia repair with intraperitoneal onlay mesh (IPOM) was performed on 35 patients during the same periods. Clinical features and surgical outcomes were compared in both groups. RESULTS: There were no significant differences in patients' clinical characteristics. There were no significant differences in defect size, location and surgical complication. While, the operation time and hospital stay were shorter, and postoperative pain was less in laparoscopic repair group (p<0.05). There was one recurrence in laparoscopic group and there were three recurrences in open group. CONCLUSION: Laparoscopic incisional hernia repair is safe and feasible procedure comparing to open method. We suggest that laparoscopic repair is initially recommended for incisional hernia if there is no contraindication or excessive adhesion.

The Effectiveness of Laparoscopic Ventral Hernia Repair with Transfascial Fixation / 대한내시경복강경외과학회지

PURPOSE: The introduction of a mesh to ventral herniorrhaphy ensures abdominal wall strength without tension, and this procedure has shown a decreased recurrence rate, a shorter hospital stay and less use of analgesics. However, the extensive tissue dissection required for mesh placement leads to increased postoperative complications. Yet with the development of laparoscopic ventral herniorrhaphy, we expect earlier recovery, fewer complications and decreased recurrence rates. This study was done to compare the outcomes after open and laparoscopic ventral herniorrhaphy with using mesh through a retrospective review. METHODS: The outcomes for 20 consecutive patients who underwent laparoscopic ventral herniorrhaphy were compared with those of 20 consecutive patients who underwent open herniorrhaphy. The laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair with transfascial fixation method in all the cases. RESULTS: The forty patients (24 women and 16 men) had a mean age of 57.48 years (range, 33~82). The mean follow-up time was 63.4 months. The mean surgery duration (67.4 min vs 142.3 min, respectively, p=0.003) and postoperative stay (4.7 vs 16.2 days, respectively, p<0.0001) were shorter for the laparoscopic group. The number of shots of analgesics during the first 3 days after surgery was 1.9 vs 2.4 shots, respectively (p=0.019). There were fewer complications (30%) and recurrences (5%) among the patients who underwent laparoscopic repair than those for the patients who underwent open repair (65% and 10 %, respectively). CONCLUSION: Those findings shows that laparoscopic ventral herniorrhaphy with transfascial fixation seems to be safe and effective and it showed a shorter operative time, fewer complications, a shorter hospital stay and less recurrence than did open ventral herniorrhaphy.