Hernia : the journal of hernias and abdominal wall surgery
-
The technique for fixation of mesh has been attributed to adverse patient and surgical outcomes. Although this has been the subject of vigorous debate in laparoscopic hernia repair, the several methods of fixation in open, anterior inguinal hernia repair have seldom been reviewed. The aim of this systematic review was to determine whether there is any difference in patient-based (recurrence, post-operative pain, SSI, quality of life) or surgical outcomes (operative time, length of operative stay) with different fixation methods in open anterior inguinal hernioplasty. ⋯ There is insufficient evidence to promote fibrin sealant, self-fixing meshes or NB2C glues ahead of suture fixation. However, these products have been shown to be at least substantially equivalent, and moderate-quality RCTs have suggested that both fibrin sealant and NB2C glues may have a beneficial effect on reducing immediate post-operative pain and chronic pain in at-risk populations, such as younger active patients. It will ultimately be up to surgeons and health-care policy makers to decide whether based on the limited evidence these products represent a worthwhile cost for their patients.
-
Randomized Controlled Trial Comparative Study
Early report of a randomized comparative clinical trial of Strattice™ reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias.
Biologic grafts are rarely used for inguinal herniorrhaphy. The aim of this study was to compare the clinical outcomes between patients undergoing a Lichtenstein's hernioplasty with a porcine mesh versus a standard synthetic. ⋯ Strattice™ is safe and effective in repairing inguinal hernia, with comparable intra-operative and early postoperative morbidity to synthetic mesh. Long-term follow-up is necessary in order to know whether the clinical outcomes of Strattice are equivalent to standard synthetic mesh in patients undergoing Lichtenstein's hernioplasty.
-
Review Meta Analysis
Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials.
Laparoscopic total extraperitoneal (TEP) inguinal hernioplasty is significantly less painful than open repair, but it is not completely painless. Local anesthetics are thought to decrease postoperative pain when placed at the surgical site. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of extraperitoneal bupivacaine treatment during laparoscopic inguinal hernia repair for the reduction of postoperative pain. ⋯ Extraperitoneal bupivacaine treatment during laparoscopic TEP inguinal hernioplasty is not more efficacious for the reduction of postoperative pain than placebo.
-
Randomized Controlled Trial
An estimate of hernia prevalence in Sierra Leone from a nationwide community survey.
A large number of unrepaired inguinal hernias is expected in sub-Saharan Africa where late presentation often results in incarceration, strangulation, or giant scrotal hernias. However, no representative population-based data are available to quantify the prevalence of hernias. We present data on groin masses in Sierra Leone to estimate prevalence, barriers to care, and associated disability. ⋯ The results indicate groin masses represent a major burden for the male population in Sierra Leone. Improving access to surgical care for adult patients with hernias and early intervention for children will be vital to address the burden of disease and prevent complications or limitations of daily activity.
-
Randomized Controlled Trial Comparative Study
Lichtenstein technique for inguinal hernia repair using polypropylene mesh fixed with sutures vs. self-fixating polypropylene mesh: a prospective randomized comparative study.
Chronic postoperative pain is probably the most significant complication of tension-free inguinal hernia repair as its presence can considerably affect the life quality of the patient. Different mesh materials and different surgical techniques for mesh fixation have been applied to reduce chronic postoperative pain, with controversial, nevertheless, results. The aim of this prospective randomized study was to evaluate the effect of a relatively new mesh with self-fixating properties, used to repair inguinal hernia with the Lichtenstein technique, on early and chronic postoperative pain. ⋯ Self-fixating mesh can be safely and effectively used in inguinal hernia repair with the additional advantage of reducing the operative time compared to the classic Lichtenstein technique. However, its use is not accompanied by reduced rates in early or chronic postoperative pain.