Laparoscopic totally extra-peritoneal groin hernia repair with self-gripping polyester mesh: a series of 780 repairs.

BACKGROUND: Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post-operative pain and infection. Post-operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self-gripping mesh, has a theoretical benefit of avoiding tacks for mesh-fixation. This case series reflects our long-term experience of this technique. METHODS: We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re-operation as primary data points. RESULTS: A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self-gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo-hernia repairs (0.38%). Post-operative follow-up was up to 4.4 years. CONCLUSIONS: Our series of laparoscopic groin hernia repair with self-gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.

Torsion of omental fibrous pseudotumour mimicking acute appendicitis.

Unusual pathologies are occasionally found at laparoscopy when appendicitis is suspected. We present a case of strangulated inflammatory fibrous pseudotumour of the omentum presenting in a similar fashion to appendicitis. The infarcted omentum was excised, facilitating prompt resolution of symptoms.

Laparoscopic Totally Extraperitoneal Groin Hernia Repair Using a Self-Gripping Mesh: Clinical Results of 235 Primary and Recurrent Groin Hernias.

INTRODUCTION: Compared with open surgery, laparoscopic groin hernia repair has been shown to significantly reduce postoperative pain. However, chronic pain remains a problem with the laparoscopic approach, affecting approximately 10% of patients. The purpose of this study was to evaluate clinical outcomes following the use of Parietex ProGrip™ (Covidien, Dublin, Ireland) self-gripping mesh during laparoscopic totally extraperitoneal groin hernia repair. MATERIALS AND METHODS: Data were collected prospectively from 145 male and 15 female patients with 235 inguinal hernias. All patients underwent repair by the laparoscopic totally extraperitoneal approach using Parietex ProGrip mesh. During follow-up ranging from 5 to 24 months, complications, pain score, patient satisfaction, and recurrence were analyzed. RESULTS: All patients were discharged on the day of surgery or the next morning. There were no immediate complications or returns to the operating room. Delayed postoperative complications included minor bruising to the genital region (3 cases), hematoma/seroma (1 case), and wound infection (1 case). The mean follow-up was 15 months, at which time there were no reports of hernia recurrence and 99% of patients were satisfied with their hernia repair. One patient (0.63%) reported severe pain (numeric rating scale score of >7), and 4 patients (2.5%) reported intermittent mild pain on exertion. CONCLUSIONS: The results of this study suggest that the use of a self-gripping mesh during the laparoscopic totally extraperitoneal approach is a promising and effective technique for repairing both primary and recurrent inguinal hernias.

Operation for adult patent ductus arteriosus using an aortic stent-graft technique.

Patent ductus arteriosus is a condition usually diagnosed and treated in childhood but in some instances is not detected until adult life. Although surgical closure remains the accepted treatment in most cases, stent-grafting has emerged as a possible alternative treatment for persistent ductus arteriosus in the adult. We describe a case of elective repair of a patent ductus arteriosus using an aortic stent-graft technique in a young man. Successful use of the endoprosthetic approach may allow more widespread use of this technique in adult patent ductus arteriosus.