Insufficiency of prosthetic posterolateral overlap related to recurrence after laparoscopic transabdominal preperitoneal inguinal hernioplasty, as assessed by video review View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-02-10

AUTHORS

Masanori Sato, Masashi Nozawa, Takahiro Watanabe, Takanobu Onoda, Atsuko Matsuyama, Norihiko Shiiya, Hidetoshi Wada

ABSTRACT

BackgroundTechnical factors leading to hernia recurrence after transabdominal preperitoneal repair include insufficient dissection, inadequate prosthetic overlap and prosthetic size, improper fixation and folding, or crinkling of the prosthesis. However, determining intraoperatively if a case will develop recurrent hernias due to these factors remains unclear.MethodsFive surgeons blind-reviewed operation videos of primary laparoscopic hernioplasty in 13 lesions that went on to develop recurrent hernias (i.e., future recurrence), as well as 28 control lesions, to assess twelve items of surgical techniques. Since we changed a surgical policy of covering myopectineal orifice (MPO) in April 2003, we analyzed the data for the earlier and later periods. The data was analyzed with hierarchical clustering to obtain a gross grouping. The differences of the ratings between the future recurrent and control lesions were then analyzed and the association of the techniques with the hernia recurrence rate, the size of the prosthesis, and the hernia type across hernia recurrence were explored.ResultsThe lesions were grouped based on the time series, and its boundary was approximated when we changed our surgical policy. This policy change caused ratings to progress from 34% satisfactory, to 79% satisfactory. The recurrence rate decreased to 0.7% (5/678), compared with 6.2% (10/161) before the policy was implemented (p < 0.001). With univariate analysis, the ratings of posterior prosthesis overlap to the MPO in the recurrent lesions were significantly lower than controls in the later period (p = 0.019). Although various types of recurrences were noted in the earlier period, only primary indirect and recurrent indirect hernias were observed in the later period (p = 0.006).ConclusionsFully covering the MPO with mesh is essential for preventing direct recurrence hernias. Additional hernia recurrence prevention can be obtained by giving appropriate attention to prosthesis overlap posterior to the MPO in a large indirect hernia. More... »

PAGES

27

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12893-020-0690-6

DOI

http://dx.doi.org/10.1186/s12893-020-0690-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1124797280

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32041581


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