ABSTRACT
INTRODUCTION: There is a continuous concern about meshes used in laparoscopic inguinal hernia repair, which mainly relates to their biocompatibility and ability to decrease postoperative complications and recurrence rate; in other words, efforts are made to find the "ideal" prosthesis. OBJECTIVES: To evaluate different prostheses used in laparoscopic inguinal hernia repair in terms of biocompatibility, postoperative complications, recurrence rate and quality of life, so that all the features could lead us to the "ideal" mesh. MATERIAL AND METHOD: Randomized controlled trials, reviews, prospective and retrospective studies, retrospective cross-sectional and experimental studies on animals published between 2000 and 2016 were analysed with respect to several features of a mesh: biocompatibility, postoperative complications, recurrence rate and quality of life. OUTCOMES: The most common comparison is between heavy-weight and light-weight mesh used in laparoscopic inguinal hernia repair. Experimental studies try to discover the "ideal" prosthesis, which could provide improved biocompatibility, low postoperative complications, decreased recurrence rate and good quality of life. The most commonly used mesh that meats the characteristics of an "ideal" prosthesis is a light-weight monofilament macroporous polypropylene mesh, with a minimum tensile strength >16 N/cm², measuring 10x15 cm. CONCLUSIONS: Published data show that the "ideal" prosthesis used in laparoscopic inguinal hernia repair has not been discovered yet. Regarding heavy- or light-weight meshes, there is no significant effect on recurrence, acute or chronic pain, incidence of seroma or return to daily activity and quality of life (1).
ABSTRACT
If morbidity and mortality are to be reduced in patients with penetrating abdominal trauma, first priority goes to prompt and accurate determination of peritoneal penetration and identification of the need for surgery. In this setting, laparoscopy may have an important impact on the rate of negative or non-therapeutic laparotomies. We analyzed indications and patient selection criteria for laparoscopy in penetrating trauma along with outcomes. The analysis focused on identification of peritoneal penetration and injuries to the diaphragm, small intestine, and mesentery. Results from the early phase of laparoscopy were compared with those from recent decades with more advanced laparoscopic equipment and instruments and more experienced surgeons. A systematic review of the role of laparoscopy in penetrating abdominal trauma shows a sensitivity ranging from 66.7 to 100%, specificity from 33.3 to 100% and accuracy from 50 to 100%. Publications from the 1990s found trauma laparoscopy to be inadequate for detecting intestinal injuries and so to lead to missed injuries. Twenty-three of the 50 studies including the most recent ones report sensitivity, specificity, and accuracy of 100%. Laparoscopy is more cost effective than negative laparotomy. Laparoscopy can be performed safely and effectively on stable patients with penetrating abdominal trauma. The most important advantages are reduction of morbidity, accuracy in detecting diaphragmatic and intestinal injuries, and elimination of prolonged hospitalization for observation, so reducing the length of stay and increasing cost effectiveness.
