Abstract
Background
In experienced hands, laparoscopic inguinal hernia repair has a low rate of recurrence, but it still can recur, and a number of reasons for this have been identified. In published studies, the majority of such cases seem to result from inadequate dissection leading to missed hernias or suboptimal mesh placement. But even with adequate dissection and proper placement of a sufficiently large mesh, recurrence sometimes happens. A number of investigators have cited mesh migration or dislocation as a possible cause, and this study examined how hip flexion affects the position of newly placed meshes and staples in totally extraperitoneal (TEP) repair of inguinal hernia.
Methods
After completion of the dissection and reduction of discovered hernias, a 15 × 15-cm polypropylene mesh was placed either unilaterally or bilaterally, as indicated. The preperitoneal space then was desufflated. The operating table, in an extended −20° position during surgery, was placed in a 90° position for approximately 15 s. After reinsufflation, the possibility of mesh migration and folding was investigated. Finally, the mesh was stapled, the table again extended and flexed, and the possibility of mesh migration and staple dislodgement investigated once more.
Results
The mesh did not migrate or become displaced from any potential hernia area, nor did any of the staples become dislodged.
Conclusions
Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group.
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References
EH Collaboration (2000) ArticleTitleLaparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87 860–867 Occurrence Handle10931019
E Felix S Scott B Crafton P Geis T Duncan R Sewell B McKernan (1998) ArticleTitleCauses of recurrence after laparoscopic hernioplasty: a multicenter study. Surg Endosc 12 226–231
C Frankum B Ramshaw J White T Duncan R Wilson E Mason G Lucas J Promes (1999) ArticleTitleLaparoscopic repair of bilateral and recurrent hernias. Am Surg 65 839–843 Occurrence Handle1:STN:280:DyaK1MvhtFyrtQ%3D%3D Occurrence Handle10484086
MTT Knook PS Stassen HJ Bonjer (2001) ArticleTitleImpact of randomized trials on the application of endoscopic techniques for inguinal hernia repair in the Netherlands. Surg Endosc 15 55–58 Occurrence Handle10.1007/s004640000244 Occurrence Handle1:STN:280:DC%2BD3M7ptlSqtQ%3D%3D Occurrence Handle11178764
BJ Leibl P Daubler CG Schmedt K Kraft R Bittner (2000) ArticleTitleLong-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repair. Br J Surg 87 780–783 Occurrence Handle10848859
BJ Leibl C Schmedt K Kraft M Ulrich R Bittner (2000) ArticleTitleRecurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of reoperations. J Am Coll Surg 190 651–655 Occurrence Handle10.1016/S1072-7515(00)00262-3 Occurrence Handle1:STN:280:DC%2BD3czivFCjsg%3D%3D Occurrence Handle10872999
M Liem E Duyn Particlevan Y Graaf T Vroonhoven Particlevan (2003) ArticleTitleRecurrence after conventional anterior and laparoscopic inguinal hernia repair. Ann Surg 237 136–141 Occurrence Handle10.1097/00000658-200301000-00019 Occurrence Handle12496541
MS Liem Y Graaf Particlevan der CJ Steensel Particlevan RU Boelhouwer GJ Clevers WS Meijer LP Stassen JP Vente WF Weidema AJ Schrijvers TJ Vroonhoven Particlevan (1997) ArticleTitleComparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336 1541–1547 Occurrence Handle1:STN:280:ByiB1M7jsF0%3D Occurrence Handle9164809
AS Lowan CJ Filipi Jr Fitzgibbons RJ R Stoppa GE Wantz EL Felix WB Crafton (1997) ArticleTitleMechanisms of hernia recurrence after preperitoneal mesh repair: traditional and laparoscopic. Ann Surg 225 422–431 Occurrence Handle1:STN:280:ByiB28bptVA%3D Occurrence Handle9114802
EH Phillips R Rosenthal M Fallas B Carroll M Arregui J Corbitt R Fitzgibbons A Seid L Schultz F Toy (1995) ArticleTitleReasons for early recurrence following laparoscopic hernioplasty. Surg Endosc 9 144–145
B Ramshaw FW Shuler B Jones TD Duncan J White R Wilson GW Lucas EM Mason (2001) ArticleTitleLaparoscopic inguinal hernia repair: lessons learned after 1,224 consecutive cases. Surg Endosc 15 50–54 Occurrence Handle10.1007/s004640001016 Occurrence Handle1:STN:280:DC%2BD3M7ptlSqtA%3D%3D Occurrence Handle11178763
P Sayad G Ferzli (1999) ArticleTitleThe extraperitoneal approach and its utility. Surg Endosc 13 1168–1169 Occurrence Handle10.1007/s004649901199 Occurrence Handle1:STN:280:DC%2BD3c%2FivVChuw%3D%3D Occurrence Handle10556465
C Tamme H Scheidbach C Hampe C Schneider F Kockerling (2003) ArticleTitleTotally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc 17 190–195 Occurrence Handle10.1007/s00464-002-8905-8 Occurrence Handle1:STN:280:DC%2BD3s%2Fms12qsQ%3D%3D Occurrence Handle12457220
P Vanclooster B Smet C Gheldere Particlede K Segers (2001) ArticleTitleLaparoscopic inguinal hernia repair: review of 6 years experience. Acta Chir Belg 101 135–138 Occurrence Handle1:STN:280:DC%2BD3Mvls1ejsg%3D%3D Occurrence Handle11501389
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Choy, C., Shapiro, K., Patel, S. et al. Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair. Surg Endosc 18, 523–525 (2004). https://doi.org/10.1007/s00464-003-8183-0
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DOI: https://doi.org/10.1007/s00464-003-8183-0