Laparoscopic Total Extraperitoneal Repair and Open Prolene Hernia System for Inguinal Hernia Repair Have Similar Outcomes: A Retrospective Study.

OBJECTIVE: To compare the results of Laparoscopic total extraperitoneal inguinal hernia repair (LTEPR) and the open prolene hernia system repair (OPHSR), in terms of complications, postoperative pain and quality of life. Background: Inguinal hernia repair is one of the most frequent surgeries made by general surgeons. Although, with the technological development and scientific advances even today it is not possible to define which is the gold standard procedure to hernia repair. Material and Methods: For this observational study, all 577 consecutive patients who underwent hernia repair were included in the study, 293 LTEPR, and 284 OPHSR. The average age for OPHSR was 62.49 years and for LTEPR 55.35 years. The average follow-up of 38.10 months, the mean operative time for OPHSR was 55.58 minutes and for LTEPR was 45.46 minutes, with a hospital stay of 1.1 and 1.08 respectively. Results: Each type of hernia was classified according to Gilbert/Rutcow-Robbins criteria, resulting in the OPHSR, 80.28 % were assigned to class 1 to 3 and only 19.72% in class 4 to 7. In the LTEPR, 52.22% of the patients are classified in degree 1 to 3 and 47.78% were class 4 to 7. In the LTEPR group there was more complications with 9 cases of bleeding controlled at the same time, one tear of the bladder, no other visceral complications; in the OPHSR group, there were fewer complications with significant differences (p= .014). The postoperative complications, principally hematoma, and seroma were the most common complication without statistic differences. The postoperative pain was in the OPHSR group, 77.46% of patients reported suffering from mild or pain-free pain, 21.47% reported moderate pain, and 1.05% reported severe pain, in the LTEPR group 74.4% of patients reported mild pain, 25.25% reported moderate pain and only one patient reported severe pain, without significant differences. In both groups, the patients reported a high index of satisfaction, and in the LTEPR group scare results were better than OPHSR (p .001). CONCLUSION: The outcomes of LTEPR are similar to OPHSR. However, LTEPR has shorter operative time, more intraoperative complications and better scar satisfaction.

Laparoscopic partial nephrectomy using a flexible CO2 laser fiber.

BACKGROUND AND OBJECTIVES: Laparoscopic partial nephrectomy (LPN) is a challenging surgery that requires precise tissue cutting and meticulous hemostasis under warm ischemia conditions. In this study, we tested the feasibility of performing LPN using CO2 laser energy transmitted through a specialized flexible mirror optical fiber. METHODS: General anesthesia and pneumoperitoneum were induced in 7 farm pigs. Various portions of a kidney, either a pole or a midportion of the kidney, were removed using a novel flexible fiber to transmit CO2 laser energy set at a power of 45W and energy per pulse of 100mJ. The collecting system was approximated with a suture or 2, but no hemostatic measures were taken besides applying a few pulses of the laser to bleeding points. The pigs were sacrificed 3 wk later. RESULTS: Average renal mass removed was 18% of the total kidney weight. All pigs tolerated surgery well. Sharp renal cutting was accomplished in a single continuous incision, with minimal tissue charring and minimal blood loss (<10cc) in all animals. Necropsy revealed no peritoneal or retroperitoneal abnormalities. Histologic examination of the cut surface showed a thin sector of up to 100 m of coagulation necrosis. CONCLUSIONS: We report on the first LPN done using a CO2 laser transmitted through a flexible fiber in an animal model. This novel application of the CO2 laser produced excellent parenchymal incision and hemostasis along with minimal damage to adjacent renal tissue, thus, potentially shortening ischemia time and kidney function loss. Further studies comparing this laser to standard technique are necessary to verify its usefulness for partial nephrectomy.

Obturator hernia as a frequent finding during laparoscopic pelvic exploration: A retrospective observational study.

Hernia through the obturator canal is usually unsuspected and hence undiagnosed. Patients with obturator hernias present as acute cases of intestinal obstruction secondary to strangulation or incarceration, with high rate of morbidity and mortality due to delayed diagnosis and treatment. The know incidence of obturator hernia is low, representing 0.073% (11 of 15,098) of all hernias repaired at the Mayo Clinic in a retrospective study of 15 years. In this study, we conducted a retrospective analysis of laparoscopic extraperitoneal hernia repairs that were performed between the years 2003 and 2007. All procedures were undertaken by 2 experienced surgeons who performed more than 150 previous surgeries. In 293 patients who underwent repair of bilateral or recurrent inguinal hernia, exploration of the obturator foramen was conducted looking for obturator hernia, which was found in 20 cases (6.82% of patients). The true incidence of obturator hernia is greater than that reported in the literature, and the chances of detecting hernia are greater if an equal number of men and women are scanned could be higher if pelvic scanning was performed.