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Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches

PURPOSE: International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position...

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Autores principales: Reinhorn, M., Fullington, N., Agarwal, D., Olson, M. A., Ott, L., Canavan, A., Pate, B., Hubertus, M., Urquiza, A., Poulose, B., Warren, J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Paris 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931785/
https://www.ncbi.nlm.nih.gov/pubmed/36125632
http://dx.doi.org/10.1007/s10029-022-02680-0
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author Reinhorn, M.
Fullington, N.
Agarwal, D.
Olson, M. A.
Ott, L.
Canavan, A.
Pate, B.
Hubertus, M.
Urquiza, A.
Poulose, B.
Warren, J.
author_facet Reinhorn, M.
Fullington, N.
Agarwal, D.
Olson, M. A.
Ott, L.
Canavan, A.
Pate, B.
Hubertus, M.
Urquiza, A.
Poulose, B.
Warren, J.
author_sort Reinhorn, M.
collection PubMed
description PURPOSE: International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position or both. Further research evaluating posterior mesh placement using open preperitoneal techniques is recommended. A potential benefit of open preperitoneal repair is the avoidance of general anesthesia, as these repairs can be performed under local anesthesia. This study compares clinical and patient-reported outcomes after unilateral laparo-endoscopic, robotic, and open posterior mesh IHRs. METHODS: We performed a propensity score matched analysis of patients undergoing IHR between 2012 and 2021 in the Abdominal Core Health Quality Collaborative registry. 10,409 patients underwent a unilateral IHR via a posterior approach. Hernia repairs were performed via minimally invasive surgery (MIS) which includes laparoscopic and robotic transabdominal preperitoneal (TAPP), laparoscopic totally extraperitoneal (TEP), or open transrectus preperitoneal/open preperitoneal (TREPP/OPP) approaches. Propensity score matching (PSM) utilizing nearest neighbor matching accounted for differences in baseline characteristics and possible confounding variables between groups. We matched 816 patients in the MIS cohort with 816 patients in the TREPP/OPP group. Outcomes included patient reported quality of life, hernia recurrence, and postoperative opioid use. RESULTS: Improvement was seen after TREPP/OPP as compared to MIS IHR in EuraHS at 30 days (Median(IQR) 7.0 (2.0–16.64) vs 10 (2.0–24.0); OR 0.69 [0.55–0.85]; p = 0.001) and 6 months (1.0 (0.0–4.0) vs 2.0 (0.0–4.0); OR 0.63 [0.46–85]; p = 0.002), patient-reported opioid use at 30-day follow-up (18% vs 45% OR 0.26 [0.19–0.35]; p < 0.001), and rates of surgical site occurrences (0.8% vs 4.9% OR 0.16 [0.06–0.35]; p < 0.001). There were no differences in EuraHS scores and recurrences at 1 year. CONCLUSIONS: This study demonstrates a potential benefit of open posterior mesh placement over MIS repair in short-term quality of life and seroma formation with equivalent rates of hernia recurrence. Further study is needed to better understand these differences and determine the reproducibility of these findings outside of high-volume specialty centers. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10029-022-02680-0.
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spelling pubmed-99317852023-02-17 Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches Reinhorn, M. Fullington, N. Agarwal, D. Olson, M. A. Ott, L. Canavan, A. Pate, B. Hubertus, M. Urquiza, A. Poulose, B. Warren, J. Hernia Original Article PURPOSE: International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position or both. Further research evaluating posterior mesh placement using open preperitoneal techniques is recommended. A potential benefit of open preperitoneal repair is the avoidance of general anesthesia, as these repairs can be performed under local anesthesia. This study compares clinical and patient-reported outcomes after unilateral laparo-endoscopic, robotic, and open posterior mesh IHRs. METHODS: We performed a propensity score matched analysis of patients undergoing IHR between 2012 and 2021 in the Abdominal Core Health Quality Collaborative registry. 10,409 patients underwent a unilateral IHR via a posterior approach. Hernia repairs were performed via minimally invasive surgery (MIS) which includes laparoscopic and robotic transabdominal preperitoneal (TAPP), laparoscopic totally extraperitoneal (TEP), or open transrectus preperitoneal/open preperitoneal (TREPP/OPP) approaches. Propensity score matching (PSM) utilizing nearest neighbor matching accounted for differences in baseline characteristics and possible confounding variables between groups. We matched 816 patients in the MIS cohort with 816 patients in the TREPP/OPP group. Outcomes included patient reported quality of life, hernia recurrence, and postoperative opioid use. RESULTS: Improvement was seen after TREPP/OPP as compared to MIS IHR in EuraHS at 30 days (Median(IQR) 7.0 (2.0–16.64) vs 10 (2.0–24.0); OR 0.69 [0.55–0.85]; p = 0.001) and 6 months (1.0 (0.0–4.0) vs 2.0 (0.0–4.0); OR 0.63 [0.46–85]; p = 0.002), patient-reported opioid use at 30-day follow-up (18% vs 45% OR 0.26 [0.19–0.35]; p < 0.001), and rates of surgical site occurrences (0.8% vs 4.9% OR 0.16 [0.06–0.35]; p < 0.001). There were no differences in EuraHS scores and recurrences at 1 year. CONCLUSIONS: This study demonstrates a potential benefit of open posterior mesh placement over MIS repair in short-term quality of life and seroma formation with equivalent rates of hernia recurrence. Further study is needed to better understand these differences and determine the reproducibility of these findings outside of high-volume specialty centers. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10029-022-02680-0. Springer Paris 2022-09-20 2023 /pmc/articles/PMC9931785/ /pubmed/36125632 http://dx.doi.org/10.1007/s10029-022-02680-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Reinhorn, M.
Fullington, N.
Agarwal, D.
Olson, M. A.
Ott, L.
Canavan, A.
Pate, B.
Hubertus, M.
Urquiza, A.
Poulose, B.
Warren, J.
Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title_full Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title_fullStr Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title_full_unstemmed Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title_short Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
title_sort posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931785/
https://www.ncbi.nlm.nih.gov/pubmed/36125632
http://dx.doi.org/10.1007/s10029-022-02680-0
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