Abstract:

Hypothesis: Laparoscopic herniorrhaphy using Surgisis® (Cook Surgical, Bloomington, IN, USA) mesh is an effective long-term treatment for repair of inguinal hernia. Patients and Intervention: Between August 1999 and April 2005, 67 patients underwent laparoscopic inguinal hernia repair by the total extraperitoneal (TEP) mesh placement technique using Surgisis® mesh. A total of 82 primary direct, indirect, pantaloon, and femoral hernias were repaired using this technique. Main Outcome Measures: Postoperative complications and recurrence as evaluated at two weeks, six weeks, three months, six months, one year, and yearly thereafter for up to five years. Results: The operations were performed successfully on all the patients. One revision was done to an open procedure. Postoperative complications were typical of inguinal hernia surgery. Average follow up was 38 (range: 4-72, median: 35 months. Four non-technical recurrences following repair of direct hernias were reported, which indicates a 4.9% recurrence rate. No recurrences of indirect hernias were noted. Conclusions: Laparoscopic inguinal herniorrhaphy using Surgisis® mesh is effective in treatment of primary inguinal hernias in adults with minimal complications and recurrence up to five years of follow up.

Authors:

David S. Edelman, M.D., F.A.C.S., Baptist Health Systems, Miami, FL; Jason P. Hodde, M.S., Cook Biotech Incorporated, West Lafayette, IN

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Abstract:

Endoscopic totally extraperitoneal inguinal hernioplasty, TEP, has become an established technique for repair of inguinal hernia. The performance of TEP usually requires a number of disposable instruments. The high cost of these devices has been a deterrent to development of laparoscopic surgery. Success in cost containment is pivotal to enhance a wider application of TEP and benefit more patients, particularly in public hospitals. The differences in the design and material of disposable and reusable instruments account for distinction in their handling and safety attributes. Replacement of disposable instruments by reusable ones sometimes requires modification of surgical techniques. Reusable instruments are economically advantageous, but they require sterilization. Wear and tear of these reusable tools after multiple procedures sometimes causes unexpected problems during operation. This chapter reviews the pros and cons of reusable and disposable instruments for performance of TEP. The selection of reusable or disposable instruments should balance the cost of the procedure, convenience of the operation theatre, safety of the patient, and experience of the surgeon. Instruments, whether reusable or disposable, should offer value for money.

Authors:

Hung Lau, M.D., M.S., F.R.A.C.S., F.A.C.S., University of Hong Kong Medical Center, Queen Mary Hospital & Tung Wah Hospital, Hong Kong SAR, China

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Abstract:

Traditionally, the inguinal hernia repair is performed through an incision in the groin. Different kinds of operations are suggested as best repairs by using the patient's own tissue, or use of prosthetic mesh to reinforce the abdominal wall. The advent of the laparoscopic repair that also uses prosthetic mesh, made it even more complex to determine the best repair. Using the Evidence Based Medicine (EBM) principles, endpoints of the treatment are not only based on recurrence rates, but also on complications, patient satisfaction, convalescence, and costs. Several meta-analyses concluded that use of mesh is superior to the non-mesh operations. More difficult to determine is which mesh repair, open or laparoscopically, is the best. The laparoscopic repair is difficult and less suitable for general practice, but the open-mesh repair results in a higher percentage of chronic postoperative pain. Further research should be focused on making the laparoscopic repair less complicated, and development of new meshes for open surgery that reduce the amount of persistent postoperative pain.

Authors:

P.M.N.Y.H. Go, M.D., Ph.D., St. Antonius Hospital, Niewegein, The Netherlands

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