Objective: To evaluate the efficacy of non-fixation versus fixation of meshes in laparoendoscopic repair of M3 inguinal hernias in terms of recurrence, postoperative pain, and surgical complications.
Summary Background Data: International guidelines recommend mesh fixation for large M3 inguinal hernias during laparoendoscopic repairs due to high recurrence rates. However, emerging experimental and registry data suggest that anatomically shaped, rigid and three-dimensional meshes may maintain stability without fixation. This study aimed to address this knowledge gap through a multicenter randomized controlled trial.
Methods: The MEFISTO Trial is a prospective, multicenter, double-blind, randomized controlled trial conducted in 12 surgical centers. A total of 204 patients with M3 inguinal hernias were randomized into two groups: a non-fixation group using three-dimensional, rigid, anatomical meshes. Fixation group using flat lightweight meshes fixed with tissue adhesive. The primary outcome was the recurrence rate at 12 months. The secondary outcomes included postoperative pain (Visual Analog Scale) and surgical site occurrence. Data were analyzed using appropriate statistical methods for non-inferiority studies.
Results: The recurrence rate at 12 months was 3.1% and 2.1% in the non-fixation and fixation groups respectively (P = 0.6847). No differences were observed in pain at discharge, 7-10 days post-surgery, or 12 months post-surgery. No significant differences were found in surgical complications or operative times between groups.
Conclusions: Non-fixation of three-dimensional meshes is non-inferior to fixation of flat lightweight meshes for M3 inguinal hernia repair. These findings support the potential revision of international hernia management guidelines to incorporate non-fixation approaches with appropriate mesh types.
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http://dx.doi.org/10.1097/SLA.0000000000006669 | DOI Listing |
Hernia
March 2025
Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Purpose: As the use of robotic platforms for inguinal hernia repairs continues to grow, the rTAPP (Robotic Trans-Abdominal Pre-Peritoneal) approach is being performed significantly more often than rTEP (Robotic Totally Extra-Peritoneal) and is predominantly taught to newly trained robotic surgeons. This study's primary objective was to evaluate the feasibility of a proposed modified rTEP technique that incorporates balloon dissection as a primary tool, enabling the horizontal placement of three trocars aligned with the umbilicus. Secondary objectives included evaluation of safety and effectiveness of this technique, and of the learning curve required to reach proficiency.
View Article and Find Full Text PDFHCA Healthc J Med
February 2025
Texas College of Osteopathic Medicine, Forth Worth, Texas.
Background: Ovarian or adnexal torsions occur when an ovary rotates around one of the supporting ligaments, often the infundibulopelvic (IP) ligament. This rotation can cause the blood flow to the ovary to be hindered, and this decrease in perfusion can often present as adnexal pain, nausea, and vomiting. A significant risk factor for developing an ovarian torsion is the presence of an ovarian mass, such as a cyst.
View Article and Find Full Text PDFCureus
February 2025
Surgery, One Brooklyn Health, Interfaith Medical Center, Brooklyn, USA.
Mesenteric hematomas, a rare and clinically significant condition, are typically associated with abdominal trauma, vascular conditions, or surgical complications. Spontaneous mesenteric hematomas, an even rarer subtype, are often seen in patients who are on anticoagulation therapy or have inguinal hernias. In this case report, we discuss an 89-year-old male patient who initially presented with stable vital signs and abdominal pain but was later discovered to have a large, stable mesenteric hematoma on an abdominal computed tomography scan.
View Article and Find Full Text PDFJ Med Case Rep
March 2025
Department of Minimal Access and General Surgery, Government Gousia Hospital, DHS, Srinagar, 1900003, Kashmir, India.
Background: Female inguinal hernias are rare to see. All inguinal hernias in females occur as indirect hernias. A single hernia sac is usually seen, but the occurrence of more than one sac in female indirect inguinal hernias is extremely rare.
View Article and Find Full Text PDFBackground: Occult inguinal hernia is a unique clinical challenge characterized by asymptomatic presentation and the absence of detectable signs on physical examination, leading to frequent misdiagnosis and underdiagnosis. The advancement of laparoscopic hernia surgery has facilitated the identification of occult hernias, yet effective diagnostic and predictive methods remain lacking.
Objective: This study aims to evaluate the incidence and clinical characteristics of occult inguinal hernias detected during laparoscopic unilateral inguinal hernia repair and to provide evidence-based recommendations for their management.
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