AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various co...AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords:stoma repair,laparoscopic,parastomal,and hernia.Case reports,studies with less than 5 patients,and articles not written in English were excluded.Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine.Two authors reviewed and analyzed each study.If there was any discrepancy between scores,the study in question was referred to another author.A meta-analysis was performed using both random and fixed-effect models.Publication bias was evaluated using Begg's funnel plot and Egger's regression test.The primary outcome analyzed was recurrence of parastomal hernia.Secondary outcomes were mesh infection,surgical site infection,obstruction requiring reoperation,death,and other complications.Studies were grouped by operative technique where indicated.Except for recurrence,most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS:Fifteen articles with a total of 469 patients were deemed eligible for review.Most postoperative morbidities were reported for the overall cohort,and not by approach.The overall postoperative morbidity rate was 1.8%(95%CI:0.8-3.2),and there was no difference between techniques.The most common postoperative complication was surgical site infection,which was seen in 3.8%(95%CI:2.3-5.7).Infected mesh was observed in 1.7%(95%CI:0.7-3.1),and obstruction requiring reoperation also occurred in 1.7%(95%CI:0.7-3.0).Other complications such as ileus,pneumonia,or urinary tract infection were noted in16.6%(95%CI:11.9-22.1).Eighty-one recurrences were reported overall for a recurrence rate of 17.4%(95%CI:9.5-26.9).The recurrence rate was 10.2%(95%CI:3.9-19.0) for the modified laparoscopic Sugarbaker approach,whereas the展开更多
Hypospadias is the most common congenital anomaly of the penis. The problem usually develops sporadically and without an obvious underlying cause. The ectopically positioned urethral meatus lies proximal to the normal...Hypospadias is the most common congenital anomaly of the penis. The problem usually develops sporadically and without an obvious underlying cause. The ectopically positioned urethral meatus lies proximal to the normal site and on the ventral aspect of the penis, and in severe cases opens onto the scrotum or perineum. The foreskin on the ventral surface is deficient, while that on the dorsal surface is abundant, giving the appearance of a dorsal hood. Chordee is more common in severe cases. Cryptorchidism and inguinal hernia are the most common associated anomalies. The frequency of associated anomalies increases with the severity of hypospadias. For isolated anterior or middle hypospadias, laboratory studies are not usually necessary. Screening for urinary tract anomalies should be considered in patients with posterior hypospadias and in those with an anomaly of at least one additional organ system. The ideal age for surgical repair in a healthy child is between 6 and 12 months of age. Most cases can be repaired in a single operation and on an outpatient basis. Even patients with a less than perfect surgical result are usually able to enjoy a satisfactory sexual life.展开更多
Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to ...Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.展开更多
Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, conside...Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the Pub Med database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, largepore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.展开更多
Hernia repair is one of the most commonly performed surgical procedures worldwide,with a multibillion dollar global market.Implant design remains a critical challenge for the successful repair and prevention of recurr...Hernia repair is one of the most commonly performed surgical procedures worldwide,with a multibillion dollar global market.Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias,and despite significant progress,there is no ideal mesh for every surgery.This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias.Next,the major milestones in implant design are discussed.Commonly encountered complications and strategies to minimize these adverse effects are described,followed by a thorough description of the implant characteristics necessary for successful repair.Finally,available implants are categorized and their advantages and limitations are elucidated,including non-absorbable and absorbable(synthetic and biologically derived)prostheses,composite prostheses,and coated prostheses.This review not only summarizes the state of the art in hernia repair,but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.展开更多
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
文摘AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords:stoma repair,laparoscopic,parastomal,and hernia.Case reports,studies with less than 5 patients,and articles not written in English were excluded.Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine.Two authors reviewed and analyzed each study.If there was any discrepancy between scores,the study in question was referred to another author.A meta-analysis was performed using both random and fixed-effect models.Publication bias was evaluated using Begg's funnel plot and Egger's regression test.The primary outcome analyzed was recurrence of parastomal hernia.Secondary outcomes were mesh infection,surgical site infection,obstruction requiring reoperation,death,and other complications.Studies were grouped by operative technique where indicated.Except for recurrence,most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS:Fifteen articles with a total of 469 patients were deemed eligible for review.Most postoperative morbidities were reported for the overall cohort,and not by approach.The overall postoperative morbidity rate was 1.8%(95%CI:0.8-3.2),and there was no difference between techniques.The most common postoperative complication was surgical site infection,which was seen in 3.8%(95%CI:2.3-5.7).Infected mesh was observed in 1.7%(95%CI:0.7-3.1),and obstruction requiring reoperation also occurred in 1.7%(95%CI:0.7-3.0).Other complications such as ileus,pneumonia,or urinary tract infection were noted in16.6%(95%CI:11.9-22.1).Eighty-one recurrences were reported overall for a recurrence rate of 17.4%(95%CI:9.5-26.9).The recurrence rate was 10.2%(95%CI:3.9-19.0) for the modified laparoscopic Sugarbaker approach,whereas the
文摘Hypospadias is the most common congenital anomaly of the penis. The problem usually develops sporadically and without an obvious underlying cause. The ectopically positioned urethral meatus lies proximal to the normal site and on the ventral aspect of the penis, and in severe cases opens onto the scrotum or perineum. The foreskin on the ventral surface is deficient, while that on the dorsal surface is abundant, giving the appearance of a dorsal hood. Chordee is more common in severe cases. Cryptorchidism and inguinal hernia are the most common associated anomalies. The frequency of associated anomalies increases with the severity of hypospadias. For isolated anterior or middle hypospadias, laboratory studies are not usually necessary. Screening for urinary tract anomalies should be considered in patients with posterior hypospadias and in those with an anomaly of at least one additional organ system. The ideal age for surgical repair in a healthy child is between 6 and 12 months of age. Most cases can be repaired in a single operation and on an outpatient basis. Even patients with a less than perfect surgical result are usually able to enjoy a satisfactory sexual life.
文摘Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.
文摘Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the Pub Med database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, largepore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.
基金This work was supported in part by National Institutes of Health awards(EB012575,CA182670,HL118498)National Science Foundation(NSF)awards(DMR1313553,CMMI1266116,CMMI1537008).
文摘Hernia repair is one of the most commonly performed surgical procedures worldwide,with a multibillion dollar global market.Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias,and despite significant progress,there is no ideal mesh for every surgery.This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias.Next,the major milestones in implant design are discussed.Commonly encountered complications and strategies to minimize these adverse effects are described,followed by a thorough description of the implant characteristics necessary for successful repair.Finally,available implants are categorized and their advantages and limitations are elucidated,including non-absorbable and absorbable(synthetic and biologically derived)prostheses,composite prostheses,and coated prostheses.This review not only summarizes the state of the art in hernia repair,but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
文摘AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
