Pain and quality of life after laparoscopic transabdominal preperitoneal hernioplasty with different ways of fixing the peritoneum. Results of early completion randomized clinical trial

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OBJECTIVE

To compare and statistically evaluate the severity of pain syndrome and quality of life depending on the method of fixation of the parietal peritoneum during laparoscopic hernia repair (suture fixation or the use of tack fixation).

METHODS

A randomized clinical trial was conducted from May to June 2021 at the Lomonosov Moscow State University Medical Center. It was planned to observe patients for a year. In the first group, the fixation of the parietal peritoneum was performed using suture fixation, in the second group, the peritoneal flap was fixed using a fixation device. In the course of statistical data processing, it was planned to study the dependence of the duration of the operation, the severity of the pain syndrome in the early postoperative period, the frequency of complications, the quality of life of patients in the postoperative period on the chosen method of the fixation of the parietal peritoneum.

RESULTS

At the initial stage of the study, 8 patients with inguinal hernias were selected in the first group during randomization, and 6 patients were selected in the second group. Each patient of the second group in the early postoperative period had a more pronounced local pain, protective muscle tension in the projection of fixation of the parietal peritoneum with tacks, which was accompanied by negative psychoemotional reactions, an increase in the dose of analgesic drugs. Due to the revealed features of the early postoperative period in patients of second group, it was considered unethical and inappropriate to continue the study within the protocol.

CONCLUSION

The results obtained do not allow us to draw statistically supported conclusions. The solution of the problem of the peritoneal flap fixation method is possible in two ways: abandoning stapler fixation in favor of suture or conducting additional clinical studies with an analysis of the impact of the choice of peritoneal fixation technique not only on acute and chronic postoperative pain, but on quality of life in the early and delayed postoperative periods.

Keywords:

inguinal hernia

laparoscopic hernia repair

TAPP

peritoneal fixation

peritoneal flap

inguinal pain

quality of life

Authors:

Agapov M.A.

Lomonosov Moscow State University

Kakotkin V.V.

Lomonosov Moscow State University

SPIN RSCI: 4162-0600
ORCID: 0000-0003-0352-2317

Gallyamov E.A.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-6359-0998

Kubyshkin V.A.

Lomonosov Moscow State University

Received:

27.01.2022

Accepted:

20.02.2022

List of references:

Wagner JP, Brunicardi CF, Amid PK. Iguinal Hernias Schwartz’s Princeples of Surgery. 10-th edition. In: Brunicardi CF, editor. New York: In chief. McGraw Hill publishing; 2016:1510-1517.
Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am. 2003;83(5):1045-1051, v-vi. https://doi.org/10.1016/S0039-6109(03)00132-4
Mikhin IV, Polyakov AA, Kosivtsov OA, Ryaskov LA. Endoscopic surgery and laparoscopy are new insights of evolution of inguinal hernia repair (in Russian only). Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2019;(3):121-128. (In Russ., In Engl.). https://doi.org/10.17116/hirurgia2019031121
HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165. https://doi.org/10.1007/s10029-017-1668-x
Richmond BK, Totten C, Roth JS, Tsai J, Madabhushi V. Current strategies for the management of inguinal hernia: What are the available approaches and the key considerations? Curr Probl Surg. 2019;56(10):100646. https://doi.org/10.1016/j.cpsurg.2019.100646
Köckerling F, Simons MP. Current Concepts of Inguinal Hernia Repair. Visc Med. 2018;34(2):145-150. https://doi.org/10.1159/000487278
S. Scott Davis, Jr, Gregory Dakin, Andrew Bates. The SAGES Manual of Hernia Surgery. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Springer International Publishing; 2019;XV:680. https://doi.org/10.1007/978-3-319-78411-3
Sukhinin AA, Petrovsky AN. Minimally invasive correction of anatomical features of anterior abdominal wall and ventral hernias. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020;(10):88-94. (In Russ.). https://doi.org/10.17116/hirurgia202010188
Bjurström MF, Irwin MR, Chen DC, Smith MT, Montgomery A. Sex Differences, Sleep Disturbance and Risk of Persistent Pain Associated With Groin Hernia Surgery: A Nationwide Register-Based Cohort Study. J Pain. 2021;22(11):1360-1370. https://doi.org/10.1016/j.jpain.2021.04.008
Gallyamov EA, Agapov MA, Busyrev YuB, Kakotkin VV, Kubyshkin VA, Donchenko KA, Gadlevskiy GS, Wu Z. Outcomes of various techniques of mesh prosthesis fixation in laparoscopic hernia repair. Khirurgiya. 2021;(1):34-41. (In. Russ.). https://doi.org/10.17116/hirurgia202101134
Egiev VN, Voskresenskiy PK. Herniae. Medpraktika-M. (In Russ.).
Bittner R, Arregui ME, Bisgaard T. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of in- guinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25:2773-2843.
Moldovanu R, Pavy G. Laparoscopic Transabdominal Pre-Peritoneal (TAPP) procedure — step-by-step tips and tricks. Chirurgia (Bucur). 2014;109(3):407-415.
Sazhin AV, Klimiashvili AD, Kochiay E. The technical characteristics and immediate results of laparoscopy transperitoneal and total extra-peritoneal hernioplasty. Rossiiskii meditsinskii zhurnal (Medical Journal of the Russian Federation, Russian journal). 2016;22(3):125-129. (In Russ.). https://doi.org/10.18821/0869-2106-2016-22-3-125-129
Shatari T, Nozawa K, Mieno K, Kodaira S. A new method of peritoneal closure following laparoscopic herniorrhaphy. Surg Today. 1998;28(8):866-867. https://doi.org/10.1007/s005950050244
Zhu Y, Liu Y, Wang M. A New Suture Technique for Peritoneal Flap Closure in TAPP: A Prospective Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech. 2020;30(1):18-21. https://doi.org/10.1097/SLE.0000000000000706
Chihara N, Suzuki H, Sukegawa M, Watanabe M, Oyama R, Shimizu T, Uchida E. Absorbable barbed suture device for laparoscopic peritoneal closure after hernia repair via the transabdominal preperitoneal approach: A single-center experience with 257 cases. Asian J Endosc Surg. 2019;12(2):162-166. https://doi.org/10.1111/ases.12626
Thalheimer A, Vonlanthen R, Ivanova S, Stoupis C, Bueter M. Mind the gap — Small bowel obstruction due to preperitoneal herniation following laparoscopic inguinal hernia repair — A case report. Int J Surg Case Rep. 2021;88:106532. https://doi.org/10.1016/j.ijscr.2021.106532
Oguz H, Karagulle E, Turk E, Moray G. Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study. Hernia. 2015;19(6):879-885. https://doi.org/10.1007/s10029-015-1431-0
Ross SW, Oommen B, Kim M, Walters AL, Augenstein VA, Heniford BT. Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life. Surg Endosc. 2015;29(7):1686-1693. https://doi.org/10.1007/s00464-014-3857-3
Ross SW, Groene SA, Prasad T, Lincourt AE, Kercher KW, Augenstein VA, Todd Heniford B. Does peritoneal flap closure technique following transabdominal preperitoneal (TAPP) inguinal hernia repair make a difference in postoperative pain? A long-term quality of life comparison. Surg Endosc. 2017;31(6):2548-2559. https://doi.org/10.1007/s00464-016-5258-2
Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ. Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg. 2012;215(5):635-642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412
Heniford BT, Lincourt AE, Walters AL, Colavita PD, Belyansky I, Kercher KW, Sing RF, Augenstein VA. Carolinas Comfort Scale as a Measure of Hernia Repair Quality of Life: A Reappraisal Utilizing 3788 International Patients. Ann Surg. 2018;267(1):171-176. https://doi.org/10.1097/SLA.0000000000002027
Köckerling F. What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair? A Systematic Review. Front Surg. 2018;5:57. https://doi.org/10.3389/fsurg.2018.00057
Chen LS, Chen WC, Kang YN, Wu CC, Tsai LW, Liu MZ. Effects of transabdominal preperitoneal and totally extraperi- toneal inguinal hernia repair: an update systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2019;33:418-428.
Sazhin AV, Klimiashvili AD, Ivakhov GB, Kotchiay E. The laparoscopic transabdominal preperitoneal hernioplasty in case of inguinal-scrotal hernia. Rossiiskii meditsinskii zhurnal (Medical Journal of the Russian Federation, Russian journal). 2016;22(4):177-179. (In Russ.). https://doi.org/10.18821/0869-2106-2016-22-4-177-179
Tolver MA, Strandfelt P, Forsberg G, Hjørne FP, Rosenberg J, Bisgaard T. Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair. Surgery. 2012;151(4):556-563. https://doi.org/10.1016/j.surg.2011.08.020

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