Laparoscopic inguinal herniorrhaphy in a swine model. Third place winner of the Conrad Jobst Award in the Gold Medal paper competition.
A simplified method of laparoscopic inguinal herniorrhaphy using prosthetic materials was evaluated in a swine hernia model. The goals of this study were to determine 1) effectiveness of repair in a rapidly growing animal, 2) effectiveness and extent of adhesion formation of different prosthetic materials, 3) the effect of repair on testicular growth, and 4) histologic effects on the hernia site and surrounding structures. In a prospective randomized study, 30 juvenile male swine (average, 23 kg) with 35 congenital indirect inguinal hernias underwent laparoscopic herniorrhaphy using one of three prosthetic materials: Group 1 (polytetrafluoroethylene/Gore-Tex), N = 10; Group 2 (polypropylene mesh/Marlex), N = 10; Group 3 (polypropylene mesh/Prolene), N = 10. A standardized laparoscopic herniorrhaphy technique consisting of stapling prosthetic material over the hernia defect without peritoneal dissection was employed. During the 3-month postoperative period, animals were sequentially examined for normal growth and development, normal testicular development, and signs of hernia recurrence. Clinically apparent complications related to herniorrhaphy occurred in five animals (17%) during the observation period (one with repair failure, one with testicular torsion, two with repair failure and bowel obstruction, and one with intestinal obstruction secondary to adhesions). All three animals with bowel obstruction died. At 90 days after surgery all remaining animals (N = 27) were euthanized (Group 1 = 9, Group 2 = 8, Group 3 = 10). Average weight was 84 kg. Necropsy findings included no additional hernia recurrences, and one mesh erosion into the urinary bladder.(ABSTRACT TRUNCATED AT 250 WORDS)
Layman
T S
TS
Department of Surgery, University of Tennessee College of Medicine, Erlanger Medical Center, Chattanooga 37403.
Burns
R P
RP
Chandler
K E
KE
Russell
W L
WL
Cook
R G
RG
D000818:Animals; D001363:Awards and Prizes; D013502:General Surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D007410:Intestinal Diseases / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011095:Polyethylenes; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D012955:Societies, Medical; D015144:Southeastern United States; D013526:Surgical Mesh; D013552:Swine; D013737:Testis / Q000254:growth & development; D000267:Tissue Adhesions / Q000209:etiology
C016674:Plastipore; D011095:Polyethylenes; D011126:Polypropylenes; D011138:Polytetrafluoroethylene