Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_842_Библиотеки_им_академика_М_И_Перельмана.pdf
Perioperative Management ofLaparoscopic Inguinal Hernia Repair
73
8
drug, given in a timely manner, seems to be optimal and provides sucient analgesic during the
early recovery phase provided that there is no
contraindication [55, 86].
Opioids may cause adverse eects such as
nausea, vomiting, and constipation, among others, which may delay postoperative recovery.
erefore, non-opioid analgesics should be used
whenever possible. However, opioids can be used
for moderate- or high-intensity pain, in addition
to non-opioid analgesia or when the combination
of an NSAID, and paracetamol is not sucient or
is contraindicated [124].
Whether extraperitoneal local anesthesia treatment administered aer the mesh placement in
endoscopic hernia repair is useful remains unclear.
A RCT [10] recommends to consider it’s use, while
a large meta-analysis regarding the same issue says
that an extraperitoneal bupivacaine treatment is
not more ecacious for the reduction of postoperative pain than placebo [115].
8.3.9 Discharge Management
Discharging the patient aer the surgical procedure means either to go home or to stay in a
nearby hotel on the same day (DC) or aer one or
two nights at ward regarding the patient’s condition (SST). It is necessary to follow an individual
approach for making the decision depending on
the medical evaluation of the patient resources.
See also 7 Sect. 8.3. Day Care (DC) or ShortStay Treatment (SST).
Discharge planning begins on the preoperative consultation prior to a patient’s admission to
the hospital/the hernia center. Patients will be
asked about their needs for the recovery period in
advance of an elective surgery.
Discharge planning is a service to assist
patients in arranging the care needed following a
hospital stay as well as to monitor the hospital stay
to ensure that optimal care is delivered in the
most ecient and cost-eective manner.
e discharge planner will collaborate with
the patient and their family, the therapy team, and
the physician to ensure that the patient’s discharge
needs are identied, and the patient is transitioned to the appropriate setting.
e discharge planner can assist with providing information and referrals to community agencies, assist with transitions to skilled nursing
facilities or long-term care facilities, and provide
information for home care services, rehabilitative
care, and out-patient medical treatment as well as
provide assistance obtaining needed home medical equipment.
When needed a social worker case manager
can collaborate with an interdisciplinary team
and community agencies to coordinate care across
the healthcare continuum.
e administratory case manager works
closely with the physicians and the insurance
companies to ensure that the patient’s hospital
stay is meeting medical guidelines and that insurance will provide nancial reimbursement.
Insurance regulations and strict federal and state
laws require continuous monitoring of the
patient’s treatment and length of stay to ensure the
level of care is appropriate.
e requirements for a successful discharge of
patients are:
5 Uninterrupted supply of medicines including
weekends
5 Prescription of remedies as necessary
5 Prescription of home care as necessary
5 Certicate of disability
5 Scheduled postoperative consultation
5 Emergency management aer discharge
(accessibility)
5 Continuous registration (Herniamed) data
input
5 Discharge information (handout)
Discharge information (FAQ) should contain the
following items and should be handed out to
every patient already while the preoperative consultation:
5 Partial physical resilience 2weeks aer
surgery: easy jogging and bicycling are
allowed.
5 Full physical resilience 4weeks aer surgery.
5 Showering allowed immediately aer
surgery: (water may reach the surgical
wounds).
5 Change of wound dressing.
5 Drug management: Analgetics,
Antithrombotics, “Bridging of
Antitrhrombotics”.
5 Certicate of disability.
5 Emergency call aer discharge: Hernia Center,
Hospital, General Emergency Call 112.
5 Scheduling post-op consultation: Phone
number Hernia Center.
74
H. Niebuhr et al.
A Cochrane database systematic review revealed
that the evidence suggests that a discharge plan
tailored to the individual patient probably brings
about reductions in hospital length of stay and
readmission rates for older people admitted to
case of severe testicular pain in terms of genito-
femoral syndrome, local inltrations of bucain
and dexamethason should be considered.
(For late postoperative pain control options,
see related 7 Chap. 17.)
hospital with a medical condition. e impact of
discharge planning on mortality, health outcomes,
and cost remains uncertain [108].
8.4.4 Timing thePeriod ofDisability
Combined information sheets and questionnaires are helpful in the successful realization of a
discharge management [29, 36].
e certicate of disability is even handed out by
the general practitioner or by the Hernia Center.
e length of disability depends on the patient’s
profession. When performing physical work it
8.4 Surgical Consultation at
Hernia Center (Post-op)
may take up to 4weeks before returning to the
job.
ere is strong evidence that endoscopic
8.4.1 Clinical Examination
8
When the patient presents at the scheduled postoperative consultation about 1 week aer discharge, a clinical examination is undertaken
containing a wound inspection, the examination
of the surgical site/inguinal region and the abdomen for swelling, pain, signs of infection, and/or
dysfunction.
inguinal hernia repair leads to signicant shorter
times of disability. Dierent meta-analyses
revealed that aer an open mesh procedure,
patients recovered 4days earlier on average than
aer a conventional repair and recovered 7days
earlier on average following an endoscopic operation than aer an open technique with mesh [17,
18, 23, 28, 45, 49, 66, 68, 80, 104, 107]. e main
cause of prolonged recovery is predominantly
pain [24].
8.4.2 Postoperative Dynamic
Inguinal Ultrasound (DIUS)
Aer the clinical examination, an ultrasound
examination is performed routinely with the aim
of depicting the correct position of the mesh, of
swellings, e.g., pseudo recurrence by hematoma of
the inguinal cord, testicular blood supply, and or
abnormal tissue ndings. e ultrasound is performed according to the above-described fourstep technique.
See also 7
Sect. 8.1.2 Dynamic Inguinal
Ultrasound (DIUS).
8.4.3 Late Postoperative
Pain Control
Normally, a prescribed postoperative analgetic
therapy is no longer requested as 3days to 1week.
In our practice in case of longer-lasting inguinal
pain, the rst choice of therapy is the administration of NSAID continuously when necessary in
combination with PPI for about 2 to 3 weeks. In
8.4.5 Documentation andData
Input toRegistry
e documentation of the postoperative consultation and the data input to registry (Herniamed)
are nalizing the postoperative surgical consultation.
A last report sent to the GP is completing the
surgical treatment of the patient in case of no further complaints.
References
1. Aga E, etal. Surgical site infections after abdominal
surgery: incidence and risk factors. A prospective
cohort study. Infect Dis (Lond). 2015;47(11):761–7.
2. Alabraba E, Psarelli E, Meakin K, Quinn M, Leung M,
Hartley M, etal. The role of ultrasound in the management of patients with occult groin hernias. Int J Surg
[Internet] England. 2014.; [cited 2015 Jan 9];12(9):
918–22.
3. Alam A, Nice C, Uberoi R.The accuracy of ultrasound in
the diagnosis of clinically occult groin hernias in
adults. Eur Radiol [Internet]. 2005;15(12):2457–61.
Perioperative Management ofLaparoscopic Inguinal Hernia Repair
75
8
4. Anwar S, Scott P.Current practice for anticoagulation
prophylaxis in inguinal hernia surgery: a questionnaire survey. N Z Med J. 2003;116(1181):U583.
5. Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F,
Vinet E, etal. Comparison between ultrasound- guided
transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open
inguinal hernia repair. Br J Anaesth England.
2011;106(3):380–6.
6. Fachgesellschaften, A.d.W.M., S3-Leitlinie Prophylaxe
der venösen Thromboembolie. AWMF Leitlinienregister Nr. 003/001, 2015.
7. Baca I, etal. Prevention of thromboembolism in minimal invasive interventions and brief inpatient treatment. Results of a multicenter, prospective,
randomized, controlled study with a low molecular
weight heparin. Chirurg. 1997;68(12):1275–80.
8. Balthazar ER, Colt JD, Nichols RL. Preoperative hair
removal: a random prospective study of shaving versus clipping. South Med J. 1982;75(7):799–801.
9. Bambrah RK, Pham DC, Rana F.Argatroban in heparininduced thrombocytopenia: rationale for use and place
in therapy. Ther Adv Chronic Dis. 2013;4(6):302–4.
10. Bar-Dayan A, Natour M, Bar-Zakai B, Zmora O, Shabtai
M, Ayalon A, Kuriansky J. Preperitoneal bupivacaine
attenuates pain following laparoscopic inguinal hernia repair. Surg Endosc. 2004;18(7):1079–81. Epub
2004 May 27.
11. Barile A, Erriquez D, Cacchio A, De Paulis F, Di Cesare E,
Masciocchi C.Groin pain in athletes: role of magnetic
resonance. Radiol Med. 2000;100(4):216–22.
12. Beaussier M, Weickmans H, Paugam C, etal. A randomized, double-blind comparison between parecoxib
sodium and propacetamol for parenteral postoperative analgesia after inguinal hernia repair in adult
patients. Anesth Analg. 2005;100:1309–15. https://doi.
org/10.1213/01.ANE.0000150972.88708.13
13. Bischo JM, Koscielniak-Nielsen ZJ, Kehlet H, Werner
MU. Ultrasound-guided ilioinguinal/iliohypogastric
nerve blocks for persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebocontrolled, crossover trial. Anesth Analg United States.
2012;114(6):1323–9.
14. International guidelines for groin hernia management. Hernia Surge Group. Hernia. 2018;22(1):1–165.
15. Bittner R, etal. Guidelines for laparoscopic (TAPP) and
endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc.
2011;25(9):2773–843.
16. Bittner R, Schmedt CG, Leibl BJ, Schwarz J. Early
postoperative and one year results of a randomized
controlled trial comparing the impact of extralight
titanized polypropylene mesh and traditional heavyweight polypropylene mesh on pain and seroma production in laparoscopic hernia repair (TAPP). World
J Surg. 2011;35(8):1791–7. https://doi.org/10.1007/
s00268-011-1148-x.
17. Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg.
2012;397(2):271–82. https://doi.org/10.1007/s00423-011-
0875-7. Epub 2011 Nov 25.
18. Bittner R, Sauerland S, Schmedt CG. Comparison of
endoscopic techniques vs Shouldice and other open
nonmesh techniques for inguinal hernia repair: a
meta-analysis of randomized controlled trials. Surg
Endosc. 2005;19:605–15.
19. Bjork I, Lindahl U. Mechanism of the anticoagulant
action of heparin. Mol Cell Biochem. 1982;48(3):161–82.
20. Bradley M, Morgan D, Pentlow B, Roe A. The groin
hernia- an ultrasound diagnosis? Ann R Coll Surg Engl
England. 2003;85(3):178–80.
21. Bradley M, Morgan J, Pentlow B, Roe A.The positive
predictive value of diagnostic ultrasound for occult
Herniae. Ann R Coll Surg Engl. 2006;88(2):165–7.
22. Beitland S, etal. Thromboprophylaxis with low molecular weight heparin versus unfractionated heparin in
intensive care patients: a systematic review with metaanalysis and trial sequential analysis. Intensive Care
Med. 2015;41(7):1209–19.
23. Bringman S, et al. Tension-free inguinal hernia repair:
TEP versus mesh-plug versus Lichtenstein: a prospective
randomized controlled trial. Ann Surg. 2003;237:142–7.
24. Callesen T. Inguinal hernia repair: anaesthesia, pain
and convalescence. Dan Med Bull. 2003;50:203–18.
25. Chen L-C, Elliott R.A, Ashcroft DM.Systematic review
of the analgesic ecacy and tolerability of COX-2
inhibitors in post-operative pain control. J Clin Pharm
Ther. 2004;29(3):215–29. https://doi.org/10.1111/
j.1365-2710.2004.00558.x.
26. Cherian PT, Parnell AP.The diagnosis and classication
of inguinal and femoral hernia on multisection spiral
CT.Clin Radiol England. 2008;63(2):184–92.
27. Chuang YJ, etal. Heparin enhances the specicity of antithrombin for thrombin and factor Xa independent of the
reactive center loop sequence. Evidence for an exosite
determinant of factor Xa specicity in heparin-activated
antithrombin. J Biol Chem. 2001;276(18):14961–71.
28. Chung RS, Rowland DY.Meta-analyses of randomized
controlled trials of laparoscopic vs conventional inguinal hernia repairs. Surg Endosc. 1999;13:689–94.
29. CMS, Centers for Medicare and Medicaid Services. Your
discharge planning checklist. https://www.medicare.
gov/Pubs/pdf/11376.pdf.
30. Counsell C, Sandercock P. Low-molecular- weight
heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Cochrane
Database Syst Rev. 2001(4):Cd000119. 31.
31. Davies KE, Houghton K, Montgomery JE.Obesity and
day-case surgery. Anaesthesia. 2001;56(11):1112–5.
https://doi.org/10.1111/j.1365-2044.2001.1962-5.x.
32. Depasquale R, Landes C, Doyle G.Audit of ultrasound
and decision to operate in groin pain of unknown
aetiology with ultrasound technique explained. Clin
Radiol. 2009;64:608–14.
33. Drew MK, Osmotherly PG, Chiarelli PE. Imaging and
clinical tests for the diagnosis of long-standing groin
pain in athletes. A systematic review. Phys Ther Sport
[Internet]. 2014. [cited 2014 Dec 4];15(2):124–9.
34. Dueholm S, Forrest M, Hjortso E, Lemvigh E.Pain relief
following herniotomy: a double-blind randomized
comparison between naproxen and placebo. Acta
Anaesthesiol Scand. 1989;33:391–4.
76
H. Niebuhr et al.
35. Engbaek J, Bartholdy J, Hjortsø N-C. Return hospital
visits and morbidity within 60 days after day surgery: a
retrospective study of 18,736 day surgical procedures.
Acta Anaesthesiol Scand. 2006;50(8):911–9. https://
doi.org/10.1111/j.1399-6576.2006.01090.x.
36. Facharztklinik Hamburg. Ermittlung des poststationären Hilfebedarfs. FO-21, Version: 03, Stand
08.05.2013.
37. Farquharson EL.Early ambulation; with special reference to herniorrhapy as an outpatient procedure. Lancet. 1955;269:517–9.
38. Garner JP, Patel S, Glaves J, Ravi K.Is herniography useful? Hernia France. 2006;10(1):66–9.
39. Garvey JFW.Computed tomography scan diagnosis of
occult groin hernia. Hernia. 2012;16(3):307–14.
40. Geerts WH, etal. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3
Suppl):338S–400S.
41. Geuens G, Bellinck P, Mulkens T, Salgado R, de Gheldere C, Vanclooster P, et al. Revisiting the role of
8
herniography in the preoperative work-up of groin
hernias? Acta Chir Belg Belgium. 2011;111(6):370–3.
42. Go P, Rutten C, Grasveld-van Berkel M, van Montfort
A.Dagbehandeling in Nederland. Utrecht: Lemma; 2002.
43. Goulbourne IA, Ruckley CV. Operations for hernia and varicose veins in a day-bed unit. Br Med J.
1979;2(6192):712–4.
44. Grant T, Neuschler E, Hartz W 3rd. Groin pain in
women: use of sonography to detect occult hernias. J
Ultrasound Med United States. 2011;30(12):1701–7.
45. Grant AM. Laparoscopic versus open groin hernia
repair: meta-analysis of randomised trials based on
individual patient data. Hernia. 2002;6:2–10.
46. Hakeem A, Shanmugam V. Current trends in the
diagnosis and management of post-herniorraphy
chronic groin pain. World J Gastrointest Surg China.
2011;3(6):73–81.
47. Handoll HH, et al. Heparin, low molecular weight
heparin and physical methods for preventing deep
vein thrombosis and pulmonary embolism following
surgery for hip fractures. Cochrane Database Syst Rev.
2002;(4):Cd000305.
48. Hawn MT, etal. Timing of surgical antibiotic prophylaxis and the risk of surgical site infection. JAMA Surg.
2013;148(7):649–57.
49. Heikkinen TJ, Haukipuro K, Hulkko A. A cost and
outcome comparison between laparoscopic and
Lichtenstein hernia operations in a day-case unit.
A randomized prospective study. Surg Endosc.
1998;12:1199–203.
50. Henriksen NA, Thorup J, Jorgensen LN. Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia. Hernia.
2012;16(4):381–5.
51. Holzheimer RG.Laparoscopic procedures as a risk factor of deep venous thrombosis, supercial ascending
thrombophlebitis and pulmonary embolism--case
report and review of the literature. Eur J Med Res.
2004;9(9):417–22.
52. Horan TC, etal. CDC denitions of nosocomial surgical site infections, 1992: a modication of CDC deni-
tions of surgical wound infections. Am J Infect Control.
1992;20(5):271–4.
53. Hureibi KA, GR ML, Kidambi AV.Is herniography useful
and safe? Eur J Radiol [Internet]. 2011. [cited 2014 Oct
5];80(2):e86–90.
54. Jarrett PEM. Day care surgery. Eur J Anaesthesiol.
2001;18(S23):32–5. https://doi.org/10.1046/j.1365-
2346.2001.018s23032.x.
55. Joshi GP, Rawal N, Kehlet H, et al. Evidence- based
management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg.
2012;99(2):168–85. https://doi.org/10.1002/bjs.7660.
56. Kahn SR, et al. Compression stockings to prevent
post-thrombotic syndrome: a randomised placebocontrolled trial. Lancet. 2014;383(9920):880–8.
57. Kim B, Robinson P, Modi H, Gupta H, Horgan K, Achuthan R.Evaluation of the usage and inuence of groin
ultrasound in primary and secondary healthcare settings. Hernia. 2015;19:367–71.
58. Kitami M, Takase K, Tsuboi M, Rikimaru Y, Hakamatsuka T, Yamada T, etal. Dierentiation of femoral and
inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional
computed tomography. J Comput Assist Tomogr
United States. 2009;33(5):678–81.
59. Kjønniksen I, Andersen BM, Søndenaa VG, Segadal
L. Preoperative hair removal-a systematic literature
review. AORN J. 2002;75(5):928–38. 940.
60. Knebel P, etal. Evidence-based antibiotic prophylaxis in
general and visceral surgery. Chirurg. 2011;82(3):227–34.
61. Köckerling F, Roessing C, Adolf D, Schug-Pass C, Jacob
D.Has endoscopic (TEP, TAPP) or open inguinal hernia
repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the
Herniamed registry. Surg Endosc. 2015;30(5):2073–81.
https://doi.org/10.1007/s00464-015-4456-7.
62. Kockerling F, et al. Do we need antibiotic prophylaxis
in endoscopic inguinal hernia repair? Results of the
Herniamed registry. Surg Endosc. 2015;29(12):3741–9.
63. König A, Bode H, Herold M. Therapiekonzepte zur
Schmerztherapie im BKB Abteilung für Anästhesie
2011/2. Revision 1.6.2014.
64. Korenkov M, Paul A, Troidl H. Color duplex sonography: diagnostic tool in the dierentiation of inguinal
hernias. J Ultrasound Med. 1999;18(8):565–8.
65. Kraft BM, Kolb H, Kuckuk B, Haaga S, Leibl BJ, Kraft K,
etal. Diagnosis and classication of inguinal hernias.
Surg Endosc. 2003;17(12):2021–4.
66. Kuhry E, et al. Open or endoscopic total extraperitoneal inguinal hernia repair? a systematic review. Surg
Endosc. 2007;21:161–6.
67. Kulstad E, Pittman L, Konicki PJ. Ultrasound in the
diagnosis of incarcerated hernia. Int J Emerg Med.
2003;1(1). https://doi.org/10.5580/2229.
68. Lau H, Patil NG, Yuen WK. Day-case endoscopic totally
extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in
males: a randomized trial. Surg Endosc. 2006;20(1):76–81.
https://doi.org/10.1007/s00464-005-0203-9.
69. LeBlanc KE, LeBlanc LL, LeBlanc KA. Inguinal hernias:
diagnosis and management. Am Fam Physician [Internet]. 2013;87(12):844–8.
Perioperative Management ofLaparoscopic Inguinal Hernia Repair
77
8
70. Lechner M, Fortelny R, Ofner D, Mayer F. Suspected
inguinal hernias in pregnancy-handle with care! Hernia. 2013;18(3):375–9. [Epub ahead of print].
71. Light D, Ratnasingham K, Banerjee A, Cadwallader R,
Uzzaman MM, Gopinath B.The role of ultrasound scan
in the diagnosis of occult inguinal hernias. Int J Surg.
2011;9(2):169–72. 201
72. Lilly MC, Arregui ME.Ultrasound of the inguinal oor for
evaluation of hernias. Surg Endosc. 2002;16(4):659–62.
73. Linkins LA, etal. Treatment and prevention of heparininduced thrombocytopenia: antithrombotic therapy
and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e495S–530S.
74. Lorenzini C, Soa L, Pergolizzi FP, Trovato M. The
value of diagnostic ultrasound for detecting occult
inguinal hernia in patients with groin pain. Chir Ital.
2008;60(6):813–7.
75. Madura JA, Madura JA 2nd, Copper CM, Worth RM.Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg. 2005;189(3):283–7.
76. Majholm B, Engbæk J, Bartholdy J, etal. Is day surgery
safe? A Danish multicentre study of morbidity after
57,709 day surgery procedures. Acta Anaesthesiol Scand.
2012;56(3):323–31. https://doi.org/10.1111/j.1399-6576.
2011.02631.x.
77. Marien T, Taouli B, Telegra S, Babb J, Lepor H. Optimizing the detection of subclinical inguinal hernias in
men undergoing open radical retropubic prostatectomy. BJU Int. 2010;106(10):1468–72.
78. Mattila K, Vironen J, Eklund A, Kontinen VK, Hynynen
M.Randomized clinical trial comparing ambulator y and
inpatient care after inguinal hernia repair in patients
aged 65 years or older. Am J Surg. 2011;201:179–85.
https://doi.org/10.1016/j.amjsurg.2010.04.024
79. McCormack K, Scott NW, Go PM, Ross S, Grant AM.Laparoscopic techniques versus open techniques for
inguinal hernia repair. Cochrane Database Syst Rev.
2003;1:CD001785. https://doi.org/10.1002/14651858.
CD001785.
80. McCormack K, et al. Laparoscopic surgery for inguinal
hernia repair: systematic review of eectiveness and
economic evaluation. Health Technol Assess. 2005;9:1–iv.
81. Medina M, etal. Risk factors of surgical wound infection in patients undergoing herniorrhaphy. Eur J Surg.
1997;163(3):191–8.
82. Michelsen MWF.Comparison of outpatient and inpatient operations for inguinal hernia (1971 to 1978)
(author’s transl). [Article in German]. Zentralbl Chir.
1982;107(2):94–102.
83. Miller J, Cho J, Michael MJ, Saouaf R, Towgh S.Role
of imaging in the diagnosis of occult hernias. JAMA
Surg [Internet]. 2014;149(10):1077–80. [cited 2014 Oct
5];25141884.
84. Moro ML, Carrieri MP, Tozzi AE, Lana S, Greco D. Risk
factors for surgical wound infections in clean surgery:
a multicenter study. Italian PRINOS study group. Ann
Ital Chir. 1996;67(1):13–9.
85. Murphy KP, O’Connor OJ, Maher MM. Adult abdominal hernias. AJR Am J Roentgenol [Internet].
2014;202(6):W506–11. Available from: http://www.ncbi.
nlm.nih.gov/pubmed/24848843.
86. Ong CKS, Seymour RA, Lirk P, Merry AF. Combining
paracetamol (acetaminophen) with nonsteroidal antiinammatory drugs: a qualitative systematic review of
analgesic ecacy for acute postoperative pain. Anesth
Analg. 2010;110(4):1170–9. https://doi.org/10.1213/
ANE.0b013e3181cf9281.
87. Orchard JW, Read JW, Neophyton J, Garlick D. Groin
pain associated with ultrasound nding of inguinal
canal posterior wall deciency in Australian rules footballers. Br J Sports Med. 1998;32(2):134–9.
88. Orlando G, etal. One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: a randomized, controlled clinical trial. Surgery.
2015;157(1):104–10.
89. Pawlak M, Niebuhr H, Bury K.Dynamic inguinal ultrasound: a diagnostic tool for hernia surgeons. Letter to
the editor. Hernia 2015;19(6):1033–4. doi: https://doi.
org/10.1007/s10029-015-1356-7.
90. Pilkington SA, Rees M, Jones O, Green I. Ultrasound
diagnosis of round ligament varicosities mimicking
inguinal hernias in pregnancy. Ann R Coll Surg Engl.
2004;86(5):400–1. PMID: 12831490 [PubMed- indexed
for MEDLINE] PMCID: PMC1964363.
91. Pineault R, Contandriopoulos AP, Valois M, Bastian
ML, Lance JM. Randomized clinical trial of one- day
surgery. Patient satisfaction, clinical outcomes, and
costs. Med Care. 1985;23(2):171–82. https://doi.
org/10.1097/00005650-198502000-00008.
92. Poelman MM, van den Heuvel B, Deelder JD, Abis GS,
Beudeker N, Bittner RR, Campanelli G, van Dam D,
Dwars BJ, Eker HH, Fingerhut A, Khatkov I, Koeckerling
F, Kukleta JF, Miserez M, Montgomery A, Munoz Brands
RM, Morales Conde S, Muysoms FE, Soltes M, Tromp
W, Yavuz Y, Bonjer HJ. EAES consensus development
conference on endoscopic repair of groin hernias. Surg
Endosc. 2013;27(10):3505–19. https://doi.org/10.1007/
s00464-013-3001.
93. Prabhu A, Chung F. Anaesthetic strategies towards
developments in day care surgery. Eur J Anaesthesiol
Suppl. 2001;23:36–42. https://doi.org/10.1046/j.1365-
2346.2001.018s23036.x.
94. Prescott RJ, Cutherbertson C, Fenwick N, Garraway
WM, Ruckley CV.Economic aspects of day care after
operations for hernia or varicose veins. J Epidemiol
Community Health. 1978;32(3):222–5.
95. Primatesta P, Goldacre MJ. Inguinal hernia repair:
incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):
835–9.
96. Quinlan DJ, Eriksson BI.Novel oral anticoagulants for
thromboprophylaxis after orthopaedic surgery. Best
Pract Res Clin Haematol. 2013;26(2):171–82.
97. Ramyil VM, Ognonna BC, Iya D.Patient acceptance of
outpatient treatment for inguinal hernia in Jos. Nigeria
Cent Afr J Med. 1999;45(9):244–6.
98. Rath NK, et al. The use of rivaroxaban for chemical
thromboprophylaxis following total knee replacement. Knee. 2013;20(6):397–400.
99. Robinson A, Light D, Kasim A, Nice C. A systematic
review and meta-analysis oft he role of radiology in
the diagnosis of occult inguinal hernia. Surg Endosc.
2013;27(1):11–8.
78
H. Niebuhr et al.
100. Robinson P, Hensor E, Lansdown MJ, Ambrose NS, Chapman AH. Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features. AJR
Am J Roentgenol [Internet]. 2006;187(5):1168–78.
101. Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T,
Juul P, etal. Danish hernia database recommendations
for the management of inguinal and femoral hernia in
adults. Dan Med Bull [Internet]. 2011;58(2):C4243.
102. Sanchez-Manuel FJ, Lozano-Garcia J, Seco-Gil
JL.Antibiotic prophylaxis for hernia repair. Cochrane
Database Syst Rev. 2012;2:CD003769.
103. Sanjay P, Jones P, Woodward A. Inguinal hernia
repair: are ASA grades 3 and 4 patients suitable for
day case hernia repair? Hernia. 2006;10(4):299–302.
https://doi.org/10.1007/s10029-005-0048-0.
104. Schmedt CG, Sauerland S, Bittner R. Comparison of
endoscopic procedures vs Lichtenstein and other
open mesh techniques for inguinal hernia repair: a
meta-analysis of randomized controlled trials. Surg
Endosc. 2005;19:188–99.
105. Schulz SL, et al. Graduated compression stockings
8
for the prevention of venous thromboembolism in
surgical patients in the age of low molecular
weight heparins. J Thromb Haemost. 2005;3(10):
2363–5.
106. Schurr MJ, Faucher LD. A prospective, randomized,
comparative trial of a COX-2 selective nonsteroidal
anti-inammatory drug versus placebo in inguinal
herniorrhaphy patients. Hernia. 2009;13:491–7.
https://doi.org/10.1007/s10029-009-0489-y
107. Scott NW, et al. Open mesh versus non-mesh for
repair of femoral and inguinal hernia. Cochrane
Database Syst Rev. 2002;6(3):130–6. CD002197.
108. Shepperd S, Lannin NA, Clemson LM, McCluskey A,
Cameron ID, Barras SL.Discharge planning from hospital to home. Cochrane Database Syst Rev.
2013;1:CD000313. https://doi.org/10.1002/14651858.
CD000313.pub4.
109. Shirasaka W, Toriyama S, Tsujikawa S, Yamashita T,
Tani Y, Ikeshita K. Use of urbiprofen before emergence from anesthesia relieves pain during immediate postoperative period after laparoscopic inguinal
hernia repair. Masui. 2015;64(1):60–4.
110. Shpitz B, Kuriansky J, Werener M, Osadchi A, Tiomkin
V, Bugayev N, etal. Early postoperative evaluation of
groins after laparoscopic total extraperitoneal repair
of inguinal hernias. J Laparoendosc Adv Surg Tech A
United States. 2004;14(6):353–7.
111. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL,
Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S,
Nordin P, Schumpelick V, Smedberg S, Smietanski M,
Weber G, Miserez M.European hernia society guidelines on the treatment of inguinal hernia in adult
patients. Hernia. 2009;13(4):343–403. https://doi.
org/10.1007/s10029-009-0529-7. Epub 2009 Jul 28
112. Tanner J, Norrie P, Melen K.Preoperative hair removal
to reduce surgical site infection. Cochrane Database
Syst Rev. 2011;9(11):CD004122. https://doi.org/10.
1002/14651858.CD004122.pub4.
113. Tanner J, Moncaster K, Woodings D. Preoperative
hair removal: a systematic review. J Perioper Pract.
2007;17(3):118–21. 124-32.
114. Tolver MA, Rosenberg J, Bisgaard T.Early pain af ter laparoscopic inguinal hernia repair. A qualitative systematic
review. Acta Anaesthesiol Scand. 2012;56(5):549–57.
https://doi.org/10.1111/j.1399-6576.2011.02633.x.
Epub 2012 Jan 19.
115. Tong YS, Wu CC, Bai CH, Lee HC, Liang HH, Kuo LJ, Wei
PL, Tam KW. Eect of extraperitoneal bupivacaine
analgesia in laparoscopic inguinal hernia repair: a
meta-analysis of randomized controlled trials. Hernia. 2014;18(2):177–83. https://doi.org/10.1007/
s10029-013-1100-0. Epub 2013 May 5.
116. Treasure T, Hill J.NICE guidance on reducing the risk
of venous thromboembolism in patients admitted to
hospital. J R Soc Med. 2010;103(6):210–2.
117. Turaga K, Wright A, Lee R, etal. A randomized trial of
the peri-operative use of COX-2 inhibitors in Lichtenstein herniorrhaphy. Hernia. 2008;12:515–9. https://
doi.org/10.1007/s10029-008-0379-8
118. Tzovaras G, Symeonidis D, Koukoulis G, Baloyiannis I,
Georgopoulou S, Pratsas C, Zacharoulis D. Longterm results after laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair under spinal
anesthesia. Hernia. 2012;16(6):641–5. https://doi.
org/10.1007/s10029-012-0934-1. Epub 2012 Jun 24.
119. van den Berg JC, de Valois JC, Go PM, Rosenbusch
G.Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic ndings. Invest Radiol. 1999;34(12):739–43.
120. Wacha H, Hoyme U, Isenmann R, Kujath P, Lebert C,
Naber K, Salzberger B. Perioperative AntibiotikaProphylaxe Empfehlungen einer Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie
e. V.Chemotherapie J. 2010;19(3):70–84.
121. Warkentin TE, et al. A spontaneous prothrombotic
disorder resembling heparin-induced thrombocytopenia. Am J Med. 2008;121(7):632–6.
122. Weber WP, etal. The timing of surgical antimicrobial
prophylaxis. Ann Surg. 2008;247(6):918–26.
123. Whalen HR, Kidd GA, O’Dwyer PJ.Easily missed? femoral hernias. BMJ. 2001;343:d7668. Published 8 December 2011.
124. Wheeler M, Oderda GM, Ashburn MA, Lipman
AG.Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3(3):
159–80. https://doi.org/10.1054/jpai.2002.123652.
125. Wilke T, etal. Oral anticoagulation after major hip or
knee replacement surgery: a process-driven managerial pharmacoeconomic analysis in German hospitals. Orthopade. 2008;37(5):448–56.
126. Young J, Gilbert AI, Graham MF. The use of ultrasound in the diagnosis of abdominal wall hernias.
Hernia. 2007;11(4):347–51.
127. Zweigner J, M.A.P, Haag LM, Gebhardt S, Meyer E,
Gastmeier P.Systematic review and evidence based
guidance on perioperative antibiotic prophylaxis.
Eur Ctr Dis Prev Control. 2013.
Transabdominal
Preperitoneal Patch
Plasty (TAPP):
Standard Technique
andSpecic Risks
ReinhardBittner, JanF.Kukleta, andDavidChen
9.1 Introduction–80
9.1.1 Indication forTAPP–80
9.1.2 Instruments–81
9.1.3 Operative Room Setup–81
9.1.4 Key Points ofTechnique–82
9.1.5 Implantation ofWorking Trocars–82
79
9
9.2 Evidence-Based Management inTAPP –91
9.2.1 Preparation ofthePatient–91
9.2.2 Establishing Pneumoperitoneum–91
9.2.3 Trocar Choice, Placement, andPositioning–93
9.2.4 Special Technical Remarks–93
9.2.5 Mesh Choice, Mesh Size, Mesh Slit, andMesh
Fixation–94
9.2.6 Comments–94
9.2.7 Peritoneal Closure–95
9.2.8 Port-Site Closure–95
9.2.9 Conclusion onTechnical Key Points inTAPP Repair–96
9.3 Specic Risks–96
References (in parentheses graduation
of evidence)–97
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
R. Bittner et al. (eds.), Laparo-endoscopic Hernia Surgery,
https://doi.org/10.1007/978-3-662-55493-7_9
80
R. Bittner et al.
9.1 Introduction
continuous improvement of the technique (transabdominal preperitoneal patch plasty (TAPP))
About 25years aer the rst description of a reliable
technique in laparoscopic inguinal hernia repair
which must be precisely standardized, reproducible, and reliable.
[1], the penetration rate of this new technique is
still below 20% in most countries. e reasons for
the slow acceptance of laparoscopic hernioplasty
9.1.1 Indication forTAPP
are rstly that the technique is estimated as dicult
and time demanding, secondly that life-threatening
complications are feared, and thirdly that higher
costs in comparison to open surgery are expected.
Most of these concerns date back to the early days
of laparoscopic surgery. Meanwhile knowledge and
skills have increased enormously. It is well proven
that using a strictly standardized technique and
being well trained, laparoscopic hernia repair may
be simple, safe, and cheap to perform.
Key feature in the process to make laparo-
scopic inguinal hernia repair more popular is the
TAPP can be used on any type of inguinal hernia
(. Fig.9.1a, b), with the exception of huge, non-
reducible scrotal hernia (more than double the
size of a man’s st) if experience is present. In our
patient pool with more than 1100 hernia repairs
yearly, TAPP can be applied to about 98% of the
cases [2]. Preconditions for a successful operation
are deep knowledge of anatomy, fully standardized
technique, precise operative strategy, visualization
of operative steps, and mental simulation of an
ideal operation.
9
a
b
. Fig.9.1 a, b Scrotal hernias with completely removed huge hernia sacs
5 mm
7 mm
5 mm
Transabdominal Preperitoneal Patch Plasty (TAPP): Standard Technique
81
9
9.1.2 Instruments
5 Veress needle
5 Two 5mm trocars
5 One 7mm trocar
5 30° camera (5mm)
5 Two endo-graspers (Overholt, Maryland)
5 One endo-scissor (Metzenbaum)
5 Blunt dissector (Reddick-Olsen)
5 Gauze for hemostasis
5 Dissection swab (Kelly)
5 Endoscopic needle holder
All the trocars and instruments used by us are
non-disposable except the 7 mm working trocar (. Fig.9.2). It is important that the trocars
should have perforators not cutting through the
tissue; we use trocars with a blunt, a conical tip,
and a radially expanding effect. With this design
we saw significant less bleeding from the trocar
site and less port-site hernias later on. EndoOverholt and endo-scissor have a connection
to monopolar electrocoagulation. In case of
large hernia sac, the dissection is carried out
using two Endo- Overholts like a rope ladder.
We recommend the Reddick-Olsen atraumatic
forceps to push the mesh which is fixed at one
edge by the clamp through the 7mm trocar.
The use of a 30° optic allows better view behind
some structures like the plica umbilicalis medialis (inspection of spatium Retzius) or down to the
lateral retroperitoneum when doing the parietalization. Mostly not lockable instruments are
used. The peritoneum is closed with running
suture.
9.1.3 Operative Room Setup
e patient is supine and at on the operating
table when installing the pneumoperitoneum.
During operation the patient is placed into a
Trendelenburg position and turned at an angle of
about 15° to the surgeon. e surgeon stands on
the side opposite to the hernia; the camera assistant
is sitting on the ipsilateral side of the hernia. Both
of the patient arms are positioned at the side of
the body, so that in case of bilateral hernia, the
surgeon can easily change sides. e monitor is
placed at the foot of the patient.
. Fig.9.2 Trocars and
position in bilateral hernias
MCL MCL
5mm 30° optic
82
R. Bittner et al.
We Do Not Use a Urinary Catheter e patient is
ordered to evacuate the urinary bladder immediately before leaving for the operating theater.
Should a full bladder be found during laparoscopy,
however, a suprapubic urinary catheter can be
inserted via percutaneous puncture.
9.1.4 Key Points ofTechnique
Creation ofPneumoperitoneum
andPlacement ofTrocars
A lot of techniques are described promising more
safety for the patients; however, a systematic
review could not demonstrate a signicant difference in safety and eectiveness of the dierent
methods of establishing pneumoperitoneum [3, 4].
Routinely we use the Veress needle and perform
all the safety tests (snap, slurp, and aspiration
tests) according to Semm [5]. Initially, a longi-
9
tudinal skin incision about 5mm long is made
in the region of the center of the umbilicus. e
edges of the wound with the abdominal layers are
held under maximum tension (with the help of
two Backhaus clamps), and the Veress needle is
inserted under careful monitoring, as described
by Semm (. Fig.9.3). It is important to develop
special feeling when perforating the dierent layers
of the abdominal wall (snap test).
Despite lack of evidence proving their useful-
ness, we are convinced the careful performance
of safety tests can help to minimize the danger for
lesion of intra-abdominal organs when doing this
rst “blind” step of the operation at least due to
continuous reminder that these serious complications can happen. Furthermore, beginning with
the insuations, the intra-abdominal pressure
and the rate of gas ow must be monitored carefully. Pressure must initially be 0mmHg, and the
gas ow must be 2–3L CO2/min. If something is
wrong (e.g., at the beginning already high pressure and low ow), stop insuation, check the
position of the needle, or change to open access
(Hasson). In patients being aer previous perium-
bilical surgery, there are two possibilities: (1) Insert
Veress needle at the palmer point (just below the le
costal margin, midclavicular line (MCL)). (2) Start
with an open access (Hasson) at the umbilicus.
When intra-abdominal pressure reaches
12 mmHg and aspiration test is regular, then the
optical trocar is inserted again under countertension of abdominal wall with the help of the Backhaus
. Fig.9.3 Creation of pneumoperitoneum (snap test)
clamps. is trocar is inserted in the direction of the
center of the naval with slightly forth and back rotating movements, the most eective way to avoid slipping of the trocar on the fascia.
9.1.5 Implantation ofWorking
Trocars
ree possibilities:
1. Use of a 10mm optical trocar (umbilicus) and
two 5mm working trocars. Position– in bilateral
hernia midclavicular line at the level of umbilicus, perforating rectus muscle. Advantage– bet-
ter cosmesis. Disadvantage– mesh, needles, and
gauze can only be introduced blindly via the
optic trocar, and this needs more time.
2. Alternatively use of a 5mm trocar on the
le side of the patient and on the right side a
10/12mm trocar. Disadvantage– worse cosmesis and some danger for trocar hernia later
on. Advantage– easy and rapid introduction
of meshes, gauzes, needle holder with needle,
or hernia stapling instruments if needed.