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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent unilateral or bilateral hernias, and patients who, because of economic pressures, must return to work within 10 days of surgery. Within these limitations we feel that the laparoscopic approach definitely has a place in repair of inguinal hernias. In the future new techniques, decreased equipment costs, and the ability to use local anesthesia may increase the applicability of laparoscopic herniorrhaphy.
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PMID:Laparoscopic herniorrhaphy. 866 8

This study compares the extraperitoneal endoscopic hernia repair (TEP, n = 96) with the technique according to Shouldice (n = 128). Intraoperatively, the rate of complications increased during the first TEP procedures, whereas the conventional procedure showed no complications. However, the TEP patients' showed significantly more comfort compared to the Shouldice technique, meaning less pain and earlier return to normal activity.
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PMID:[Endoscopic extraperitoneal hernioplasty in comparison with conventional surgical procedures--a prospective controlled study]. 910 48

In recent years endoscopic techniques using mesh implantation have been added to the many options for the repair of inguinal hernia to diminish postoperative pain, shorten the reconvalescence period and improve the recurrence figures of the classical repair. The purpose of this paper is to evaluate our first experiences gained by applying the TEP laparoscopic hernia repair. Between March and December 1996, 20 laparoscopic herniorrhaphies were performed with complete extraperitoneal balloon dissection. A large polypropylene prosthesis was inserted to cover all potential defects. The follow-up was 2-10 months. There were 10 indirect, 6 direct, 1 combined direct and indirect, 1 femoral and 2 scrotal hernias. Age (26-86 years) and operative time (52-120 mins) had a wide range. Hospital stay lasted from 1-5 days. Morbidity was low: scrotal emphysema (3), peritoneal lesion (2) and palpable mesh crease (1) occurred in a few cases. No recurrences have been seen so far. It seems that the TEP laparoscopic hernia repair is a highly successful procedure with minimal morbidity. Preliminary results are promising. Further experiences and long term follow-up studies will determine the future of laparoscopic hernia surgery.
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PMID:The totally extraperitoneal (TEP) laparoscopic hernia repair. 940 88

The value of the minimal invasive approach for treating groin hernias is not yet well defined. The standard treatment for primary hernia repair in Europe is an open approach (i.e. Shouldice) without mesh implantation. A mesh may be used to repair a so-called complicated hernia with a complete myopectineal defect, as well as for recurrent and bilateral hernias. These hernias can well be treated laparoscopically despite the fact that the approach is difficult and that there is an increase of direct costs. Whether or not a transabdominal (TAPP) or preperitoneal (TEP) endoscopic approach is used depends on the type of hernia, the risk to the patient, and the surgeon's experience. Morbidity and long-term follow-up are identical for both techniques (TAPP and TEP). The advantages for TAPP repair are that the technique is simpler, with a large working space and good diagnostic tools.
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PMID:[Laparoscopic transperitoneal inguinal hernia operation (TAPP)]. 945 6

Within the range of treatment of inguinal hernias, the paper concentrates on the following procedures: Shouldice, the "tension-free" repairs of Lichtenstein, Rutkow, TIPP, and the laparoscopic procedures TAPP and TEP. An individual, selective approach tailored to the type of hernia, as well as the age and profession of the patient is recommended. A multicenter study comparing these procedures would be useful. Conventional repair of incisional hernias (simple closure, Mayo) has a depressing recurrence rate of 30%-40%. Better results are obtained by using a synthetic prosthesis, which can be implanted using the sublay inlay, or onlay technique.
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PMID:[Abdominal wall hernias (inguinal hernia, incisional hernia)]. 957 4

Over the past 15 years, laparoscopic herniorrhaphy has made the transition from an experimental to a proven procedure. With increasing laparoscopic skills in the surgical community, many surgeons are now faced with the question of when to recommend laparoscopic herniorrhaphy to their patients. A surgeon's best hernia repair is the one with which they have had the greatest experience. This results in the lowest recurrence and complication rate in his or her hands. Certainly, simple, unilateral hernias and bilateral hernias can be repaired with either anterior or laparoscopic techniques. Many times, laparoscopic herniorrhaphy is too much surgery for a young patient with a unilateral hernia. In such a case, repair is best performed with the patient under local anesthesia. Also, young patients in whom it is advantageous to avoid mesh should not undergo laparoscopic herniorrhaphy. The authors prefer laparoscopic TEP herniorrhaphy in patients with recurrent hernias, bilateral hernias, and unilateral hernias with a suspected contralateral hernia. There is also a consensus that patients with multiple recurrent hernias in whom a preperitoneal repair is appropriate are best served with a laparoscopic repair. Surgeons without advanced laparoscopic skills or without the time to develop the skills necessary to perform laparoscopic herniorrhaphy should consider referring patients with recurrent hernias to surgeons with experience in TEP. TEP is preferable to TAPP because of its lower complication and recurrence rates and in the authors' hands is the "best repair." TAPP should be reserved for patients with prior lower abdominal wall incisions that make the dissection of the peritoneum from the underside of the incision impossible. Patients who cannot tolerate general anesthesia or who have had extensive lower abdominal surgery should not undergo laparoscopic herniorrhaphy. Complication and recurrence rates, although initially higher than traditional repairs, have now fallen to equal or lower levels at centers experienced in laparoscopic techniques. Prospective randomized trials prove that when patients are selected properly and surgeons are adequately trained and proctored, laparoscopic herniorrhaphy can be performed with acceptably low incidences of recurrence and complications.
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PMID:Laparoscopic repair and groin hernia surgery. 992 83

The "Tension free" and TEP (total preperitoneal repair) of groin hernia gained more popularity in surgical practice in the last five years. The aim of the study was to reveal our experience with these two surgical techniques. The TEP procedure was done in 29 cases, till "Tension free" herniorraphy was performed at 32 cases. Postoperative complications in the group with TEP hernia repair were found in 1 case. Two complications were observed in the "Tension free" group. The follow up of the patients revealed I recurrence in the group of TEP herniorraphy and no recurrence in "Tension free" group. These two techniques for repair of groin hernias had several advantages and in spite of increased operating theater costs should be adopted on a routine basis in some cases than conventional techniques for repair of groin hernia.
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PMID:[Comparative study between laparoscopic "TEP" and "tension-free" repair of groin hernia]. 1202 70

Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique, which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias. Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group, and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day). Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two procedures.
Hernia 2002 Jul
PMID:Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair. 1215 42

The authors report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM) in 56 patients. 34 patients had a bilateral hernia, 6 of which were recurrent and 22 had a monolateral hernia, of which 9 had recurrent hernia. Overall, a total of 90 hernias were treated. The hernia repair was performed utilizing "GORE-TEX DualMesh Plus biomaterial with holes" in the first 32 cases and the latest "...Corduroy" type in the remaining 24 cases. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Five minor post-operative complications (5.5%), 2 seromas and 3 transient paresthesias, were observed. Four patients (7.1%) needed analgesics after the first 24 hours. Mean hospital stay was 36 hours, with a minimum of 24 and a maximum of 48. Mean resumption of normal activity was 8 days with return to work within two weeks. At an average 18 months follow-up, 3 recurrences were recorded (3.3%). The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of recurrent and bilateral hernias or when a hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited series and the short follow-up ask for randomized prospective long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.
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PMID:[Laparoscopic inguinal hernia repair "IPOM" with Dual-Mesh]. 1287 Feb 82

Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta glucan-coated polypropylene mesh both objectively (early recurrence) and functionally (pain and quality of life). The mass of the coated mesh is reduced by 50% compared to a typical polypropylene implant. Beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. One hundred fifteen patients with a mean age of 55 years with a primary or recurrent inguinal hernia were treated with a prosthesis (Glucamesh). Fifty-eight patients underwent a Lichtenstein procedure, and 57 had a laparoscopic procedure (TEP, TAPP). Mean operative time was 40 min. There was no mortality, and morbidity was 8.6%. At 3 months follow-up, no recurrences were observed. The characteristics of the prosthesis were considered to be good or excellent in 93.9-100% of cases. Residual postoperative pain (analogue pain score less than 2) occurred in 4.3% of cases at day 15 and in 2.7% at day 90. The quality-of-life health score of the SF36 questionnaire preoperatively and postoperatively showed a significant improvement ( P<0.05) in the scores and a quality of life equivalent to healthy control subjects. This prosthesis is associated with a rapid and significant resolution of postoperative pain and a quick return to normal activity with an improved quality of life. In addition, the plant origin of the prosthesis eliminates any risk of viral or prion contamination.
Hernia 2004 Feb
PMID:Inguinal hernia repair with beta glucan-coated mesh: prospective multicenter study (115 cases)--preliminary results. 1368 Mar 4


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