Hernia : the journal of hernias and abdominal wall surgery
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The aim of this study was to demonstrate the safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Sofradim Production, Trévoux, France) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 12 months was evaluated. ⋯ This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate.
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Randomized Controlled Trial Comparative Study
Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein's method: an analysis alongside a randomized clinical study.
The Lichtenstein technique is the treatment of first choice according to guidelines for primary inguinal hernia treatment. Postoperative chronic pain has been reported as complication in 15-40 % after Lichtenstein's repair. The postoperative effects on health status after open preperitoneal hernia repair have hardly been examined. Development of an open technique that combines the safe anterior approach of the Lichtenstein with the 'promising' preperitoneal soft mesh position was done; the transinguinal preperitoneal (TIPP) mesh repair. A double-blind prospective randomized controlled trial (TULIP trial, ISRCTN93798494) was conducted to compare different outcome parameters after TIPP or Lichtenstein, one parameter is topic of evaluation in this paper; the health status after TIPP and Lichtenstein for inguinal hernia repair. ⋯ In conclusion, the SF-36 'physical function' and 'physical pain' dimensions after TIPP show significant better patient outcomes at 1 year compared with the Lichtenstein patients in this trial. These differences are in line with reported significant differences in less patients with postoperative chronic pain after TIPP compared with Lichtenstein at 1 year.
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Persistent inguinal pain, influencing daily activities, is seen in about 5 % of patients following inguinal herniorrhaphy. Surgical treatment of patients with persistent postherniorrhaphy pain has been associated with pain relief and improvement in functional status. However, the detailed long-term outcome effects remain to be clarified. The aim of this study was to determine the long-term effects of mesh removal and selective neurectomy in patients with persistent postherniorrhaphy pain after previous open repair. ⋯ Mesh removal and attempted neurectomy may provide long-lasting analgesic effects in most patients and with a small proportion being worse, without relation to pain history and operative findings. Detailed multicenter collaboration is required to define preoperative diagnostics and the indication for mesh removal and neurectomy, the exact surgical procedure (type of neurectomy) and with detailed follow-up.
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Comparative Study
Recurrence and chronic pain after mesh fixation with skin staples versus sutures in Lichtenstein's inguinal hernioplasty: a retrospective cohort study.
Reduction in operating time has been reported with skin staples instead of original technique of mesh fixation with sutures in Lichtenstein's hernioplasty. Few studies have been conducted, however, with inadequate follow-up and variable results. We have undertaken this study to compare the duration of surgery and incidence of recurrence (beyond 1 year) and chronic pain after mesh fixation with staples versus sutures. ⋯ Our study confirms that staples are superior to the sutures due to shorter operative time and do not cause any additive risk of recurrence or chronic pain. Prospective trial with long-term follow-up for each patient is required to validate these findings in order to generate definite guidelines.
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To report on the use of the laparoscopic implantation of neuroprosthesis (LION) procedure on the sensitive branches of the lumbar plexus for the treatment of refractory postherniorrhaphy neuropathic inguinodynia. ⋯ The presented technique of laparoscopic implantation permits a selective implantation and neuromodulation of all sensitive branches of the lumbar plexus. These preliminary results suggest that the technique described is effective, safe, minimally invasive, and must be indicated in patients after failure of all other treatments.