Inguinal Hernioplasty
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Recent papers in Inguinal Hernioplasty
Laparoscopic revolution made inguinal hernioplasty a topic of intense study again. Most crucial step in laparoscopic total extraperitoneal preperitoneal (TEPP) repair is creation of an avascular preperitoneal space. Preperitoneal access... more
Laparoscopic revolution made inguinal hernioplasty a topic of intense
study again. Most crucial step in laparoscopic total extraperitoneal
preperitoneal (TEPP) repair is creation of an avascular preperitoneal
space. Preperitoneal access requires balloon dissection or telescopic
dissection with/without prior needle insufflation. Present study
prospectively evaluated sixty adult male patients undergoing TEPP
hernioplasty (N=65) for inguinal hernia (N=68). Standard 3-midlineport
technique with mainly direct telescopic dissection was utilized.
Patients were evenly distributed across the 3rd to 8th decade of life
and across their professional occupation. Mean patient age was 50.1
± 17.2 years with a range of 18-80 years, and their mean BMI was
22.6 ± 2.0 kg/m2 with a range of 19.3-31.2 kg/m2). There occurred
early conversion to open anterior repair (n=1), open preperitoneal
repair (n=1) and transabdominal laparoscopic repair (n=1). Access to
avascular preperitoneal plane was made at or just below the level of
the middle working port by surgically creating a transverse opening
either through transversalis fascia in presence of a classical incomplete
posterior rectus sheath with a primary Arcuate line (N=41), or through
both posterior rectus sheath and transversalis fascia in presence of a
complete posterior rectus sheath without a primary Arcuate line (N=14)
or a long incomplete posterior rectus sheath with a low primary Arcuate
line (N=10). No conversion was forced secondary to the so-called
difficult dissection, and there was no major complication. Unhurried
telescopic dissection provided accurate recognition of morphology
of posterior wall of posterior rectus canal for its judicious division,
invariably resulting in successful access to preperitoneal space for
joyful completion of TEPP repair, and the technique with all steps under
direct vision, the most fundamental principle of modern laparoscopy,
is strongly recommended. Sound understanding of variable multilayered
anatomy of preperitoneal access is essential for seamless TEPP
hernioplasty and widespread popularization.
study again. Most crucial step in laparoscopic total extraperitoneal
preperitoneal (TEPP) repair is creation of an avascular preperitoneal
space. Preperitoneal access requires balloon dissection or telescopic
dissection with/without prior needle insufflation. Present study
prospectively evaluated sixty adult male patients undergoing TEPP
hernioplasty (N=65) for inguinal hernia (N=68). Standard 3-midlineport
technique with mainly direct telescopic dissection was utilized.
Patients were evenly distributed across the 3rd to 8th decade of life
and across their professional occupation. Mean patient age was 50.1
± 17.2 years with a range of 18-80 years, and their mean BMI was
22.6 ± 2.0 kg/m2 with a range of 19.3-31.2 kg/m2). There occurred
early conversion to open anterior repair (n=1), open preperitoneal
repair (n=1) and transabdominal laparoscopic repair (n=1). Access to
avascular preperitoneal plane was made at or just below the level of
the middle working port by surgically creating a transverse opening
either through transversalis fascia in presence of a classical incomplete
posterior rectus sheath with a primary Arcuate line (N=41), or through
both posterior rectus sheath and transversalis fascia in presence of a
complete posterior rectus sheath without a primary Arcuate line (N=14)
or a long incomplete posterior rectus sheath with a low primary Arcuate
line (N=10). No conversion was forced secondary to the so-called
difficult dissection, and there was no major complication. Unhurried
telescopic dissection provided accurate recognition of morphology
of posterior wall of posterior rectus canal for its judicious division,
invariably resulting in successful access to preperitoneal space for
joyful completion of TEPP repair, and the technique with all steps under
direct vision, the most fundamental principle of modern laparoscopy,
is strongly recommended. Sound understanding of variable multilayered
anatomy of preperitoneal access is essential for seamless TEPP
hernioplasty and widespread popularization.
Background/objective: Incisional hernias (IHs) are a major problem following abdominal surgery. In an effort to resolve large IHs adequately, we herein present our own modified " open intraperitoneal mesh " technique, termed the Garestin... more
Background/objective: Incisional hernias (IHs) are a major problem following abdominal surgery. In an effort to resolve large IHs adequately, we herein present our own modified " open intraperitoneal mesh " technique, termed the Garestin technique. Methods: We analyzed early postoperative complications (EPCs; wound infection, hematoma, and seroma) and late postoperative complications (recurrence) in 124 patients operated for IHs and recurrent IHs (RIHs) using our new technique. Our technique involved repairing hernias by preserving the hernia sac, which was later used to conceal the mesh that replaced the abdominal wall defect, thus dividing the mesh from subcutaneous tissue. Results: We operated 66 patients with IH and 58 patients with RIH. In the 4-week postoperative follow-up, 29 patients had EPC; 9 of them had wound infections that healed upon antibiotic therapy, without the need for any surgical procedure. Of the 10 patients with recurrent her-niation in the long-term follow-up, 6 previously had EPC. Recurrences occurred 4e25 months after the operation. Conclusion: Our method is reliable and safe for large ventral hernia disposal, but the final conclusion requires a larger number of patients and a longer follow-up period.
- by Alen Pajtak and +2
- •
- Mesh, Abdominal Wall Hernias, Inguinal Hernioplasty
Background/objective: Incisional hernias (IHs) are a major problem following abdominal surgery. In an effort to resolve large IHs adequately, we herein present our own modified "open intraperitoneal mesh" technique, termed the Garestin... more
Background/objective: Incisional hernias (IHs) are a major problem following abdominal surgery. In an effort to resolve large IHs adequately, we herein present our own modified "open intraperitoneal mesh" technique, termed the Garestin technique. Methods: We analyzed early postoperative complications (EPCs; wound infection, hematoma, and seroma) and late postoperative complications (recurrence) in 124 patients operated for IHs and recurrent IHs (RIHs) using our new technique. Our technique involved repairing hernias by preserving the hernia sac, which was later used to conceal the mesh that replaced the abdominal wall defect, thus dividing the mesh from subcutaneous tissue. Results: We operated 66 patients with IH and 58 patients with RIH. In the 4-week postoperative follow-up, 29 patients had EPC; 9 of them had wound infections that healed upon antibiotic therapy, without the need for any surgical procedure. Of the 10 patients with recurrent herniation in the long-term follow-up, 6 previously had EPC. Recurrences occurred 4e25 months after the operation. Conclusion: Our method is reliable and safe for large ventral hernia disposal, but the final conclusion requires a larger number of patients and a longer follow-up period.
- by Ivica Biskup and +1
- •
- Surgery, Treatment Outcome, Herniorrhaphy, Medicine
Conclusion: The use of ultrasound-guided regional anesthesia with ropivacaine as an anesthetic in inguinal hernia repair for elderly patients is safe and effective, and ropivacaine is optimally effective at the concentration of 0.5% with... more
Conclusion: The use of ultrasound-guided regional anesthesia with ropivacaine as an anesthetic in inguinal hernia repair for elderly patients is safe and effective, and ropivacaine is optimally effective at the concentration of 0.5% with least side effects.
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Read this original research and sign up to receive Patient Preference and Adherence journal here: https://www.dovepress.com/articles.php?article_id=23830
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