Alberto Aiolfi1, Marta Cavalli2, Simona Del Ferraro2, Livia Manfredini2, Gianluca Bonitta1, Piero Giovanni Bruni2, Davide Bona1, Giampiero Campanelli2,3. 1. Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy. 2. Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy. 3. Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Abstract
BACKGROUND: Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS: Systematic review and network meta-analyses of randomized controlled trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS: Thirty-five RCTs (7777 patients) were included. Overall, 3496 (44.9%) underwent Lichtenstein, 1269 (16.3%) TAPP, and 3012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12 hours, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs Lichtenstein (WMD = -3.3; 95% CrI -4.9 to -1.8) and TEP vs Lichtenstein (WMD = -3.6; 95% CrI -4.9 to -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches, whereas no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS: Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
BACKGROUND: Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS: Systematic review and network meta-analyses of randomized controlled trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS: Thirty-five RCTs (7777 patients) were included. Overall, 3496 (44.9%) underwent Lichtenstein, 1269 (16.3%) TAPP, and 3012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12 hours, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs Lichtenstein (WMD = -3.3; 95% CrI -4.9 to -1.8) and TEP vs Lichtenstein (WMD = -3.6; 95% CrI -4.9 to -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches, whereas no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS: Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
Authors: A Sartori; A Balla; E Botteri; F Scolari; M Podda; P Lepiane; M Guerrieri; S Morales-Conde; A Szold; M Ortenzi Journal: Hernia Date: 2022-05-26 Impact factor: 4.739
Authors: Jeremy A Balch; Dan Neal; Cristina Crippen; Crystal N Johnson-Mann; Thomas E Read; Tyler J Loftus; Mazen R Al-Mansour Journal: Surg Endosc Date: 2022-06-08 Impact factor: 4.584
Authors: A Aiolfi; M Cavalli; F Gambero; E Mini; F Lombardo; L Gordini; G Bonitta; P G Bruni; D Bona; G Campanelli Journal: Hernia Date: 2022-08-03 Impact factor: 2.920
Authors: Ivan David Lozada-Martinez; Jaime Enrique Covaleda-Vargas; Yuri Alexandra Gallo-Tafur; David Andrés Mejía-Osorio; Andrés Mauricio González-Pinilla; Mayra Alejandra Florez-Fajardo; Fabian Enrique Benavides-Trucco; Julio Cesar Santodomingo-Rojas; Nancy Karol Julieth Bueno-Prato; Alexis Rafael Narvaez-Rojas Journal: Ann Med Surg (Lond) Date: 2022-06-05
Authors: F Köckerling; D Adolf; R Lorenz; B Stechemesser; A Kuthe; J Conze; B Lammers; R Fortelny; F Mayer; K Zarras; W Reinpold; H Hoffmann; D Weyhe Journal: Hernia Date: 2021-04-24 Impact factor: 2.920