Advertisement

Surgical Endoscopy

, Volume 30, Issue 12, pp 5165–5172 | Cite as

Convalescence after laparoscopic inguinal hernia repair: a qualitative systematic review

  • Mette Astrup Tolver
  • Jacob Rosenberg
  • Thue Bisgaard
Review

Abstract

Background

Duration of convalescence after inguinal hernia repair is of major socio-economic interest and an often reported outcome measure. The primary aim was to perform a critical analysis of duration of convalescence from work and activity and secondary to identify risk factors for unexpected prolonged convalescence after laparoscopic inguinal hernia repair.

Methods

A qualitative systematic review was conducted. PubMed, Embase and the Cochrane database were searched for trials reporting convalescence after laparoscopic inguinal hernia repair in the period from January 1990 to January 2016. Furthermore, snowball search was performed in reference lists of identified articles. Randomized controlled trials and prospective comparative or non-comparative trials of high quality were included. Trials with ≥100 patients, >18 years of age and manuscripts in English were included. Scoring systems were used for assessment of quality.

Results

The literature search identified 1039 papers. Thirty-four trials were included in the final review including 14,273 patients. There was overall a large variation in duration of convalescence. Trials using non-restrictive recommendations of 1–2 days or “as soon as possible to return to all activities” reported overall a shorter duration of convalescence compared with trials not using recommendations for convalescence. Strenuous physical activity at work, strenuous leisure activity and patients with expectations of a prolonged period of convalescence may be risk factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair.

Conclusions

Patients should be recommended a duration of 1–2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration of convalescence without increasing risk of pain, complications or recurrence rate.

Keywords

Convalescence Risk factor TAPP TEP Laparoscopic inguinal hernia repair 

Notes

Compliance with ethical standards

Disclosure

Dr. Rosenberg reports Grants from Baxter Healthcare, Grants from Johnson & Johnson, Grants and personal fees from Bard, personal fees from Merck, outside the submitted work. Dr. Bisgaard reports Grants from Johnson & Johnson, Covidien, Baxter Healthcare and travel/accommodation expenses for international meetings covered by Baxter Healthcare. Mette A. Tolver has no conflicts of interest or financial ties to disclose

References

  1. 1.
    Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827CrossRefPubMedGoogle Scholar
  2. 2.
    Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M (2011) Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243PubMedGoogle Scholar
  3. 3.
    Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26:3355–3366CrossRefPubMedGoogle Scholar
  4. 4.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785. doi: 10.1002/14651858.CD001785
  5. 5.
    Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492CrossRefPubMedGoogle Scholar
  7. 7.
    Bay-Nielsen M, Thomsen H, Andersen FH, Bendix JH, Sorensen OK, Skovgaard N, Kehlet H (2004) Convalescence after inguinal herniorrhaphy. Br J Surg 91:362–367CrossRefPubMedGoogle Scholar
  8. 8.
    Callesen T, Klarskov B, Bech K, Kehlet H (1999) Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work. Eur J Surg 165:236–241CrossRefPubMedGoogle Scholar
  9. 9.
    Buhck H, Untied M, Bechstein WO (2012) Evidence-based assessment of the period of physical inactivity required after inguinal herniotomy. Langenbeck’s Arch Surg 397:1209–1214CrossRefGoogle Scholar
  10. 10.
    Hamza Y, Gabr E, Hammadi H, Khalil R (2010) Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg 8:25–28CrossRefPubMedGoogle Scholar
  11. 11.
    Lorenz D, Stark E, Oestreich K, Richter A (2000) Laparoscopic hernioplasty versus conventional hernioplasty (Shouldice): results of a prospective randomized trial. World J Surg 24:739–745CrossRefPubMedGoogle Scholar
  12. 12.
    Velasco JM, Gelman C, Vallina VL (1996) Preperitoneal bilateral inguinal herniorrhaphy evolution of a technique from conventional to laparoscopic. Surg Endosc 10:122–127CrossRefPubMedGoogle Scholar
  13. 13.
    Bisgaard T, Kehlet H, Rosenberg J (2001) Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg 167:84–96CrossRefPubMedGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Slim K, Bousquet J, Kwiatkowski F, Pezet D, Chipponi J (1997) Analysis of randomized controlled trials in laparoscopic surgery. Br J Surg 84:610–614CrossRefPubMedGoogle Scholar
  16. 16.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMedGoogle Scholar
  17. 17.
    Eccles M, Freemantle N, Mason J (1998) North of England evidence based guidelines development project: methods of developing guidelines for efficient drug use in primary care. BMJ 316:1232–1235CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tolver MA, Strandfelt P, Forsberg G, Hjorne FP, Rosenberg J, Bisgaard T (2012) Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery 151:556–563CrossRefPubMedGoogle Scholar
  19. 19.
    Berndsen F, Arvidsson D, Enander LK, Leijonmarck CE, Wingren U, Rudberg C, Smedberg S, Wickbom G, Montgomery A (2002) Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1042 patients. Hernia 6:56–61CrossRefPubMedGoogle Scholar
  20. 20.
    Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Osterberg J, Montgomery A (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 93:1060–1068CrossRefPubMedGoogle Scholar
  21. 21.
    Fleming WR, Elliott TB, Jones RM, Hardy KJ (2001) Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique. Br J Surg 88:1183–1188CrossRefPubMedGoogle Scholar
  22. 22.
    Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH (2004) Quantification of pain and satisfaction following laparoscopic and open hernia repair. Arch Surg 139:596–600CrossRefPubMedGoogle Scholar
  23. 23.
    Johansson B, Hallerback B, Glise H, Anesten B, Smedberg S, Roman J (1999) Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 230:225–231CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251:819–824CrossRefPubMedGoogle Scholar
  25. 25.
    Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med 336:1541–1547CrossRefPubMedGoogle Scholar
  26. 26.
    Wilson MS, Deans GT, Brough WA (1995) Prospective trial comparing Lichtenstein with laparoscopic tension-free mesh repair of inguinal hernia. Br J Surg 82:274–277CrossRefPubMedGoogle Scholar
  27. 27.
    The MRC Laparoscopic Groin Hernia Trial Group (1999) Laparoscopic versus open repair of groin hernia: a randomised comparison. Lancet 354:185–190CrossRefGoogle Scholar
  28. 28.
    Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382CrossRefPubMedGoogle Scholar
  29. 29.
    Kald A, Anderberg B, Carlsson P, Park PO, Smedh K (1997) Surgical outcome and cost-minimisation-analyses of laparoscopic and open hernia repair: a randomised prospective trial with one year follow up. Eur J Surg 163:505–510PubMedGoogle Scholar
  30. 30.
    Khoury N (1998) A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Tech A 8:367–372CrossRefPubMedGoogle Scholar
  31. 31.
    Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D (1998) Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 317:103–110CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Savarise MT, Simpson JP, Moore JM, Leis VM (2001) Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair. Surg Endosc 15:574–578CrossRefPubMedGoogle Scholar
  33. 33.
    Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 25:234–239CrossRefPubMedGoogle Scholar
  34. 34.
    Juul P, Christensen K (1999) Randomized clinical trial of laparoscopic versus open inguinal hernia repair. Br J Surg 86:316–319CrossRefPubMedGoogle Scholar
  35. 35.
    Kald A, Anderberg B, Smedh K, Karlsson M (1997) Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparosc Endosc 7:86–89CrossRefPubMedGoogle Scholar
  36. 36.
    Schmedt CG, Daubler P, Leibl BJ, Kraft K, Bittner R (2002) Simultaneous bilateral laparoscopic inguinal hernia repair: an analysis of 1336 consecutive cases at a single center. Surg Endosc 16:240–244CrossRefPubMedGoogle Scholar
  37. 37.
    Lau H, Patil NG, Yuen WK (2003) A comparative outcome analysis of bilateral versus unilateral endoscopic extraperitoneal inguinal hernioplastics. J Laparoendosc Adv Surg Tech A 13:153–157CrossRefPubMedGoogle Scholar
  38. 38.
    Kald A, Domeij E, Landin S, Wiren M, Anderberg B (2000) Laparoscopic hernia repair in patients with bilateral groin hernias. Eur J Surg 166:210–212CrossRefPubMedGoogle Scholar
  39. 39.
    Pawanindra L, Philips P, Chander J, Ramteke VK (2010) Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair. Surg Endosc 24:1737–1745CrossRefGoogle Scholar
  40. 40.
    Knook MT, Weidema WF, Stassen LP, van Steensel CJ (1999) Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias. Surg Endosc 13:507–511CrossRefPubMedGoogle Scholar
  41. 41.
    Lau H (2004) Endoscopic totally extraperitoneal inguinal hernioplasty for recurrence after open repair. ANZ J Surg 74:877–880CrossRefPubMedGoogle Scholar
  42. 42.
    Bringman S, Wollert S, Osterberg J, Heikkinen T (2005) Early results of a randomized multicenter trial comparing Prolene and VyproII mesh in bilateral endoscopic extraperitoneal hernioplasty (TEP). Surg Endosc 19:536–540CrossRefPubMedGoogle Scholar
  43. 43.
    Heikkinen T, Wollert S, Osterberg J, Smedberg S, Bringman S (2006) Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hernia 10:34–40CrossRefPubMedGoogle Scholar
  44. 44.
    Chowbey PK, Garg N, Sharma A, Khullar R, Soni V, Baijal M, Mittal T (2010) Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc 24:3073–3079CrossRefPubMedGoogle Scholar
  45. 45.
    Langenbach MR, Schmidt J, Ubrig B, Zirngibl H (2008) Sixty-month follow-up after endoscopic inguinal hernia repair with three types of mesh: a prospective randomized trial. Surg Endosc 22:1790–1797CrossRefPubMedGoogle Scholar
  46. 46.
    Garg P, Nair S, Shereef M, Thakur JD, Nain N, Menon GR, Ismail M (2011) Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India. Surg Endosc 25:3300–3306CrossRefPubMedGoogle Scholar
  47. 47.
    Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 245:222–231CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Olmi S, Scaini A, Erba L, Guaglio M, Croce E (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142:40–46CrossRefPubMedGoogle Scholar
  49. 49.
    Tran H, Turingan I, Tran K, Zajkowska M, Lam V, Hawthorne W (2014) Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 18:731–744CrossRefPubMedGoogle Scholar
  50. 50.
    Deans GT, Wilson MS, Brough WA (1998) Controlled trial of preperitoneal local anaesthetic for reducing pain following laparoscopic hernia repair. Br J Surg 85:1013–1014CrossRefPubMedGoogle Scholar
  51. 51.
    Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg 136:917–921CrossRefPubMedGoogle Scholar
  52. 52.
    Ottesen M, Sorensen M, Kehlet H, Ottesen B (2003) Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scand 82:359–366CrossRefPubMedGoogle Scholar
  53. 53.
    Tolver MA, Strandfelt P, Bryld EB, Rosenberg J, Bisgaard T (2012) Randomized clinical trial of dexamethasone versus placebo in laparoscopic inguinal hernia repair. Br J Surg 99:1374–1380CrossRefPubMedGoogle Scholar
  54. 54.
    Currie A, Andrew H, Tonsi A, Hurley PR, Taribagil S (2012) Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis. Surg Endosc 26:2126–2133CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mette Astrup Tolver
    • 1
  • Jacob Rosenberg
    • 1
  • Thue Bisgaard
    • 2
  1. 1.Department of Surgery, Herlev HospitalUniversity of CopenhagenHerlevDenmark
  2. 2.Department of Surgery, Hvidovre HospitalUniversity of CopenhagenHvidovreDenmark

Personalised recommendations