Laparoscopic inguinal herniorrhaphy: Results of a multicenter trial

Robert Joseph Fitzgibbons, José Camps, Douglas A. Cornet, Nam X. Nguyen, Bradley S. Litke, Riccardo Annibali, Giovanni M. Salerno

Research output: Contribution to journalArticle

286 Citations (Scopus)

Abstract

Objective: The purpose of this study was to determine if laparoscopic inguinal herniorrhaphy represents a viable alternative to the conventional repair and to assess whether a prospective randomized controlled trial comparing both procedures is warranted. Methods: Three types of laparoscopic inguinal herniorrhaphies (transabdominal preperitoneal [TAPP], intraperitoneal onlay mesh [IPOM], and totally extraperitoneal [EXTRA]) were studied in a phase II design. Twenty-one investigators from 19 institutions participated. Approval from the local human research committee was required at each institution before patients could be enrolled. Results: There were 686 patients with 869 hernias; 366 (42.1%) were direct, 414 (47.6%) were indirect, 22 (2.5%) were femoral, and 67 (7.7%) were combination hernias. The TAPP procedure was used for 562 hernias, the IPOM was used for 217 hernias, and the EXTRA was used for 87 hernias. Sixty-one patients had additional abdominal procedures performed at the time to laparoscopy without any adverse affects on their herniorrhaphies. The overall recurrence rate was 4.5%, with a minimum follow up of 15 months. Complications were divided into the following three groups: 1) those related to laparoscopy, 2) those related to the patient, and 3) those related to the herniorrhaphy. Complications related to the laparoscopy occurred in 5.4% of patients; bleeding or abdominal wall hematomas occurred 31 times, (two patients required transfusion); one patient had bowel perforation, which was sutured laparoscopically; a bladder injury required laparotomy for management. Patient complications occurred in 6.7%. The majority involved the urinary tract (5.8%). Two patients required secondary abdominal procedures for adhesions, one for pain in the right lower quadrant and the other for adhesive small bowel obstruction. Postoperative myocardial infarction on day 5 resulted in the only operative mortality, for a rate of 0.1%. Complications related to the herniorrhaphy itself occurred in 17.1%. Most of these were minor, consisting of transient groin pain (3.5%), seroma (3.5%), transient leg pain (3.3%), hematoma (1.5%), or transient cord or testicular problems (0.9%). The incidence of leg pain decreased dramatically as surgeons became more familiar with the anatomy of the nerve supply to the groin when viewed laparoscopically. Ninety-three percent of patients were discharged within 24 hours of their operations. Conclusions: Laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures. The TAPP, IPOM, and EXTRA procedures appear to be equally effective. A controlled randomized trial is needed to compare this procedure with conventional inguinal herniorrhaphy.

Original languageEnglish
Pages (from-to)3-13
Number of pages11
JournalAnnals of Surgery
Volume221
Issue number1
StatePublished - Jan 1995

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Groin
Herniorrhaphy
Multicenter Studies
Hernia
Inlays
Laparoscopy
Pain
Hematoma
Leg
Randomized Controlled Trials
Seroma
Inguinal Hernia
Abdominal Wall
Thigh
Urinary Tract
Adhesives
Laparotomy
Anatomy
Urinary Bladder
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Fitzgibbons, R. J., Camps, J., Cornet, D. A., Nguyen, N. X., Litke, B. S., Annibali, R., & Salerno, G. M. (1995). Laparoscopic inguinal herniorrhaphy: Results of a multicenter trial. Annals of Surgery, 221(1), 3-13.

Laparoscopic inguinal herniorrhaphy : Results of a multicenter trial. / Fitzgibbons, Robert Joseph; Camps, José; Cornet, Douglas A.; Nguyen, Nam X.; Litke, Bradley S.; Annibali, Riccardo; Salerno, Giovanni M.

In: Annals of Surgery, Vol. 221, No. 1, 01.1995, p. 3-13.

Research output: Contribution to journalArticle

Fitzgibbons, RJ, Camps, J, Cornet, DA, Nguyen, NX, Litke, BS, Annibali, R & Salerno, GM 1995, 'Laparoscopic inguinal herniorrhaphy: Results of a multicenter trial', Annals of Surgery, vol. 221, no. 1, pp. 3-13.
Fitzgibbons RJ, Camps J, Cornet DA, Nguyen NX, Litke BS, Annibali R et al. Laparoscopic inguinal herniorrhaphy: Results of a multicenter trial. Annals of Surgery. 1995 Jan;221(1):3-13.
Fitzgibbons, Robert Joseph ; Camps, José ; Cornet, Douglas A. ; Nguyen, Nam X. ; Litke, Bradley S. ; Annibali, Riccardo ; Salerno, Giovanni M. / Laparoscopic inguinal herniorrhaphy : Results of a multicenter trial. In: Annals of Surgery. 1995 ; Vol. 221, No. 1. pp. 3-13.
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abstract = "Objective: The purpose of this study was to determine if laparoscopic inguinal herniorrhaphy represents a viable alternative to the conventional repair and to assess whether a prospective randomized controlled trial comparing both procedures is warranted. Methods: Three types of laparoscopic inguinal herniorrhaphies (transabdominal preperitoneal [TAPP], intraperitoneal onlay mesh [IPOM], and totally extraperitoneal [EXTRA]) were studied in a phase II design. Twenty-one investigators from 19 institutions participated. Approval from the local human research committee was required at each institution before patients could be enrolled. Results: There were 686 patients with 869 hernias; 366 (42.1{\%}) were direct, 414 (47.6{\%}) were indirect, 22 (2.5{\%}) were femoral, and 67 (7.7{\%}) were combination hernias. The TAPP procedure was used for 562 hernias, the IPOM was used for 217 hernias, and the EXTRA was used for 87 hernias. Sixty-one patients had additional abdominal procedures performed at the time to laparoscopy without any adverse affects on their herniorrhaphies. The overall recurrence rate was 4.5{\%}, with a minimum follow up of 15 months. Complications were divided into the following three groups: 1) those related to laparoscopy, 2) those related to the patient, and 3) those related to the herniorrhaphy. Complications related to the laparoscopy occurred in 5.4{\%} of patients; bleeding or abdominal wall hematomas occurred 31 times, (two patients required transfusion); one patient had bowel perforation, which was sutured laparoscopically; a bladder injury required laparotomy for management. Patient complications occurred in 6.7{\%}. The majority involved the urinary tract (5.8{\%}). Two patients required secondary abdominal procedures for adhesions, one for pain in the right lower quadrant and the other for adhesive small bowel obstruction. Postoperative myocardial infarction on day 5 resulted in the only operative mortality, for a rate of 0.1{\%}. Complications related to the herniorrhaphy itself occurred in 17.1{\%}. Most of these were minor, consisting of transient groin pain (3.5{\%}), seroma (3.5{\%}), transient leg pain (3.3{\%}), hematoma (1.5{\%}), or transient cord or testicular problems (0.9{\%}). The incidence of leg pain decreased dramatically as surgeons became more familiar with the anatomy of the nerve supply to the groin when viewed laparoscopically. Ninety-three percent of patients were discharged within 24 hours of their operations. Conclusions: Laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures. The TAPP, IPOM, and EXTRA procedures appear to be equally effective. A controlled randomized trial is needed to compare this procedure with conventional inguinal herniorrhaphy.",
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N2 - Objective: The purpose of this study was to determine if laparoscopic inguinal herniorrhaphy represents a viable alternative to the conventional repair and to assess whether a prospective randomized controlled trial comparing both procedures is warranted. Methods: Three types of laparoscopic inguinal herniorrhaphies (transabdominal preperitoneal [TAPP], intraperitoneal onlay mesh [IPOM], and totally extraperitoneal [EXTRA]) were studied in a phase II design. Twenty-one investigators from 19 institutions participated. Approval from the local human research committee was required at each institution before patients could be enrolled. Results: There were 686 patients with 869 hernias; 366 (42.1%) were direct, 414 (47.6%) were indirect, 22 (2.5%) were femoral, and 67 (7.7%) were combination hernias. The TAPP procedure was used for 562 hernias, the IPOM was used for 217 hernias, and the EXTRA was used for 87 hernias. Sixty-one patients had additional abdominal procedures performed at the time to laparoscopy without any adverse affects on their herniorrhaphies. The overall recurrence rate was 4.5%, with a minimum follow up of 15 months. Complications were divided into the following three groups: 1) those related to laparoscopy, 2) those related to the patient, and 3) those related to the herniorrhaphy. Complications related to the laparoscopy occurred in 5.4% of patients; bleeding or abdominal wall hematomas occurred 31 times, (two patients required transfusion); one patient had bowel perforation, which was sutured laparoscopically; a bladder injury required laparotomy for management. Patient complications occurred in 6.7%. The majority involved the urinary tract (5.8%). Two patients required secondary abdominal procedures for adhesions, one for pain in the right lower quadrant and the other for adhesive small bowel obstruction. Postoperative myocardial infarction on day 5 resulted in the only operative mortality, for a rate of 0.1%. Complications related to the herniorrhaphy itself occurred in 17.1%. Most of these were minor, consisting of transient groin pain (3.5%), seroma (3.5%), transient leg pain (3.3%), hematoma (1.5%), or transient cord or testicular problems (0.9%). The incidence of leg pain decreased dramatically as surgeons became more familiar with the anatomy of the nerve supply to the groin when viewed laparoscopically. Ninety-three percent of patients were discharged within 24 hours of their operations. Conclusions: Laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures. The TAPP, IPOM, and EXTRA procedures appear to be equally effective. A controlled randomized trial is needed to compare this procedure with conventional inguinal herniorrhaphy.

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