P G Bruni1,2, M Cavalli3, A Aiolfi4, F Lombardo1,2, A Morlacchi1,2, G Bonitta5, G Campanelli1,2,6,7,8,9,10. 1. Insubria University, Varese, Italy. 2. General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico Sant Ambrogio, Milan, Italy. 3. University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy. 4. Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy. alberto.aiolfi86@gmail.com. 5. Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy. 6. Past President of European Hernia Society, Hamburg, Germany. 7. Past President of Italian Society of Day and Ambulatory Surgery, Milan, Italy. 8. President of Fondazione Day Surgery Onlus, Milan, Italy. 9. Chairman of 1st World Conference on Abdominal Wall Hernia Surgery, Milan, Italy. 10. Editor in Chief Hernia Journal SpringerNature, Basingstoke, UK.
Abstract
BACKGROUND: In modern abdominal wall hernia surgery, the achievement of the most effective tailored repair for each specific defect with the less possible invasiveness, the quicker recovery, the lower costs and the fewer risk of local occurrences, recurrences and chronic pain is the most desirable and cutting-edge goal. METHODS: Since 1989 about 4219 primary unilateral not complicated inguinal hernias have been treated with specific indications with a sutureless and minimally invasive anterior open approach. The great majority of these procedures were performed under local anaesthesia in a day surgery regimen, with a systematic and careful nerve sparing, preservation of cremasteric muscle, and with a 3-5 cm skin incision. RESULTS: The minimally invasive sutureless nerve sparing open approach has shown a very low rate of seromas (0.45%), haematomas (0.24%) and infections (0.07%) while the width of skin incision challenges even laparoscopy. A significant reduction of both postoperative pain (2.7%) and chronic neuralgia (0.047%) has led to excellent outcomes in patients, also in terms of quality of life. Compared to the Lichtenstein's tension-free technique, which is at now the gold standard open treatment for primary inguinal hernia worldwide, there are no significant differences in the observed recurrence rate (well below 1%). CONCLUSION: In our experience of almost 30 years we have been able to experiment and refine more and more the sutureless technique proposed by Trabucco for the treatment of primitive inguinal hernia, peer to peer, improving the local anaesthesia and the ability to detect hidden defects during the repair (Spigelian included), reducing the width of the incisions and tractions on the tissues, introducing the concept of a gentle and bloodless "finger surgery" according to a minimally invasive, extremely anatomic, safe, inexpensive, very effective anterior open approach.
BACKGROUND: In modern abdominal wall hernia surgery, the achievement of the most effective tailored repair for each specific defect with the less possible invasiveness, the quicker recovery, the lower costs and the fewer risk of local occurrences, recurrences and chronic pain is the most desirable and cutting-edge goal. METHODS: Since 1989 about 4219 primary unilateral not complicated inguinal hernias have been treated with specific indications with a sutureless and minimally invasive anterior open approach. The great majority of these procedures were performed under local anaesthesia in a day surgery regimen, with a systematic and careful nerve sparing, preservation of cremasteric muscle, and with a 3-5 cm skin incision. RESULTS: The minimally invasive sutureless nerve sparing open approach has shown a very low rate of seromas (0.45%), haematomas (0.24%) and infections (0.07%) while the width of skin incision challenges even laparoscopy. A significant reduction of both postoperative pain (2.7%) and chronic neuralgia (0.047%) has led to excellent outcomes in patients, also in terms of quality of life. Compared to the Lichtenstein's tension-free technique, which is at now the gold standard open treatment for primary inguinal hernia worldwide, there are no significant differences in the observed recurrence rate (well below 1%). CONCLUSION: In our experience of almost 30 years we have been able to experiment and refine more and more the sutureless technique proposed by Trabucco for the treatment of primitive inguinal hernia, peer to peer, improving the local anaesthesia and the ability to detect hidden defects during the repair (Spigelian included), reducing the width of the incisions and tractions on the tissues, introducing the concept of a gentle and bloodless "finger surgery" according to a minimally invasive, extremely anatomic, safe, inexpensive, very effective anterior open approach.
Authors: Igor Belyansky; Victor B Tsirline; David A Klima; Amanda L Walters; Amy E Lincourt; Todd B Heniford Journal: Ann Surg Date: 2011-11 Impact factor: 12.969
Authors: Giampiero Campanelli; Manuel Hidalgo Pascual; Andreas Hoeferlin; Jacob Rosenberg; Gérard Champault; Andrew Kingsnorth; Marc Miserez Journal: Ann Surg Date: 2012-04 Impact factor: 12.969
Authors: S Alfieri; P K Amid; G Campanelli; G Izard; H Kehlet; A R Wijsmuller; D Di Miceli; G B Doglietto Journal: Hernia Date: 2011-03-02 Impact factor: 4.739
Authors: M P Simons; T Aufenacker; M Bay-Nielsen; J L Bouillot; G Campanelli; J Conze; D de Lange; R Fortelny; T Heikkinen; A Kingsnorth; J Kukleta; S Morales-Conde; P Nordin; V Schumpelick; S Smedberg; M Smietanski; G Weber; M Miserez Journal: Hernia Date: 2009-07-28 Impact factor: 4.739