Effectiveness of mesh inguinal hernia repair. A systematic review. Correspondencia a :. There is controversy about the effectiveness of mesh techniques for inguinal hernia repair IHR when compared with non-mesh procedures.
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Standard open anterior inguinal hernia repair is nowadays performed using a soft mesh to prevent recurrence and to minimalize postoperative chronic pain. To further reduce postoperative chronic pain, the use of a preperitoneal placed mesh has been suggested. In extremely large hernias, the lateral side of the mesh can be insufficient to fully embrace the hernial sac.
We describe the use of two preperitoneal placed meshes to repair extremely large hernias. Extremely large indirect hernias were repaired by using two inverted meshes to cover the deep inguinal ring both medial and lateral. Follow up was at least 6 months. VAS pain score was assessed in all patients during follow up. Outcomes of these Butterfly repairs were evaluated. Medical drawings were made to illustrate this technique. A Total of patients underwent anterior hernia repair — All these patients were men.
Mean age Recurrence did not occur after repair. Chronic pain was not reported. Open preperitoneal hernia repair of extremely large hernias has not been described. The seven patients were trated with this technique uneventfully. No chronic pain occurred. The Butterfly Technique is an easy and safe alternative in anterior preperitoneal repair of extremely large inguinal hernias.
In standard inguinal hernia repair a mesh is used to prevent recurrence. A soft mesh with memory ring is positioned in the preperitoneal space, using an anterior transinguinal approach. TIPP placement of a mesh may have multiple advantages.
Just like in TEP the mesh is entrapped between the peritoneum and the posterior surface of the abdominal wall by intra-abdominal pressure and due to the memory ring does not require fixation sutures. There is no contact with the nerves in the inguinal canal.
The TIPP technique may provide the advantages of a preperitoneal positioned soft mesh without the hypothetical drawbacks of endoscopic procedures. The TIPP approach may be comparable to conventional open techniques.
Even though the shapes and sizes of preperitoneal meshes are sufficient to cover both direct and indirect hernias in almost all patients, concern has been raised about the lateral side of preperitoneal meshes such as the Polysoft hernia patch in extremely large direct hernias, as well as in extremely large pantaloon hernias.
It can be difficult to cover both the medial and lateral component. We describe a technique using two inverted hernia patches to cover extremely large hernias. Pre-operative screening was performed following standard hospital protocol. Spinal anaesthesia was used.
Peroperatively the EHS hernia classification was used. The standard transinguinal approach of the preperitoneal space TIPP was performed under spinal anaesthesia. The inguinal canal is opened using the standard anterior approach. The extremely large hernia sac is liberated from the inguinal cord and is reduced. The PPS is developed by gentle finger moves, first to medial and then to lateral. The medial border is the rectus abdominis muscle.
A Langebeck speculum is moved medial, protecting the epigastric vessels by keeping them ventrally. Cooper's ligament is seen. A dissection gauze is used to keep the peritoneum away from the mesh position in the PPS. A hernia patch size large is introduced in the PPS using a clamp Fig.
The large patch is unfold from medial to lateral in the PPS. A second patch size medium or large is brought into the PPS and positioned with its great curvature towards lateral. The second patch is positioned ventrally from the first patch.
The wide inguinal ring is in the middle of the patch. The notches of both patches are positioned over the iliac vessels. The hernia patches form a butterfly-like shape now. The patients are asked to strain and cough to control the position of the patches Fig.
Standard closure is performed of the aponeurosis of the external oblique muscle with Vicryl 3. Scarpa's fascia is closed using one Vicryl 3.
The skin is closed intracutaneously with Vicryl rapide 4. Baseline characteristics such as age, co-morbidities, visual analogue scale VAS score were assessed. VAS score was assessed direct postoperatively and after 14 days, 3 months and 6 months.
Written informed consent was obtained from the patient for publication of this case report and accompanying images.
A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Medical drawings were made by a medical illustrator to clarify this technique. ASA classification varied from 1 to 3. Patients were all satisfied after 2 weeks, 3- and 6 months. All were free of postoperative and chronic pain. No re-interventions were necessary. No limitations during regular activities of daily life or work were present. No recurrences occurred. No conversions to other techniques were necessary.
Baseline characteristics of patients with an extremely large inguinal hernia. All treated with the Butterfly Technique. We have not found any reports in literature describing any similar anterior preperitoneal technique to repair extremely large inguinal hernias. The TIPP technique using the memory patch may be associated with less chronic postoperative pain after hernia repair. Concerns have been raised among some patch users on the small curved lateral side when used for large indirect pantaloon hernias.
The complete coverage of the lateral side of the hernia sac could be difficult to achieve in extremely large hernias. Adjustments of the current hernia patch have been suggested by some patch users. The need for solid coverage of both the medial and lateral defect of the extremely large hernia can be achieved by the use of two inverted patches in our experience.
However, two hernia patches are positioned in the PPS drawings. We describe the feasibility of 2 patches to fully cover the lateral part of an extremely large hernia. No fixating sutures are necessary in the PPS. The intra abdominal pressure fixates the two patches. The patches form a butterfly-like shape in the PPS Fig. Chronic pain did not occur Table 1. Follow up was completed by all patients. We searched literature as described in our methods.
No similar anterior preperitoneal technique has been described to repair extremely large hernias so far. GK contributed for study design, data collections, data analysis and writing; PV contributed for study design, data collections, data analysis, writing and development Butterfly technique.
National Center for Biotechnology Information , U. Int J Surg Case Rep. Published online Nov 3. Giel G. Author information Article notes Copyright and License information Disclaimer.
Department of Surgery, St. Koning: ln. Vriens: ln. Published by Elsevier Ltd. All rights reserved. Discussion Open preperitoneal hernia repair of extremely large hernias has not been described. Introduction In standard inguinal hernia repair a mesh is used to prevent recurrence. Methods Pre-operative screening was performed following standard hospital protocol. Open in a separate window. Surgical technique of Butterfly The inguinal canal is opened using the standard anterior approach.
Table 1 Baseline characteristics of patients with an extremely large inguinal hernia. Conflict of interest statement None. Funding None. Ethical approval Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Reparación abierta de hernia inguinal (herniorrafia, hernioplastia)
The Stoppa procedure in inguinal hernia repair: to drain or not to drain. Aldo Junqueira Rodrigues Jr. On the second postoperative day, all patients underwent abdominal pelvic computed tomography scan examination to detect the presence of abdominal fluid collection. RESULTS: In group A, no patient developed fluid collection in the preperitoneal space, and 1 patient presented with an abscess in the preperitoneal space on the 15th postoperative day. In group B, 12 patients presented with fluid collections in the preperitoneal space on computed tomography scan evaluation. However, only 3 patients presented minor complications. None of the patients developed a major complication.
Inguinal hernia surgery
Recurrence of Lichtenstein inguinal hernioplasty: the use of the polypropylene mesh plug. It is tension-free technique and present the smallest published recurrence rates. The treatment after Lichtenstein recurrence is controversial. AIM: To show the results after the use polypropylene mesh plug in this condition.
Las hernias inguinales son un problema frecuente de salud que afecta a ambos sexos en todas las edades. Los resultados se exponen en tablas y figuras. La muestra estuvo constituida por pacientes y hernias en total, debido a que 18 de ellos presentaron hernias bilaterales. Tabla 2. Tabla 3.