Abstract
Background
Inguinal hernia repairs are among the most common operations performed worldwide. An increasing number is performed minimally invasively with mesh placed pre-peritoneally. Some situations may require mesh removal. This can be complex and challenging. We share our technique to remove pre-peritoneal mesh using a minimally invasive approach.
Methods
The multiple steps involved in robotic-assisted pre-peritoneal mesh removal are reviewed in detail, including preoperative planning, intraoperative positioning, review of anatomic landmarks, and systematic approach with technical tips to reduce complications.
Results
We provide an attached narrated video guide with a written summary to outline pre-peritoneal inguinal mesh removal. The steps are applicable to both robotic-assisted and laparoscopic approaches. We present a video of the robotic-assisted approach. We prefer the robotic-assisted approach for most pre-peritoneal mesh removal based on results of our retrospective series of 26 patients undergoing 31 mesh removals. We noted that our robotic-assisted approach was more effective than the laparoscopic approach, with significantly less incidence of vascular injury (0 vs 5, p < 0.05) and less nerve (1 vs 4) and spermatic cord injuries (0 vs 1).
Conclusions
As pre-peritoneal inguinal mesh implantation becomes more popular, surgeons may be seeing more patients with complications who may require mesh removal. We provide a detailed step-by-step approach with video to serve as a guide to surgeons who are planning for safe removal of pre-peritoneal inguinal hernia mesh.
Similar content being viewed by others
References
Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358(9288):1124–1128
Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83(5):1045–1051 (v–vi)
Kouhia S, Vironen J, Hakala T, Paajanen H (2015) Open mesh repair for inguinal hernia is safer than laparoscopic repair or open non-mesh repair: a nationwide registry study of complications. World J Surg 39(8):1878–1884
Winslow ER, Quasebarth M, Brunt LM (2004) Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 18(2):221–227
Rutkow IM (1998) Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am 78(6):941–951 (v-vi)
Slooter GD, Zwaans WAR, Perquin CW, Roumen RMH, Scheltinga MRM (2018) Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients. Surg Endosc 32(3):1613–1619
Tschuor C, Metzger J, Clavien PA, Vonlanthen R, Lehmann K (2015) Inguinal hernia repair in Switzerland. Hernia 19(5):741–745
Bittner R, Schwarz J (2012) Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg 397(2):271–282
Ravindran R, Bruce J, Debnath D, Poobalan A, King PM (2006) A United Kingdom survey of surgical technique and handling practice of inguinal canal structures during hernia surgery. Surgery 139(4):523–526
Saleh F, Okrainec A, D’souza N, Kwong J, Jackson TD (2014) Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short-term outcomes. Am J Surg 208(2):195–201
Neumayer L, Giobbie-hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350(18):1819–1827
HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165
Bjurström MF, Nicol AL, Amid PK, Chen DC (2014) Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res 7:277–290
Cunningham LA, Ramshaw B (2016) Mesh removal for chronic pain: a review of laparoscopic and open techniques. In: Jacob BP, Chen DC, Ramshaw B, Towfigh S (eds) The SAGES manual of groin pain. Springer, Switzerland, pp 301–317
Alvarez R (2016) Dermatome mapping: preoperative and postoperative assessment. In: Jacob BP, Chen DC, Ramshaw B, Towfigh S (eds) The SAGES manual of groin pain. Springer, Switzerland, pp 277–292
Bjurström MF, Álvarez R, Nicol AL, Olmstead R, Amid PK, Chen DC (2017) Quantitative validation of sensory mapping in persistent post-herniorrhaphy inguinal pain patients undergoing triple neurectomy. Hernia 21(2):207–214
Langbach O, Holmedal SH, Grandal OJ, Røkke O (2016) Adhesions to mesh after ventral hernia mesh repair are detected by MRI but are not a cause of long term chronic abdominal pain. Gastroenterol Res Pract 2016:2631598
Zarrinkhoo E, Towfigh S (2016) Risks of laparoscopic versus robotic-assisted mesh removal after inguinal hernia repair. In: Annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, Boston, MA, March 16–19
International Association for the Study of Pain, Subcommittee on Taxonomy (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain 3(Suppl):S1–S226
Koning GG, Wetterslev J, Van laarhoven CJ, Keus F (2013) The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS ONE 8(1):e52599
Öberg S, Andresen K, Klausen TW, Rosenberg J (2018) Chronic pain after mesh versus non-mesh repair of inguinal hernias: a systematic review and a network meta-analysis of randomized controlled trials. Surgery 163(5):1151–1159
Lange JF, Kaufmann R, Wijsmuller AR, Pierie JP, Ploeg RJ, Chen DC, Amid PK (2015) An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 19(1):33–43
Valvekens E, Nijs Y, Miserez M (2015) Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution. Hernia 19(4):587–594
Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T, Sfeclan C, Canziani M (2013) Surgical treatment of chronic pain after inguinal hernia repair. Hernia 17(3):347–353
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Dr. Shirin Towfigh reports research grants from Bard/Davol, Inc, research grants from Intuitive Surgical, Inc., and consultantship from Tela Bio, Inc. All are relevant outside the submitted manuscript. Dr. Adam Truong and Badr Saad Al-Aufey have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material video (MP4 333332 KB)
Rights and permissions
About this article
Cite this article
Truong, A., Al-Aufey, B.S. & Towfigh, S. Step-by-step guide to safe removal of pre-peritoneal inguinal mesh. Surg Endosc 33, 2680–2685 (2019). https://doi.org/10.1007/s00464-018-6558-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6558-5