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A PROSPECTIVE NON‐RANDOMIZED STUDY OF 737 CONSECUTIVE CASES OF LAPAROSCOPIC INGUINAL/FEMORAL HERNIA REPAIR: SUPERIORITY OF THE LAPAROSCOPIC EXTRAPERITONEAL APPROACH BY A SPECIALIST HERNIOLOGIST
Author(s) -
Tran H. M.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04119_6.x
Subject(s) - medicine , urinary retention , surgery , inguinal hernia , prospective cohort study , hernia , laparoscopy , hernia repair , incidence (geometry) , general surgery , physics , optics
Laparoscopic hernia repair remains controversial. This study aims to assess its safety and efficacy by a specialist herniologist. Materials and Methods A prospective assessment of all patients referred from 1st January 2002 to 31st December 2006 for laparoscopic extra‐peritoneal inguinal/femoral hernia repair was undertaken. Polypropylene mesh was used prior to June 2004 and light weight mesh after. Patients were followed up for 5 years. Results There were 737 hernias performed in 525 patients (including 34 recurrent and 78 Workers Compensation cases) with a median age of 51 years. Mean operation time was 48 minutes for unilateral and 65 minutes for bilateral. Mean follow‐up was 3 years with one recurrence. Conversion to open operation occurred in 4 patients. Day surgery was achieved in 92% of cases with most of those staying overnight for social reasons. There was no mortality. Morbidity was low: 2 cases of urinary retention, 1 case of minor urethral bleeding and 3 cases of pneumomediastinum. Return to work/resumption of full activities occurred at a mean of 14 days. Significant chronic pain occurred in 4 patients (1 with light weight mesh) and all settled with Carbamazepine or Neurontin. Conclusions Laparoscopic inguinal/femoral hernia repair can safely be performed as day cases with zero mortality, minimal morbidity, early resumption of physical activities and low recurrence. The use of light weight mesh resulted in fewer cases of chronic pain. Preoperative catheterization seemed to reduce incidence of urinary retention. Careful preoperative counseling achieved identical resumption of physical activities/work with Workers’ Compensation cases.