Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial.
It is unknown at present what the best method is among mesh implantation, central incision, reconstructing the deep inguinal ring, or a non-incised mesh implant in laparoscopic hernia surgery. Further, it is unproven to what extent a circular enclosure of the cremasteric structures by an incised mesh implant could cause postoperative complications and complaints. To evaluate the possible effects of different configurations and fixation techniques of mesh implants in transperitoneal repair of inguinal hernias, a randomized trial (phase IIIa study) was conducted to compare incised versus non-incised mesh and clip fixation versus suturing the mesh. A total of 360 male patients with unilateral primary hernias were randomized to 3 groups. Postoperative complaints were documented by means of a visual analog scale. These values showed no significant differences between study arms. At the first postoperative control, on day 3, patients after repair of Nyhus type II hernias had significantly fewer complaints than those after Nyhus type IIIa and IIIb repair. To gain additional facts, a duplex flow examination of testicular vessels was performed pre- and postoperatively. Testicular perfusion was not influenced by mesh configurations in the trial. There were no statistical differences in postoperative complications and recurrence rates between groups. In conclusion no influence on postoperative complaints and complications could be demonstrated by different mesh fashioning and fixation alternatives studied in this trial.
Leibl
Bernhard J
BJ
Clinic for General and Visceral Surgery, Marienhospital, Böheimstrasse 37, D-70199, Stuttgart, Germany. bernhardleibl@vinzenz.de
Kraft
Barbara
B
Redecke
Jens Daniel
JD
Schmedt
Claus Georg
CG
Ulrich
Martin
M
Kraft
Klaus
K
Bittner
Reinhard
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
D000700:Analgesics