laparoscopicinguinalherniarepair-110210095254-phpapp02

7/24/2019 laparoscopicinguinalherniarepair-110210095254-phpapp02

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LAPAROSCOPIC INGUINAL HERNIA REPAIR

George Ferzli, MD, FACS

Professor of Surgery, SUNY

Were !re "e i#


2/59

$ese !re %e &ues%io#s

"e !'e !lre!(y

!#s"ere()


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W!% !re %e i#(i*!%io#s for l!+!ros*o+i*

i#gui#!l er#i! re+!ir

Re*urre#% er#i! Avoids scar tissue

Visualizes occult hernia

-il!%er!l er#i!

Decreased pain

Earlier return to work

No difference in recurrence or complication

O.ese / A%le%i* +!%ie#%s

Definitive diagnosis

Reduced infection in susceptible population Gilmores groin

P!%ie#%s "i% *o#%r!l!%er!l i#0ury %o '!s (efere#s

!ess chance to in"ure other vas


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Are %ere *o#%r!i#(i*!%io#s %o l!+!ros*o+i*


Co#%r!i#(i*!%io#s #atients for whom general anesthesia and

pneumoperitoneum are risks $cardiac% pulmonar&

disease'

Rel!%i'e Co#%r!i#(i*!%io#s

#rior pre(peritoneal surger& $prostate% hernia% vascular%

kidne& transplant'

#rior laparotom&

Ascites

)trangulated hernia

Giant scrotal hernia

Anticipated bleeding $patients on anti(coagulation'


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Ho" (o re*urre#*e r!%es for o+e# !#(

l!+!ros*o+i* er#i! re+!ir *o1+!re

Refere#*e Ye!r P%s/R Hr#s Her#i! $e* RR

-!y2Nielso# *++, -./ !ap ,012

3%34* !icht ,0+2

.%5/5 6uscle repair *0/2

EU Her#i! *++* ,%1.5 !ap *0*2

$ri!lis% Coll!. ,%1,* 7pen ,0/2

Neu1!yer *++. 41* !ap ,+0,2

45. 7pen .032

3Higly e4+erie#*e(5 !ap 8-2

3Less %!# 6785 !ap 9,+2

No difference in rate of recurrence between laparoscopic and open

procedures forprimaryhernia repair.


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W!% is %e role of l!+!ros*o+y for

%re!%i#g re*urre#% i#gui#!l er#i!

!ess recurrence

!ess pain

Earlier return to activit&

No missed hernia


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W!% +er*e#%!ge of ! ge#er!l surgeo#9s

+r!*%i*e !re re*urre#% er#i!s

: Repair of recurrent hernia is a surrogate for actual recurrence rate0: ;he reoperation rate is not e


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Co#si(er 2 you !'e %o .e goo( !%

re+!iri#g re*urre#% i#gui#!l er#i!s

-isg!!r( *++4 Danish >ernia Database $1/%5+1 primar& repairs'

Recurrence rate of primar& inguinal hernia repair 50,2

Recurrence rate after recurrent inguinal hernia repair 4042

7ther studies demonstrate re(recurrence rates as high as 552

Indeed,specialt& centers show low recurrence rates for their

techni


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Re2re*urre#*e !f%er $APP for re*urre#*e


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$EP for re*urre#% i#gui#!l er#i!

Refere#*e Ye!r P%s R$ RRR

-!y2Nielso# *++, /4 ;E# ,052

,%13/ !icht 50*2

1.- 6uscle repair 10/2

?oui! *++3 .3 ;E# +0+2

#rospective randomized ./ !icht 10.2

#tsC patients@ R;C recurrent techni


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P!i# s*ore !f%er $APP for re*urre#%

i#gui#!l er#i!Refere#*e Ye!r $e*#i&ue No> of P!%ie#%s Me(i!# @AS

-ee%s ,333 ;A##?G#RV) .*?5/ *0*?*03 $p +0+-'

M!o# *++5 ;A##?!icht0 1+?1+ *04?.05 $p +0++5'

De(e1!(i *++1 ;A##?!icht0 *.?5* ,0+?*0+ $p +0++,'

E;lu#( *++/ ;A##?!icht0 /5?/. ,*- mm?,1- mm

$p +0+,3'

Neu1!yer *++. !ap0?!ich0 Differe#*e i# @AS

Da& of surger& ,+0* mm $favoring ;A##'

;wo weeks after surger& 10, mm $favoring ;A##'

;hree months after surger& No difference

VA)% visual analog of pain score@ ;A##% trans(abdominal pre(peritoneal repair@

G#RV)% giant prosthesis for reinforcement of visceral sac@ !icht0% !ichtenstein

repair@ !ap% laparoscop&


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P!i# s*ore !f%er $EP for i#gui#!l er#i!

Refere#*e Ye!r $e*#i&ue No> of P!%ie#%s Me(i!# @AS

-ri#g1!# *++5 ;E#?!icht?6esh(plug 3*?,+5?,+. ,?*?* $p +0++,'

E;lu#( *++/ ;E#?!icht 1/-?/+1 ,+-?,/- $p +0++,'

Cro#i* P!i#

?oui! *++3 ;E#?!icht ./?.3 .?,5 $p +0+*'

VA)C visual analog of pain score@ ;E#C totall& eBtra(peritoneal repair@

!ichtC !ichtenstein repairs


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Re%ur# %o regul!r !*%i'i%y !f%er $APP for

re*urre#% i#gui#!l er#i!

Refere#*e Ye!r $e*#i&ue Me(i!# (!ys %o re%ur# %o "or; / !*%i'i%y-ee%s ,333 ;A##?G#RV) ,5?*5 $p +0+5'

M!o# *++5 ;A##?!icht ,,?.* $p 8 +0++,'

Neu1!yer *++. !ap0?!icht0 .?- $ad"0 >R ,0*@ 3-2 F ,0, ( ,05'

De(e1!(i *++1 ;A##?!icht ,.?*+ $p +0++,'

E;lu#( *++/ ;A##?!icht 4?,1 $p +0++,'

;A##% trans(abdominal pre(peritoneal repair@ G#RV)% giant prosthesis for reinforcement

of visceral sac@ !icht0% !ichtenstein repair@ >R% hazard ratio@ F% confidence interval@ !ap%

laparoscop&


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Re%ur# %o regul!r !*%i'i%y !f%er $EP


Refere#*e Ye!r $e*#i&ue Me(i!# (!ys %o re%ur# %o "or; /!*%i'i%y

-ri#g1!# *++5 ;E#?!icht?6esh(plug ,.?*-?*3 $p 8 +0+++,'

E;lu#( *++/ ;E#?!icht /?,* $p 8+0++,'

?oui! *++3 ;E#?!icht ,-?,4 $p +0+-'

;E#% totall& eBtra(peritoneal repair@ !icht0% !ichtenstein repair


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rawford found an incidence of 42 occult femoral hernia at laparoscopic repair%

and eliB found 32 concurrent femoral hernia0

Feli4,331 Re*urre#% Pri1!ry

n ,-* patients emoral 32 .2

n ,/5 recurrent hernias #antaloon *-2 ,.2

hans series of **- repairs of femoral hernia repairs demonstrated -+032 had

concurrent Fnguinal hernia

-042 had bilateral femoral hernia and ,40*2 had prior groin hernia repair0

han believes prior inguinal hernia repair ma& precipitate a femoral hernia $,- B

higher according to 6ikklesen etal'0

-isg!!r( *++4 Re+!ir %y+e Fe1or!l re*ur> Re2re*urre#*eR!%e

n *%,,/ re(operations Endoscopic rep0 n 5. +0++2

7pen repair n ,1, 40+/2

;A## allows full visualization of the floor and avoids missed concomitant

ipsilateral or contralateral hernias0

No 1isse( er#i! !f%er $APP/$EP for

re*urre#% er#i!


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No 1isse( er#i! ernia Register

: ,%.3+ men% *%.3+ women

: 5-032 $n ,%.5+' underwent emergenc& surger& versus .032 of

inguinal hernia repair

: Howel resection ( **0/2 of emergent femoral repair versus -0.2

of emergent inguinal repair

: Iomen at higher risk than men $.+012 versus *40,2'

: 6ortalit& ,+ times greater versus elective repair

Dahlstrand et al0Ann Surg*++3


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,0 Ihat is the role of ;A##?;E#after ;A##?;E#J

ues%io#s re1!i#i#g i# 688B


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S%u(y Pri1!ry Re+!ir Re*ur> Re+!ir $e*> Re2re*urre#*e Follo" u+?#oo;,333 Various !ap0 ;A## +0+2 5- monthsReview $n 5.';hree institutionsn 5. patientsn 5. recurrent hernias;A## is a reliable techni


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S%u(y Pri1!ry Re+!ir Re*ur> Re+!ir $e*> Re2re*urre#*e Follo" u+

?ei(er*++* ;A## ? ;E# ;A## ? ;E# +0+2 5/ months

Review $n 5'

)ingle institution

n 5 re(operations b& laparoscop& after / re(recurrences after laparoscop&

!aparoscopic recurrent hernia repair is effective and superior to historical series0 Ft should be the method ofchoice if cost could be

reduced0

-i%%#er*++/ ;A## ;A## +0/.2 NA

Review $n ,5-'

)ingle institution

n ,5- recurrent hernias

;A## can be performed for recurrent inguinal hernia after ;A## with low recurrence rate% but the learningcurve is high0

-isg!!r(*++4 !aparoscopic ;A## $K?( 3-2' $n ,.' /0,2 NA

Review of prospective $n ,++' !ichtenstein $n /5' *0/2Danish hernia registr& Nonmesh $n 4' +0+2

n 1/%5+1 primar& repairs 6esh $non(!icht0' $n -' +0+2

n ,++ recurrent hernias after lap0

!aparoscopic repair is recommended for reoperation of a recurrence after primar& !ichtenstein repair0

;rend favors laparoscopic repair of recurrence after non(mesh and non(!ichtenstein mesh primar& repair0

!aparoscopic repair of recurrence after laparoscopic primar& repair shows no advantage in terms of

re(recurrence0

$APP/$EP !f%er Re*urre#*e of $APP/$EPHer#i! Re+!ir


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TAPP after

prperit.mesh-rep.

n = 13!

op-time "median#min.$ %

morbidit& '#1 (

reop.-rate )#) (

rec.-rate *#%+ (

return to wor, "med#d$ 1%

age "median$ ")-*$

/0 "median$ )

/arienhospital Stuttgart 0 2 3 400 2 * resultsresults

Laparoscopic Hernia Repair (TAPP)

*own recurrences n=73 from outside n=62


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n 5Prof6! 1-+51-)*6! +7-*5)1-+*6! 1-135+1-76!

(6/93-12/98) (12/98-02/02) 52/02-11/05)

op-time Lmedian%min0M$Prof.6! ')# 5'%#6! %1 5'6! %% 5%#6!

morbidit& 1+( ' ( )(

reop.-rate )#)( )#)( )#) (

rec.-rate - - )#) (

return to wor,"med.#d$ 1' 1% 1%

8esults8esults 5n=1365n=136"9learning cur:e;$"9learning cur:e;$

TAPP after preperitoneal mesh repair

/arienhospital Stuttgart 0 23 400 2 *


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*0 Do we have an answer for

groin pain after hernia repairJ


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Ner'es +ro#e %o i#0ury !% er#iorr!+y)

!#%erior !#( +os%erior


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Author of #ts#ainO #ain )evere 7utcome of #ain

A0 )0 #oobalan *++, **1 5+2 9 5 mo

6orten Ha&(Nielsen *++, ,,11 *40/2 9 &ear 52

)0 Pumar *++* .-. 5+2 9*, mo

0 A0 ourtne& *++* .+1* 9 5 mo 52 9 *0- &rs /,2 have pain)evere in **26ild in .-2

/arcello Picchio )**+ -35 *-2 9 , &r 129, &r A0 60 Grant *++. 3*4 30/29, &r ,042 9 - &rs

Qrg Pninger *++. *+4 512 $)houldice'5,2 $!ichtenstein',-2 $;A##'9 -* mo


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u!li%y of lifeAuthor #ts #ain affects the


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C!uses !#( ris; f!*%ors of groi# +!i#A#!%o1i*!l

@!ri!%io#

Fnnervation s&mmetr& ( .+012

Normal distribution ( *+052SNormalT anatomic pattern ( -1052

Mes re+!ir No clear correlation between use of mesh and chronic pain

Age )tudies disagree on correlation between older age and post(herniorrhaph& pain

Pre2o+er!%i'e +!i# #ain associated with hernia before repair is associated withpost(operative pain

-MI No correlation found between elevated H6F and post(operative pain

Pos%2o+er!%i'e*o1+li*!%io#s

#ostoperative complications linked to an increased risk forlong term pain

Re*urre#% er#i!

D!y *!se surgery

O+e# 'ersusl!+!ros*o+i*

Recurrence associated with recurrent pain

;he probabilit& of developing chronic pain is *0- timeshigher in da&(case patients% controlling for age

7pen repair strongl& correlated with post(operative paincompared to laparoscopic repair


27/59

$y+es of +os%2o+er!%i'e groi# +!i#

Neuro+!%i*

:#erineural fibrosis:Neuroma:Nerve entrapment:Direct lesions due to stretching

contusion%electrical in"ur&%

and partial or complete division

No#2

#euro+!%i*

:7steitis pubis:)tapalgia:6eshalgia

@is*er!l:)permatic cord problems:7rchitis:Vas deferens issues


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No#2surgi*!l 1!#!ge1e#%

Non(operative attempts at pain resolution includeC: Hiofeedback

: 6edications

: #h&sical therap&

: #ercutaneous treatment with local anesthetics% steroids%

phenol% alcohol% cr&oprobes% radiofre


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Surgi*!l 1!#!ge1e#%)

1es/s%!+le re1o'!l

)urgical treatment for periosteal reaction or osteitis pubis consists ofremoving suture materials% staples% bulk& suture knots% and?or bulk

forming or rolled mesh material from the pubic tubercle area0

uses preention nd sur"ic! mn"ement of post#erniorr#p# neuropt#ic in"uidni+

.rip!e neurectom wit# proim! end imp!nttion$ &mid $ Hernia 2004 8+ 343349$


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Surgi*!l 1!#!ge1e#%) #eure*%o1yAuthor of #ts EBcellent

relief

#artial relief #oor

result

!&on ,3.* 1 452

6agee ,3.- - ,++2

)tarling ,34/ 5+ 452

ath& > !ee*+++ -. 142FF /42

F> 452

G -+2

,+2,,2

,/2

*-2

Amid #P *++. **- 4+2 ,-2 -2

Qames A06adura *++-

Aasvang *++3

,++

*,

/*2

1*2

*-2

*.2

$no change'

52

,.2


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Surgi*!l 1!#!ge1e#%) 1es re1o'!l,

#eure*%o1y !#( er#i! re+!ir;he laparoscopic approachC

Diagnostic

Definitive hernia repair in unaltered tissues

Anterior approachC

Removal of the offending foreign bod&Appropriate nerve resection

*, pts !icht $n,*'% 6cVa& $n,'% plug ? patch $n*'% )houldice $n,'% !ap $n1'

1 weeks ?=% *+?*, pts were significantl& improved

$5 pts had persistent numbness in the ilioinguinal nerve distributionbut remained satisfied with the procedure0'

Keller JE, Stefanidiis D, Dolce CJ, Ianitti DA, Kercher KW, Heniford TB. Combined open and

laparoscopic approach to chronic pain following open inguinal hernia repair. 2008 Amer Surg74:

695-701


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+ro+yl!*%i* #eure*%o1yAuthor of #ts #ain $Neurectom& vs

Non(neurectom&'

#aresthesia

Ravichandran

*+++

*+bilateral

+2 vs -2 ,+2 vs +2

6arcello #icchio*++.

.+4

vs .+-

6ildC *,2 vs ,42

6oderateC 52 vs .2

)evereC 52 vs *2

p +0--p +0--

Numbness .2 vs 12

p +053

!oss of touch sensation

,,2 vs .2 p +0++*

!oss of pain sensation

32 vs 42 p +043

DE ;saka&annis*++.

,3, + Numbness 10*42

)ensor& !oss ,0+.2

George IDittrick *++.

11

vs *.

1 mos052 vs *12 $p+0++,'

, &r 52 vs *-2 $p +0++5'

,42 vs0 .2 $p +0,+'

,52 vs0 -2 $p +05*'

Iilfred !ik(6an6ui *++1

-+

vs -+

42 vs *4012 $p +0++4' .* vs .*03 $# +035,'


33/59


#er'e i(e#%ifi*!%io#

: Fdentification and preservation of nerves during open inguinal hernia repair

reduce chronic incapacitating groin pain0

: hronic pain at 1 months after surger& was zero in those patients in whom all 5

nerves were identified and preserved% compared with the .+2 incidence when

these nerves were all divided% or .0/2 when not all nerves were identified0

%nf!uence of resertion ersus iision of %!ioin"uin! %!io#po"stric nd Genit! eres urin" pen es#:erniorr#p#Prospective Multicentric Study of Chronic Pain Sergio Alfieri, MD, Ann Surg &pri!2006 243+ 553558

NervesnotFDed

=AO

RR 3-2F #

6VOO

RR 3-2F #

, +03 +0*50. N) *0* +0**10. +0-53

* *0, +0140, N) ,*0. ,05,,-05 +0+*/

5 504 ,0*,,0. +0+,3 ,30* *05,-/0/ +0++1

* ;nirite &n!sis+


34/59

50 Ihat is the role of laparoscop&

in the compleB inguinal herniaJ

: )crotal hernia

Fncarcerated

)trangulated herniaC in the setting ofperitonitis and bowel necrosis


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resultsresults

"/arienhospital Stuttgart Apr> 3 ?e@> *%$

Oeigene RezidiveC n3* eBtern voropC n/+

#> $without preop0'

last *+++

.+

,%/2

+%52

+%,2

,+

-+ L,/(,++M

*-

#>

n,5,51

.+

*%42

+%.2

+%/2

,.

1+ L,/(3/M

*-

scrotal hernia

n4+/

1+

.%.2

+%4-2

*%52

,/

1,$,4(3/'

*-

post0 repair

n,1*O

/-

/%+2

5%42

+%12

,/

-3 L*3(3+M

*-

n

op(timeLmed0%min0M

morbidit&

reop0(rate

rec0(rate

out of work Lmed0%da&s

ageL6edianM

H6FL6edianM

TAPP Marienhospital Stuttgart, 3 / 1993 12 / 2007


36/59

W!% Are %e Re*o11e#(!%io#s for

L!+!ros*o+i* M!#!ge1e#% of Co1+le4 Her#i!s

Co1+le4

Her#i! $y+e

M!#!ge1e#% Re*o11e#(!%io#s Le'el of

E'i(e#*e


37/59

Co#*lusio#s)

: !aparoscopic inguinal hernia repair in

*++3 is feasible for primar&% bilateral and

recurrent hernias0

: ;he main challenge remains the learning

curve0

: A thorough knowledge of the anatom& is

of utmost importance0


38/59


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Refere#*es

,' 6ahon D% Decadt 6% Rhodes 60 #rospective randomized trial of laparoscopic $transabdominal

preperitoneal' vs open $mesh' repair for bilateral and recurrent inguinal hernia0 Surg ndosc*++5@,/C,5413+

*' eliu U% Qaurrieta E% Vinas U% et al0 Recurrent inguinal herniaC a ten &ear review0 B Caparoendosc Ad: Surg

Tech A*++.@,.C51*/

5' Eklund A% Rudberg % !ei"onmarck E% et al0 Recurrent inguinal herniaC randomized multicenter trial

comparing laparoscopic and !ichtenstein repair0 Surg ndosc*++/@*,C15..+

.' )arli !% Fusco D% )ansebastiano G% et al0 )imultaneous repair of bilateral inguinal herniasC a prospective

randomized stud& of open% tension(free versus laparoscopic approach0 Surg Caparosc ndosc Percutan

Tech*++,@,,C*1*/

-' Ha&(Nielson 6% Pehlet >% )trand !% 6almstrom Q% Andersen >% Iara #% Quul #% allesen ;0 ualit&

assessment of *1 5+. herniorrhaphies in DenmarkC a prospective nationwide stud&0 Cancet$*++,' 5-4C

,,*.(,,*4

1' E= >ernia ;rialists ollaboration0 Repair of groin hernia with s&nthetic mesh% meta(anal&sis of

randomized controlled trials0Ann Surg*++*@*5-C5**5*

/' Neuma&er !% et al0 7pen mesh versus laparoscopic mesh repair of inguinal hernia0 New ng B /ed

$*++.' 5-+$,4'C ,4,3(,4*/

4' Peller QE% )tefanidiis D% Dolce Q% Fanitti DA% Percher PI% >eniford ;H0 ombined open and laparoscopic

approach to chronic pain following open inguinal hernia repair0 *++4Amer Surg/.C13-(/+,


40/59

Refere#*es

30 Hisgaard ;% et al0 Re(recurrence after operation for recurrent inguinal hernia0 A nationwide 4(&ear follow(upstud& on the role of t&pe of repair0Ann Surg% *++4% *./$.'C/+/(/,,

,+0 Ha&(Nielson 6% Pehlet >% )trand !% 6almstrom Q% Andersen >% Iara #% Quul #% allesen ;0 ualit&assessment of *1 5+. herniorrhaphies in DenmarkC a prospective nationwide stud&0Cancet $*++,' 5-4C ,,*.(,,*4

,,0 >aapaniemi )% et al0 Reoperation After Recurrent Groin >ernia RepairAnn Surg$*++,'% *5.$,'C ,**,*1

,*0 Nilsson E% et al0 6ethods of repair and risk for reoperation in )wedish hernia surger& from ,33* to ,3310 rit BSurg$,334'% 4-C ,141,13,

,50 Amid #P% )hulman AG% !ichtenstein% F!0 7penStension(freeT repair of inguinal herniasC the !ichtensteintechni


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*+' eliB E!% et al0 !aparoscopic repair of recurrent hernia0Amer B Surg$,331' ,/*C -4+(-4.

*,' Qarhult Q% et al0 !aparoscopic treatment of recurrent inguinal herniasC EBperience from *4, operations0 SurgCaparosc# ndosc E Perc Tech$,333' 3$*'C,,-(,,4

**' 6emon 6A% et al0 !aparoscopic repair of recurrent hernias0 Surg ndosc$,333' ,5C 4+/4,+

*5' Ramshaw H% et al0 !aparoscopic inguinal hernia repairC !essons learned after ,%**. consecutive cases0 Surgndosc$*++,' ,-C -+(-.

*.' >awasli A% et al0 !aparoscopic transabdominal preperitoneal inguinal hernia repair for recurrent inguinal hernia0Am Surg$*++*' 14C 5+5(5+4

*-' Peider A% et al0 !aparoscopic repair of recurrent inguinal herniaC !ong(term follow up0 Surg ndosc$*++*' ,1C,/+4(,/,*

*1' Iara #% et al0 #rospective nationwide anal&sis of laparoscopic versus !ichtenstein repair of inguinal hernia0 rit BSurg$*++-' 3*C ,*//(,*4,

*/' HWkeler =% et al0 ;A##C An ideal techniernia@ #revention and ;reatment VFFF *105@ >ow to treat recurrent inguinalhernia ;A##

5+' Pnook 6;% et al0 !aparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaph&0 ,333% ,5C

,,.-(,,./

Refere#*es


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5,' !iebl H% et al0 Recurrence after endoscopic transperitoneal hernia repair $;A##'C auses% reparative

techniuttunen )% )ilvasti)% >eiskanen Q% Ahtola >% =otila(Nieminen 6% Piviniemi V% >akala ; !ichtenstein

hernioplast& versus totall& eBtraperitoneal laparoscopic hernioplast& in treatment of recurrent inguinal herniaX

A prospective randomized trial0 *++3 Ann Surg*.3C 54.(54/

55' eliu U% ;orres G% Vinas U% 6artinez(Rodenas % ernandez()allent E% #ie Q0 #reperitoneal repair for recurrentinguinal herniaC laparoscopic and open approach0 >ernia0 $*++.' 4$*'C ,,5(1

5.' Pnook 6;;% Ieidema I% )tassen !#)% van )teensel Q0 Endoscopic total eBtraperitoneal repair of primar&and recurrent inguinal hernias0 Surg ndosc$,333' ,5C -+/-,,

5-' )a&ad #% erzli G0 !aparoscopic preperitoneal repair of recurrent inguinal hernias0 B Caparoendosc Ad: SurgTech A0 $,333' 3$*'C ,*/(5+0

51' Aeberhard #% Plaiber % 6e&enberg A% 7sterwalder A% ;schudi Q0 #rospective audit of laparoscopic totall&eBtraperitoneal inguinal hernia repair ( A multicenter stud& of the )wiss Association for !aparoscopic and;horacoscopic )urger& $)A!;'0 Surg ndosc$,333' ,5C ,,,-,,*+

5/' )taarink 6% van Veen RN% >op I% Ieidema I0 A ,+(&ear follow(up stud& on endoscopic totaleBtraperitoneal repair of primar& and recurrent inguinal hernia0 Surg ndosc0 $*++4' **$4'C ,4+5(1

54' van der >em QA% >amming Q% 6eeuwis QD% 7ostvogel >Q0 ;otall& eBtraperitoneal endoscopic repair ofrecurrent inguinal hernia0 r B Surg.$*++,' 44$1'C 44.(1

53' Ramshaw HQ% ;ucker QG% Duncan ;D% >eithold D% Garcha F% 6ason E6% Iilson Q#% !ucas GI0 ;echnicalconsiderations of the different approaches to laparoscopic herniorrhaph&C an anal&sis of -++ cases0 Am Surg.5,331' 1*$,'C 13(/*0

.+' eliB E!% 6ichas A% 6cPnight R!0 !aparoscopic repair of recurrent hernias0 Surg ndosc.$,33-' 3$*'C ,5-(4

Refere#*es


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.,' ;hill V% )imeons % )mets D% Ngongang % da osta #60 !ong(term results of a non(ramdomized prospectivemono(centre stud& of ,+++ laparoscopic totall& eBtraperitoneal hernia repairs0Acta Dhir elg.$*++4' ,+4$.'C

.+-(4

.*' Alani A% Duff& % 7Dw&er #Q0 !aparoscopic or open preperitoneal repair in the management of recurrent groinhernias0 Fernia $*++1' ,+$*'C ,-1(4

.5' Hingener Q% Dorman Q#% Valdes G0 Recurrence rate after laparoscopic repair of recurrent inguinal herniasC havewe improvedJ Surg ndosc.$*++5' ,/$,,'C ,/4,(5

..' eliu U% Qaurrieta E% Vinas U% 6acarulla E% Abad Q6% ernandez()allent E0 Recurrent inguinal herniaC a ten(

&ear review0 B Caparoendosc Ad: Surg Tech A.$*++.' ,.$1'C 51*(/

.-' rankum E% Ramshaw HQ% Ihite Q% Duncan ;D% Iilson RA% 6ason E6% !ucas G% #romes Q0 !aparoscopicrepair of bilateral and recurrent hernias0Am Surg.$,333' )ep@1-$3'C 453(.*

.1' Harrat % )urlin V% Hordea A% hampault G0 6anagement of recurrent inguinal herniasC a prospective stud& of,15 cases0 Fernia$*++5' /$5'C ,*-(3

./' Hringman )% Ramel )% >eikkinen ;Q% Englund ;% Iestman H% Anderberg H0 ;ension(free inguinal hernia repairC;E# versus mesh(plug versus !ichtensteinC a prospective randomized controlled trial0 Ann Surg*++5

Qan@*5/$,'C ,.*(/

.4' 6cormack P% )cott NI% Go #6% Ross )% Grant A6@ E= >ernia ;rialists ollaboration0 !aparoscopictechni


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-,' #alanivelu % Rangara"an 6% Qohn )Q0 6odified techniaraguchiY0 !aparoscopic approach to incarcerated inguinal

hernia0 Surg ndosc$,331' ,+C ,,,,,,,5

--' !egnani G!% Rasini 6% #astori )% )arli D0 !aparoscopic trans(peritoneal hernioplast& $;A##' for the acutemanagement of strangulated inguino(crural herniasC a report of nine cases0 Fernia $*++4' ,*C ,4-(,44

-1' )cierski A0 !aparoscopic operations of incarcerated inguinal and femoral hernias0 Giad Ce,$*++.' -/$-(1'C *.-(*.4

-/' erzli G% )hapiro P% haudr& G% #atel )0 !aparoscopic eBtraperitoneal approach to acutel& incarceratedinguinal hernia0 Surg ndosc$*++.' ,4$*'C**4(5,

-4' ;amme % )cheidbach >% >ampe % )chneider % PWckerling 0 ;otall& eBtraperitoneal endoscopic inguinalhernia repair $;E#'0 Surg ndosc$*++5' ,/$*'C ,3+(,3-

-3' Aasvang EP% Pehlet >0 ;he effect of mesh removal and selective neurectom& on persistent postherniotom&pain0Ann Surg *++3@*.3C5*/(5.

1+' !au >% #atil N% Yuen I0 Da&(case endoscopic totall& eBtraperitoneal inguinal hernioplast& versus open

!ichtenstein hernioplast& for unilateral primar& inguinal hernia in males Surg ndosc$*++1' *+C /14,

Refere#*es


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1,' Eklund A% Rudberg A% )medberg % Enander !P% !ei"onmark E% 7sterberg% Q0 )hort(term results of a

randomized clinical trial comparing !ichtenstein open repair with totall& eBtraperitoneal laparoscopicinguinal hernia repair r B Surg*++1 )ep@35$3'C,+1+(4

1*' Dahlstrand% =% Iollert )% Nordin% #0 Emergenc& femoral hernia repair a stud& based on a national

register 0Ann Surg*.3@ 54.(54/

Refere#*es


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$APP !f%er $APP Her#i! re2re*urre#*e

Refere#*e Ye!r P%s/R Hr#s P$ R$ P%s or Hr#s= RRR

?#oo; ,333 5.?5. !ap0 ;A## $5.' +0+

Lie.l *+++ ..?.1 ;A## ;A## $..'% ;E# $*' +0+

-i%%#er *++/ NA?,5- ;A## ;A## $,5-' +0/.

-isg!!r( *++4 NA?,++ !ap0 !ap $,.@ 3-2 ;A##' /0,

!icht0 $/5' *0/2

Nonmesh $4' +

6esh $non(!icht0' $-' +

#ts% patients@ R >rns% recurrent hernias@ #;% primar& techni


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$APP !#( $EP for i#*!r*er!%e(

fe1or!l er#i!

Fncarcerated femoral hernia can be repaired b& ;A## or ;E#

but literature has been limited to case reports

$APP for i#*!r*er!%e( fe1or!l er#i!

Iatson $n ,'

Yau $n 4'

omman $n ,'

Rebuffat $n /'

$EP for i#*!r*er!%e( fe1or!l er#i!

erzli $n ,'


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Co1.i#e( l!+!ros*o+i* !#( o+e# %re!%1e#%


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S!#(.il*er ,331 A#%erior


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-ee%s,333 A#%erior = $APP $n -1' ,*0-2

5. months

Randomized controlled trial GPR@S $n -*' ,032

n /3 patients

n 35 recurrent hernias

n ,- concomitant primar& hernias

!aparoscopic recurrent hernia repair has lower morbidit& vs0 G#RV) but is difficult and has higher recurrence rate0

Me1o# ,333 A#%erior = L!+!roso+i*

*/ months

Review $APP $n 14' *03. 2;hree institutions $EP $n 4' +

n 4- patients IPOM $n ,3 ' ,+0-52

n 31 recurrent hernias U#;#o"# $n ,' +

!aparoscopic recurrent hernia repair is safe% with acceptable recurrence and complication rates0

H!!+!#ie1i*++, A#%erior = L!+>


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S%u(y Pri1!ry Re+!ir Re*ur> Re+!ir $e*#> Re2re*urre#*e Follo" u+

-!y2Nielso# *++, @!rious $APP $n -1+' *032 NA

Review of prospective $EP $n /4' ,052

Danish >ernia Registr& Mus*le re+!ir $n 1.-' 10/2

n patient total not provided Li*%e#s%ei# $n ,%13/' 50*2

n 5%3.5 recurrent hernias Plug $n *,*' 5042

Plug !#( +!%* $n 5-4' 5012

O%er 1es$n 535' -012

6esh repairs have lower reoperation rates than conventional open repair0

H!"!sli *++* A#%erior = $APP $screen and plug' +0/2 - &ears

Review

)ingle institution

n ,*+ patients

n ,5- recurrent hernias

Recurrent hernia rate is high0 ;hese patients have a tendenc& toward contralateral hernia0 6ost recurrences

occur after ,+ &ears0 ;A## is a good repair for recurrent inguinal hernia

?ei(er *++* A#%erior $APP$n ,,-'% -0/2 5/ monthsReview $EP$n ,-'

)ingle institution

n ,5+ patients

n ,-+ recurrent hernia

!aparoscopic recurrent hernia repair is effective and superior to historical series it should be the method of

choice if cost could be reduced0

Re*urre#*e !f%er $APP/$EP for Prior Her#i! Re+!ir Re*urre#*e


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S%u(y Pri1!ry Re+!ir Re*urre#% Re+!ir $e*#i&ue Re2re*urre#*e Follo" u+

M!o# *++5 A#%erior = $APP $n 1+' 101/2 5 months

Randomized Li*%e#s%ei# $n 1+' ,01/2

#rospective

)ingle institution

n ,*+ patients

n .* recurrent% /, bilateral and / both bilateral and recurrent hernias

;A## is beneficial% in terms of pain and return to work% for patients undergoing bilateral or recurrent hernia

repair0

Neu1!yer*++. A#%erior


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S%u(y Pri1!ry Re+!ir Re*ur> Re+!ir $e*#> Re2re*urre#*e

Follo" u+

De(e1!(i*++1 A#%erior = $APP $n *.' 405525 &ears

#rospective $EP $n *1' /0132

Randomized Li*%e#s%ei# $n 5*' ,-0152

n 4* patients

n 4* recurrent hernias

!aparoscopic hernia repair is the method of choice for recurrent inguinal hernia0

E;lu#(*++/ A#%erior = $APP $n /5' ,10..2

- &ears#rospective Li*%e#s%ei# $n /.' ,10*52

Randomized

6ulti(center

n ,./ patients

n ,./ recurrent hernias

!aparoscopic hernia repair has the short term advantage of less post(op pain and shorter sick leave0

-o;eler *++4 A#%erior = $APP +01+2NA

Retrospective

)ingle institution

n ,%143 patients

n ,%/-- recurrent hernias

!aparoscopic hernia repair should be the SGold standardT in the treatment of recurrent hernias after anterior repair% but it is

essential to gain eBperience b& using the laparoscopic techni


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S%u(y Pri1!ry Re+!ir Re*urre#% Re+!ir $e*#i&ue Re2re*urre#*e Follo" u+

-isg!!r(*++4 Li*%e#s%ei# $APP$approB0 3-2' $n 544' ,052 NA

Review of prospective Li*%e#s%ei#$n 5..' ,,052

Danish hernia registr& No#1es$n ,34' ,30*2

n patient total not provided Mes$non(!ichtenstein' $n ,3.' /0*2

n ,%,*. recurrent hernias

!aparoscopic repair is recommended for reoperation of recurrence after primar& open !ichtenstein repair0 ;rend favors laparoscopic repair of

recurrence after non(mesh and non(!ichtenstein mesh primar& repair0 !aparoscopic repair of recurrence after laparoscopic primar& repair shows

no advantage in terms of re(recurrence0

$!#%i!*++4 Anterior $not sp0' ;A## $n 5/'% ;E# $n *4' +01-2 51 months

#rospective)ingle institution

n 1, patients

n 1- recurrent hernias

!aparoscopic repair of recurrent inguinal hernia is safe and effective with low morbidit& and recurrence and should be the gold standard forthese

hernias0

?oui! *++3 .3 ;E#+0+2

#rospective randomized ./ !icht - &ears

10.2

#tsC patients@ R;C recurrent techni


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Pos%2o+er!%i'e +!i# !f%er $APP/$EP for re*urre#% er#i!

S%u(y Re+!ir $e*#i&ue Me(i!# @isu!l A#!logof P!i# S*ore


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S%u(y Re+!ir $e*#i&ue Me(i!# @AS

De(e1!(i *++1

Da& of )urger& $APP $n *.' . p +0++.

Li*%e#s%ei#$n 5*' -

*. hrs after surger& $APP , p +0++,

Li*%e#s%ei# .

/ da&s after surger& $APP , p +0++, Li*%e#s%ei# *

A#!lgesi! use Me!# !#!lgesi! use$APP ,03 da&s p +0++,

Li*%e#s%ei# 50* da&s p +0++,

E;lu#(*++/ Me(i!# @AS

#ain at , week after surger& $APP $n /5' ,*- mm p +0+,3 Li*%e#s%ei# $n /.' ,1- mm p +0++,

6edian analgesia consumption decreased with ;A## vs !ichtenstein

;he short term advantage for patients who undergo laparoscopic repair is less postoperative pain0

Pos%2o+er!%i'e +!i# !f%er $APP/$EP for re*urre#% er#i!


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Re%ur# %o "or; !f%er $APP/$EP for re*urre#% er#i!

S%u(y Me(i!# Re%ur# %o Wor; / D!ily A*%i'i%ies

-ee%s ,333 $APP ,5 da&s $p +0+5'

GPR@S *5 da&s

M!o# *++5 $APP ,, da&s $p 8 +0++,'

Li*%e#s%ei# .* da&s

Neu1!yer*++. L!+!ros*o+y . da&s $ad"usted hazard ratio ,0*@ 3-2 F% ,0,(,05' Li*%e#s%ei# - da&s

De(e1!(i *++1 $APP ,. da&s $p +0++,'

Li*%e#s%ei# *+ da&s

E;lu#(*++/ $APP 4 da&s $p+0++,'

Li*%e#s%ei# ,1 da&s

;rend increased with increased occupational eBertion $p +0++,'

;he short term advantage for patients who undergo laparoscopic repair is shorter sick leave0


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$APP !#( $EP for s*ro%!l er#i!

!aparoscopic repair of the scrotal hernia is controversial and the literature on

the sub"ect is scarce0 ,331 ( erzli described laparoscop& for scrotal hernia in ,/ patients0

=tilized ;E#0 No recurrences0 ,

,333 !iebl addressed sub"ect of ;A## for scrotal hernia0

,3, prospectivel& studied ;A## repairs for scrotal hernias0

)ac rarel& transected0

7perative times slightl& increased vs0 normal ;A## repair0

6inor complication rateC

,*2 for scrotal vs0 -2 for routine ;A## repair0

6ost common complicationC seroma0

6a"or complication rateC ,012 for scrotal vs0 +012 for routine repair0

Recurrence rate was ,20*

#alanivelu also presented a small series of patients using ;A## to repair

irreducible scrotal hernias with good results0 5

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