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Published on: September 7, 2022
Femoral hernia repair
1Department of Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi-shi, Mie-ken 510-8567, Japan. thachi88@m2.cty-net.ne.jp
Insights
The PerFix mesh plug technique offers a superior approach to femoral hernia repair, significantly reducing recurrence rates and improving patient recovery times. This method is recommended for elective cases, ensuring fewer complications and shorter hospital stays.
Area of Science:
- Surgical innovation in hernia repair.
- Gastrointestinal surgery.
- Minimally invasive surgical techniques.
Background:
- Historical femoral hernia repair methods, including simple closure and the inguinal approach using Cooper's ligament, were associated with high recurrence and complication rates.
- Tension on approximated tissues in Cooper's ligament repair led to postoperative pain and prolonged recovery.
- The development of the plug technique by Lichtenstein, Gilbert, and Rutkow aimed to address the limitations of previous methods.
Purpose of the Study:
- To evaluate the efficacy and safety of the PerFix mesh plug technique for femoral hernia repair.
- To compare the outcomes of the PerFix mesh plug technique with historical repair methods.
- To assess the suitability of the PerFix mesh plug technique for elective versus emergency femoral hernia cases.
Main Methods:
- Repair of all elective femoral hernia cases using the PerFix mesh plug technique over a 7-year period.
- Data collection on complications, recurrence rates, operating time, postoperative pain, and hospital stay.
- Comparison of outcomes with historical Cooper's ligament repair data.
Main Results:
- The PerFix mesh plug technique resulted in no complications in elective cases.
- Patients experienced minimal groin pain, were discharged on postoperative day one, and resumed activities quickly.
- Operating times were significantly shorter compared to Cooper's ligament repair, with no prosthesis infections even in cases with bowel resection.
- 70% of cases were elective, indicating that emergency surgery is not always necessary for femoral hernias.
Conclusions:
- The PerFix mesh plug technique is a highly effective and safe option for elective femoral hernia repair, offering reduced recurrence, shorter hospital stays, and fewer complications.
- Cooper's ligament repair remains a consideration for strangulated cases with severe infection due to prosthesis infection risks.
- The study suggests a shift towards elective repair for femoral hernias, reserving emergency surgery for cases with severe symptoms like abdominal pain or ileus.
Abstract:
Femoral hernia repair has a long history. In the nineteenth century, simple closure of the femoral orifice by the femoral approach was favored. Such renowned surgeons as Bassini, Marcy, and Cushing authored papers about the femoral approach to femoral hernia. The recurrence rate was so high, however, that it was replaced by the inguinal approach. The man who popularized the inguinal approach was Chester McVay, who demonstrated the precise insertion of the tranversus abdominis muscle and transversalis fascia to the Cooper's ligament. He used Cooper's ligament for the femoral hernia repair by the inguinal approach. The complication and recurrence rate after the Cooper's ligament repair for femoral hernia was not satisfactory, however, due to tension on the approximated tissues, which caused postoperative pain and inability to resume normal activities. Irving Lichtenstein first introduced the plug technique to femoral hernia repair and it was further developed by Gilbert and Rutkow. In the present series, all elective cases were repaired by the PerFix mesh plug technique without any complications. Patients were discharged from the hospital on the first postoperative day and returned to normal activities shortly thereafter. These patients had few complaints of pain in the groin. The operating time using a PerFix plug was markedly shorter when contrasted with the Cooper's ligament repair. No infection of the prosthesis occurred, even in the cases in which the small intestine was necrotic and resected. From our 7-year experience of mesh plug femoral hernia repairs, I have come to regard this operation as the first choice in elective and noninfected cases of femoral hernia. In strangulated cases in which severe infection occurs. Cooper's ligament repair should be used, because there is a risk or infection to implanted prosthesis. Finally, femoral hernia is usually thought of as requiring emergency surgical treatment. Only 30% of our cases were treated as emergency operations, however, whereas 70% were elective. Unless patients complain of severe abdominal pain or ileus, surgeons need not perform emergency operations. In summary, the PerFix mesh plug hernia repair for femoral hernia has resulted in a reduced recurrence rate, shortened hospital stay, and a low rate of postoperative complications.