[Total endoscopic pre-peritoneal mesh implant in primary or recurrent inguinal hernias]. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study Outcomes of Lichtenstein Hernioplasty for Primary and Recurrent Inguinal Hernia A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: long-term chronic pain at 10 years. Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach A randomized prospective trial comparing clinical outcomes 3 years after surgery by Marcy repair and Prolene Hernia System® repair for adult indirect inguinal hernia 
Totally extraperitoneal repair of recurrent inguinal hernia
 Longterm results of a prospective study of 225 femoral hernia repairs: indications for tissue and mesh repair. [Tension-free laparoscopic versus open inguinal hernia repair]. Low reoperation rates in young males after sutured repair of indirect inguinal hernia: Arguments for a tailored approach.
INTRODUCTION Since 1994 we perform laparoscopic total extraperitoneal hernia repair ( TEP ) for primary and recurrent inguinal hernias at our institution . The aim of this study was to investigate and compare the results of TEP in primary inguinal hernias and recurrent inguinal hernias and to determine whether there are differences in patient data , complication rates and outcome between these two groups . METHODS In a prospect i ve trial 338 patients were analyzed who underwent 500 laparoscopic TEP repairs .  In all , 431 TEP repairs were performed for primary inguinal hernias , and 69 for recurrent inguinal hernias . For data acquisition the SALTC study protocol was used . All patients were clinical ly examined 3 and 12 months after the operation . RESULTS The mean operation time was 67.3 min for TEP repair of primary hernias and 68.1 min for TEP repair of recurrent hernias , respectively . The conversion rate to an open procedure was 0 % . Conversion from TEP into TAPP was required in 0.5 % of patients with primary inguinal hernias and 1.4 % of patients with recurrent inguinal hernias . As the sole difference between the two groups the intraoperative complication rate could be identified . In the TEP repair group of recurrent inguinal hernias a higher incidence of injury to the peritoneum and a higher occurrence of bleeding from the epigastric vessels was found ( P = 0.03 ) . The postoperative complication rate was identical in the two groups , amounting to 5.1 % and 5.7 % , respectively . No differences were found in the 1 year follow-up between the two groups . The 1-year recurrence rate was 0.5 % for primary hernias . However , in the group of recurrent hernias there have been no recurrences to date . CONCLUSIONS The use of laparoscopic TEP repair has proven to be a safe and effective treatment in patients with primary and recurrent inguinal hernias . Because of scar tissue with possible adhesions a higher intraoperative complication rate was observed in the TEP repair of recurrent hernias than in TEP repair of primary inguinal hernias . However , no single recurrence was observed in the TEP repair group of recurrent hernias . In our opinion TEP is the optimal hernia repair for recurrent and bilateral inguinal hernias Background During totally extraperitoneal ( TEP ) endoscopic repair of inguinal hernias , it is possible to see the internal opening of the femoral canal . The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair .  Method This was a retrospective review of prospect ively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period , May 2005 to May 2010 . During surgery , both inguinal and femoral canal orifices were routinely inspected . The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly . Results There were a total of 362 patients . More males ( 343 , 95 % ) underwent a TEP hernia repair than females ( 19 , 5 % ) . There were more cases of unilateral ( 240/362 , 66 % ) than bilateral ( 122/362 , 34 % ) inguinal hernias . A total of 18 cases of synchronous femoral hernias were found during operation . There was a higher incidence of femoral hernia in females ( 7/19 , 37 % ) compared to males ( 11/343 , 3 % ) ( P < 0.001 ) . None of the femoral hernias were clinical ly detectable preoperatively . Conclusion Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males . We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal . TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery Background The current prospect i ve r and omized controlled clinical study aim ed to assess the short- and long-term results of recurrent inguinal hernia repair , and to compare the results for transabdominal preperitoneal ( TAPP ) and totally extraperitoneal ( TEP ) procedures with those for open tension-free repair . Methods For this study , 82 patients were r and omly assigned to undergo TAPP ( group A , n = 24 ) , TEP ( group B , n = 26 ) , or open Lichtenstein hernioplasty ( group C , n = 32 ) . All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures . Physical examination showed  Nyhus type II hernia in the vast majority of the patients ( 59 % ) . High-risk patients ( American Society of Anesthesiology [ ASA ] III or IV ) ; coagulation disorders ; previous abdominal or pelvic surgery ; and irreducible , congenital , and massive scrotal or sliding hernias were excluded from the study . Results There was a statistically significant difference ( p = 0.001 ) in operating time favoring the open procedure . The intensity of postoperative pain was greater in the open hernia repair group 24 h , 48 h , and 7 days after surgery ( p = 0.001 ) , with a greater consumption of pain medication among these patients ( p < 0.004 ) . The median time until return to work was 14 days for group A , 13 days for Group g , and 20 days for group C. The comparison was in favor of laparoscopically treated patients . Nine recurrences ( 4 in the laparoscopic groups and 5 in the open group ) were documented within 3 years of follow-up evaluation . Conclusion Laparoscopic inguinal hernia repair ( TAPP or TEP ) is the method of choice for dealing with recurrent inguinal hernia Introduction The Lichtenstein hernioplasty for the repair of primary inguinal hernia in male patients is well established and constitutes the current gold st and ard . However a gold st and ard technique for the repair of recurrent inguinal hernia has not been established . The aim of this study was to analyze the outcomes of Lichtenstein hernioplasty for the repair of primary inguinal hernia and recurrent inguinal hernia , applying for that purpose the Qualitative and Quantitative Measurement Instrument ( QQMI ) . Methods We studied 75 recurrent inguinal hernia patients and 287 primary inguinal hernia patients with a follow-up period ranging from 60 to 107 months . Results The final QQMI score demonstrated that most patients in both groups reached scores between 8 and 11 points , with a significant difference in the maximum score ( 11 points ) favoring primary hernia patients . Conclusions All evaluated parameters showed better outcomes in primary hernia patients . Applying the QQMI , we have demonstrated that the outcomes of  Lichtenstein hernioplasty  are not similar between primary and recurrent inguinal hernia ; there is a tendency toward better outcomes for primary inguinal hernia patients , although the Lichtenstein hernioplasty st and s as a safe option for repair of recurrent inguinal hernias Background Inguinal hernia recurrence after surgical repair is a major concern . The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias . Methods After institutional review board approval , a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009 , and the data for 172 patients who met the inclusion criteria were analyzed .  Surgical variables and clinical outcomes were compared using Student ’s t test , the Mann – Whitney U test , chi-square , and Fisher ’s exact test as appropriate . Results The review showed that 172 patients had undergone either open mesh repair ( n = 61 ) or laparoscopic mesh repair ( n = 111 ) for recurrent inguinal hernias . Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group ( p = 0.70 ) . Five patients ( 8.2 % ) in the open group and four patients ( 3.6 % ) in the laparoscopic group had re-recurrent inguinal hernias ( p = 0.28 ) . Four patients in the open group ( 9.5 % ) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation ( p = 0.046 ) . In the laparoscopic group , 76 patients ( 68.5 % ) underwent  total extraperitoneal  ( TEP ) repair , and 35 patients ( 31.5 % ) had  transabdominal preperitoneal ( TAPP ) repair . Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group ( p = 0.44 ) . Two patients ( 2.6 % ) in the TEP group and two patients ( 5.7 % ) in the TAPP group had re-recurrent inguinal hernias ( p = 0.59 ) . Conclusions This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation . However , the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation . Both procedures were comparable in terms of intra- and postoperative complications . Among laparoscopic techniques , TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia . A multicenter prospect i ve r and omized control trial is needed to confirm the findings of this study Introduction The aim of the study was to investigate the effectiveness of laparoscopic inguinal hernia repair in daily clinical practice . Patients and methods All patients admitted to the hospital for surgery of an inguinal hernia during a 1-year period were prospect ively documented and included in a follow-up study . The follow-up was performed at least 5 years after surgery and consisted of a clinical examination , ultrasound investigation and a question naire . Results From January 2000 to January 2001 a total of 1208 inguinal hernias in 952 patients were consecutively operated by a total of 11 general surgeons in daily clinical routine . Of the patients , 98.02 % were operated on laparoscopically with the transabdominal preperitoneal patch plasty technique ( TAPP ) and 1.98 % had an open repair . The frequency of intraoperative and early postoperative complications was 2.8 % . The complication rate in the patients presenting a complex hernia was not higher than in patients with uncomplicated unilateral hernias . Life-threatening complications were seen in four patients ( bowel lesion—0.4 % ) , but all four patients presented extensive adhesions in the abdominal cavity after previous abdominal surgery . The follow-up rate after 5 years was 85.3 % . After 5 years the recurrence rate was 0.4 % and the rate of severe chronic pain 0.59 % . None of the patients took analgesics or had to change his occupation . Conclusion Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain . Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen BACKGROUND Open mesh or non-mesh inguinal hernia repair may influence the incidence of chronic postoperative pain differently . METHODS A total of 300 patients scheduled for repair of a primary unilateral inguinal hernia were r and omized to non-mesh or mesh repair .  The primary outcome measure was clinical outcome including persistent pain and discomfort interfering with daily activity . Long-term results at 3 years of follow-up have been published . Included here are 10-year follow-up results with respect to pain . RESULTS Of the 300 patients , 87 patients ( 30 % ) died and 49 patients ( 17 % ) were lost to follow-up . A total of 153 were physically examined in the outpatient clinic after a median long-term follow-up of 129 months ( range , 109 to 148 months ) . None of the patients in the non-mesh or mesh group suffered from persistent pain and discomfort interfering with daily activity . CONCLUSIONS Our 10-year follow-up study provides evidence that mesh repair of inguinal hernia is equal to non-mesh repair with respect to long-term persistent pain and discomfort interfering with daily activity . An important new finding from the patient 's perspective is that chronic postoperative pain seems to dissipate over time Background This prospect i ve , clinical , r and omized , controlled study was performed to define the incidence of chronic pain after total extraperitoneal ( TEP ) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias . Methods Consecutive patients with bilateral inguinal hernias were recruited for TEP inguinal hernia repair under general anesthesia . Heavyweight mesh was r and omly assigned to one side of the groin and lightweight mesh to the other . Patients were followed up regularly for up to 1 year by an independent surgeon who was unaware of the mesh assignment . The postoperative pain score by means of a visual analogue scale ( VAS ) and other data were recorded . Results Fifty bilateral TEP hernia repairs were performed between September 2007 and February 2009 . Six patients ( 12 % ) complained of chronic pain 3 months after the operation . A higher average pain score was observed for the side of hernia repaired by heavyweight mesh compared with lightweight mesh , but the difference was not statistically significant . More patients complained about foreign body sensation on the side repaired with heavyweight mesh ( 24 % ) compared with the side with lightweight mesh ( 8 % ; P < 0.05 ) . There was no recurrence or need for reintervention for either type of mesh . Conclusions Lightweight polypropylene mesh may be preferable to heavyweight mesh for TEP inguinal hernia repair because it provides less postoperative foreign body sensation ; however , there was no significant difference in the incidence of chronic pain Introduction Seroma is a frequent complication of endoscopic totally extraperitoneal ( TEP ) mesh repair of direct inguinal hernia that may cause discomfort and anxiety . Its volume is proportional to the size of the preperitoneal dead space created after the reduction of the hernia . Attempts to reduce its incidence have included tacking the transversalis fascia ( TF ) to the pubic ramus or closed suction drainage of the preperitoneal space . Both of these techniques are not without problems . The aim of this study was to evaluate the efficiency of a new alternate technique that must be safe and easily reproducible , using a widely available and inexpensive pre-tied suture loop ( Endoloop ® Ligature ) for plication of the weakened TF . Methods This is a prospect i ve study of consecutive patients diagnosed with inguinal hernia during a 33-month period and eligible for endoscopic TEP repair . A single surgeon performed all operations . Each of the M2 or M3 direct defects , according to the European Hernia Society ( EHS ) , were systematic ally closed prior to the introduction of the prosthetic mesh and as follows : grasping and inversion of the attenuated TF at its apex , using a laparoscopic forceps and plication of the TF by placing a tight Endoloop of Polydioxanone ( PDS ) at its base . All meshes were secured with fibrin sealant only . Patients were review ed in the clinic 2 and 6 weeks after the operation . Further follow-up was scheduled if it was deemed necessary . The primary post-operative outcome parameter was seroma formation ; secondary outcome parameters included groin pain , surgical complications , and recurrence . Results Two hundred and fifty hernia repairs were prospect ively recorded during this period . All procedures were carried out endoscopically . Seventy-nine patients with 94 direct inguinal hernias were selected in a sequential manner . There were 75 males and four females , with a median age of 57 years . Of those , 55 were combined with an indirect inguinal defect . In total , Endoloops of PDS were used to close the weakened TF in 76 cases ( 30 M3 , 44 M2 , and two M1 ) . Only one patient ( 1.3 % ) complained of a residual seroma formation , which was still clinical ly present at 3 months post-operatively , but was not symptomatic . There were only two minor post-operative complications , which occurred in the same patient and were not related to the Endoloop technique . Finally , no patient complained of chronic groin pain and there was no hernia recurrence after a median follow-up of 18 months . Conclusions The primary closure of direct inguinal hernia defects with a pre-tied suture loop during endoscopic TEP repair is safe , efficient , and very reliable for the prevention of post-operative seroma formation , without increasing the risk of developing chronic groin pain or hernia recurrence . This technique should be the preferred method over stapling of the TF or the insertion of a closed suction drainage device in such a situation Purpose The use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries , but no r and omized controlled trials have so far been reported in Japan . The purpose of the present r and omized prospect i ve trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm ( I-1 or I-2 of Japanese Hernia Society Classification ) . Methods Patients with a primary unilateral inguinal hernia and I-1 or I-2 surgical findings were r and omized to undergo either Marcy repair or Prolene Hernia System ® repair . Primary endpoints were recurrence , infection , and pain , with follow-up continued for 3 years postoperatively . Results Ninety-one of 479 patients with an inguinal hernia during the study period did not meet the exclusion criteria , and 46 were allocated to Marcy repair and 45 were allocated to Prolene Hernia System ® repair .  No recurrence was observed in either group , and no significant differences were identified between the groups in any of the primary endpoints . Conclusion This r and omized prospect i ve trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair . A large-scale r and omized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias Background : A variety of procedures with substantial differences in results are employed to treat recurrent inguinal hernia . The advantages of totally extraperitoneal patch repair ( TEP ) are even more evident when it is applied to recurrent compared to primary hernias . To investigate the superiority of this method more closely , we review ed our results obtained for recurrent inguinal hernias over a period of 2 years . Methods : We performed a prospect i ve single-center study using data obtained in consecutive patients with recurrent inguinal hernia who were operated on in 1997 and 1998 . Results : A total of 179 patients with recurrent inguinal hernia were recruited . Overall , 1329 patients with inguinal hernia were treated in the 2-year period , of whom 1270 underwent TEP .  The percentage of recurrent hernias was 14 % . The average age of the patients was 56 years . The follow-up rate was 87.5 % , and the mean follow-up period was 2.3 years . The 154 patients who were followed up underwent a total of 225 hernia repairs  , of which 181 were for recurrent hernias . The average operating time was 57 min . In 68 % ( 104/154 ) of the patients , adhesions , adherent epigastric vessels , or cicatricial changes were found , which result ed in the inadvertant opening of the peritoneum in 26.3 % of the patients . All the openings in the peritoneum were closed by endoscopic suturing . Intraoperative complications developed in 4 patients ( 2.3 % ) , including one injury to the bladder and three cases of bleeding from side branches of the epigastric vessels . The conversion rate was 0 % . The sole postoperative complication was treatment requiring hematomas in 7 patients , in 2 of whom reoperation became necessary . In both cases , a diffuse hemorrhage due to a preoperatively undiagnosed coagulation disorder was found . No cases of wound or patch infection were observed . In a patient undergoing both primary and recurrent hernia repair , displacement of a mesh led to a recurrence on the primary hernia side ( recurrence rate , 0.4 % ; re-recurrence rate , 0 % ) . Conclusions : Although for its definitive management , recurrent hernia requires a reliable operative technique , current data do not support the recommendation of any of the currently available procedures as the gold st and ard . In a representative patient population with recurrent hernia , we were able to demonstrate that TEP achieves very good results in terms of re-recurrence rate , intraoperative and postoperative complications , and rehabilitation . Prerequisites for the reliable and low-complication application of the method are a high level of st and ardization of the procedure and an advanced learning curve BACKGROUND Femoral hernias are uncommon , and there are relatively few clinical studies of longterm outcomes after repair . Although the McVay repair has been classically described , the infrainguinal plug technique has gained popularity in recent years . Evidence supporting these repairs is sparse . STUDY DESIGN A prospect i ve study of elective femoral hernia repairs was done at the Shouldice Hospital from June 1999 until June 2003 . The tissue-based complete groin repair ( CGR ) and a preperitoneal mesh repair were performed for specific indications . Patients were followed annually for 5 years to examine for recurrences and complications . RESULTS Two hundred fifty-six patients were enrolled , with 225 completing 5 years of followup . Median age was 55 years , and hernias on the right side were more common ( 63.1 % ) . Concurrent inguinal hernias were found in 115 patients ( 51 % ) , and 41 ( 18.2 % ) had a previous inguinal hernia repair . A complete groin repair was performed in 120 patients and a preperitoneal mesh repair in 78 . The remaining had an infrainguinal mesh repair . The overall recurrence rate was 3.1 % , with a median time to recurrence of 12 months . There was no significant difference between mesh and suture repairs . Chronic postoperative pain was experienced by 20 patients ( 8.9 % ) . CONCLUSIONS Femoral hernias can be repaired electively with a tissue-based or a preperitoneal mesh technique , with durable longterm results . Mesh repair is indicated for recurrent femoral hernias , inguinofemoral hernias , prevascular hernias , association with concurrent direct hernias , and , if tension is anticipated , with complete groin repair . Infrainguinal mesh repair is used only when there has been a successful previous inguinal hernia repair AIM During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique , esthetic , and functional benefits of mini-invasive surgery . Anyway controversy persists regarding the most effective inguinal hernia repair . The aim of this study is to compare the open technique and the laparoscopic approach concerning : complications , recurrences , recovery time and return to usual activity . METHODS A r and omized prospect i ve analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period . Male well-informed patients with primary monolateral inguinal hernia ( ASA I-II ) were divided into 2 groups and consecutively treated ; group A was treated with  laparoscopic transabdominal preperitoneal approach ( TAPP ) ( median age 47+/-7 years , 57 patients ) , group B with open mesh herniorrhaphy ( 45+/-6 years , 64 patients ) . RESULTS Complication rate was 5.26 % for group A ( none needed conversion ) and 4.68 % for group B. All complications were considered minor . No recurrences were observed over a 12-month follow-up in both groups . Post-operative hospital stay and return to activity show statistically significant differences . Median post-hospital stay was 1.7 days for group A while it was longer ( 2.9 days ) for group B. Significant difference was observed in the duration of convalescence too ( group A 9.3+/-7.2 days ; group B 12.1+/-7 . 1 days ) . CONCLUSION On the basis of our experience , even if a longer follow-up is needed , the validity of laparoscopic approach to inguinal hernia is confirmed . General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity BACKGROUND The aim of this study was to investigate the reoperation rates after open indirect inguinal hernia repair with and without mesh in young males and other age groups . Younger males have higher risk of developing chronic pain after open inguinal hernia repair with mesh compared with older patients . Avoiding mesh among younger patients could be justified , if they have an acceptable low risk of recurrence compared with other groups and compared with Lichtenstein repair . METHODS Data were extracted from the nationwide Danish Hernia Data base which is recording prospect ively . Included were males with primary indirect inguinal hernia , repaired with Lichtenstein or annulorrhaphy from the period January 1 , 1998 to December 31 , 2015 .  Reoperation rate for recurrence was used as outcome . RESULTS In total 52,281 primary repairs of open indirect inguinal hernia were included of which 49,951 were Lichtenstein repairs and 2330 were annulorrhaphies .  The overall reoperation rates increased year after year in both groups but the 18 - 29 year old males had a significant lower risk of reoperation after annulorrhaphy compared with all other age groups ( cumulative reoperation rate 8.1 % versus 12.5 % , log rank p = 0.001 ) . CONCLUSIONS The cumulative reoperation rate after annulorrhaphy for 18 - 29 year old males was significantly lower compared with all other age groups . When taken into consideration , that young males at the same time have the highest risk of developing chronic pain after mesh repair the results indicate , that annulorrhaphy could be a valid option for young men with indirect inguinal hernias . Thus , we propose a tailored approach for this patient group
There is insufficient epidemiologic evidence to draw meaningful conclusions about ( i ) the existence of causal associations between specific occupational mechanical exposures and the development of inguinal hernia , and ( ii ) the influence of these exposures on prognosis after inguinal hernia repair with respect to hernia recurrence and persistent pain
OBJECTIVES The aim of this review was to evaluate the epidemiologic evidence for ( i ) a causal effect of occupational mechanical exposures on incidence of inguinal hernia , and ( ii ) a prognostic effect of such exposures on hernia recurrence and persistent pain after inguinal hernia repair .