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Published in: Hernia 3/2013

01-06-2013 | Original Article

The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions

Authors: A. Lourenço, R. S. da Costa

Published in: Hernia | Issue 3/2013

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Abstract

Purpose

Experience with a novel hernioplasty procedure—the ONSTEP approach—for inguinal hernia repair in a large series of patients performed by two surgeons at two institutions is described, focusing in particular on the duration of surgery, the time taken to return to normal activities, chronic pain, complication and recurrence rates.

Methods

Adult patients underwent inguinal hernia repair using the ONSTEP approach. The hernia defect was repaired using a PolySoft™ hernia patch. Patients were followed up for 1 year for pain, complications and recurrences.

Results

A total of 693 patients underwent ONSTEP inguinal hernia repair. The mean duration of surgery (±SD) was 17 ± 6 min; the time to discharge from hospital was less than 24 h in all patients; and the mean time to return to normal daily activities was 6.1 ± 3.0 days. The overall complication rate was 1.0 % and the overall recurrence rate was 0.6 %. Residual pain was present in 4 patients at 6 months and was cured by removal of the memory ring in 3 patients and disappeared spontaneously in one case, so that there was no case of chronic pain at 1 year.

Conclusions

The ONSTEP inguinal hernia repair technique described is simple, quick to perform, produces consistent results and is associated with very low overall complication, chronic pain and recurrence rates. It may offer an alternative to both Lichtenstein and laparoscopic inguinal hernia repair.
Literature
2.
go back to reference Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157(2):188–193PubMedCrossRef Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157(2):188–193PubMedCrossRef
3.
go back to reference Koning GG, Koole D, de Jongh MAC, de Schipper JP, Verhofstad MH, Oostvogel HJ, Vriens PW (2011) The transinguinal preperitoneal hernia correction vs. Lichtenstein’s technique; is TIPP top? Hernia 15(1):19–22PubMedCrossRef Koning GG, Koole D, de Jongh MAC, de Schipper JP, Verhofstad MH, Oostvogel HJ, Vriens PW (2011) The transinguinal preperitoneal hernia correction vs. Lichtenstein’s technique; is TIPP top? Hernia 15(1):19–22PubMedCrossRef
4.
go back to reference Pélissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10(3):248–252PubMedCrossRef Pélissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10(3):248–252PubMedCrossRef
5.
go back to reference Berrevoet F, Maes L, Reyntjens K, Rogiers X, Troisi R, de Hemptinne B (2010) Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias. Langenbecks Arch Surg 395(5):557–562PubMedCrossRef Berrevoet F, Maes L, Reyntjens K, Rogiers X, Troisi R, de Hemptinne B (2010) Transinguinal preperitoneal memory ring patch versus Lichtenstein repair for unilateral inguinal hernias. Langenbecks Arch Surg 395(5):557–562PubMedCrossRef
6.
go back to reference Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574PubMedCrossRef Grant AM, Scott NW, O’Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574PubMedCrossRef
7.
go back to reference Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomized controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012–1013PubMedCrossRef Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomized controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012–1013PubMedCrossRef
8.
go back to reference Pélissier EP, Monek O, Blum D, Ngo Ph (2007) The Polysoft® patch: prospective evaluation of feasibility, postoperative pain and recovery. Hernia 11(3):229–234PubMedCrossRef Pélissier EP, Monek O, Blum D, Ngo Ph (2007) The Polysoft® patch: prospective evaluation of feasibility, postoperative pain and recovery. Hernia 11(3):229–234PubMedCrossRef
9.
go back to reference Pélissier EP, Blum D, Ngo Ph, Monek O (2008) Transinguinal preperitoneal repair with the polysoft patch: prospective evaluation of recurrence and chronic pain. Hernia 12(1):51–56PubMedCrossRef Pélissier EP, Blum D, Ngo Ph, Monek O (2008) Transinguinal preperitoneal repair with the polysoft patch: prospective evaluation of recurrence and chronic pain. Hernia 12(1):51–56PubMedCrossRef
10.
go back to reference Edwards CC II, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10:149–153PubMed Edwards CC II, Bailey RW (2000) Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 10:149–153PubMed
11.
go back to reference Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg 88:653–661CrossRef Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg 88:653–661CrossRef
12.
go back to reference Neumayer L, Giobbie-Hurder A, Joasson 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 350:1819–1827PubMedCrossRef Neumayer L, Giobbie-Hurder A, Joasson 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 350:1819–1827PubMedCrossRef
13.
go back to reference McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: a systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203PubMed McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: a systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203PubMed
14.
go back to reference Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97(5):765–771PubMedCrossRef Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97(5):765–771PubMedCrossRef
15.
go back to reference Ferzli G, Masaad A, Albert P, Worth MH (1993) Endoscopic extraperitoneal herniorrhaphy versus conventional hernia repair. A comparative study. Curr Surg 50:291–294 Ferzli G, Masaad A, Albert P, Worth MH (1993) Endoscopic extraperitoneal herniorrhaphy versus conventional hernia repair. A comparative study. Curr Surg 50:291–294
16.
go back to reference McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28PubMedCrossRef McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28PubMedCrossRef
17.
go back to reference Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21(2):161–166PubMedCrossRef Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21(2):161–166PubMedCrossRef
18.
go back to reference O A, A G, M J, H WC, Al-Kandari A, S C, M M (2011) Is laparoscopic inguinal hernia repair more effective than open repair? J Coll Physicians Surg Pak 21(5):291–296 O A, A G, M J, H WC, Al-Kandari A, S C, M M (2011) Is laparoscopic inguinal hernia repair more effective than open repair? J Coll Physicians Surg Pak 21(5):291–296
19.
go back to reference Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89(11):1476–1479PubMedCrossRef Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89(11):1476–1479PubMedCrossRef
20.
go back to reference Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199PubMedCrossRef Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199PubMedCrossRef
21.
go back to reference Eklund A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97(4):600–608PubMedCrossRef Eklund A, Montgomery A, Bergkvist L, Rudberg C, Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) study group (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97(4):600–608PubMedCrossRef
22.
go back to reference Yang B, Zhou J, Lai DM, Zhang YC, Jiang ZP, Chen S (2010) Open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision. Zhonghua Wai Ke Za Zhi 48(17):1295–1297 (Article in Chinese)PubMed Yang B, Zhou J, Lai DM, Zhang YC, Jiang ZP, Chen S (2010) Open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision. Zhonghua Wai Ke Za Zhi 48(17):1295–1297 (Article in Chinese)PubMed
23.
go back to reference McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperiotneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114PubMedCrossRef McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperiotneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114PubMedCrossRef
24.
go back to reference Napier T, Olson JT, Windmiller J, Treat J (2008) A long-term follow-up of a single rural surgeon’s experience with laparoscopic inguinal hernia repair. WMJ 107(3):136–139PubMed Napier T, Olson JT, Windmiller J, Treat J (2008) A long-term follow-up of a single rural surgeon’s experience with laparoscopic inguinal hernia repair. WMJ 107(3):136–139PubMed
25.
go back to reference Staarink M, van Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22(8):1803–1806PubMedCrossRef Staarink M, van Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22(8):1803–1806PubMedCrossRef
26.
go back to reference Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D (2010) Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review. Hernia 14(5):477–480PubMedCrossRef Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D (2010) Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review. Hernia 14(5):477–480PubMedCrossRef
27.
go back to reference Langeveld HR, Van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lang J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251(5):819–824PubMedCrossRef Langeveld HR, Van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lang J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251(5):819–824PubMedCrossRef
28.
go back to reference Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L (2011) Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study. Surg Endosc 25:1624–1629PubMedCrossRef Brandt-Kerkhof A, van Mierlo M, Schep N, Renken N, Stassen L (2011) Follow-up period of 13 years after endoscopic total extraperitoneal repair of inguinal hernias: a cohort study. Surg Endosc 25:1624–1629PubMedCrossRef
29.
go back to reference Swadia ND (2011) Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience. Hernia 15(3):273–279PubMedCrossRef Swadia ND (2011) Laparoscopic totally extra-peritoneal inguinal hernia repair: 9 year’s experience. Hernia 15(3):273–279PubMedCrossRef
Metadata
Title
The ONSTEP inguinal hernia repair technique: initial clinical experience of 693 patients, in two institutions
Authors
A. Lourenço
R. S. da Costa
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Hernia / Issue 3/2013
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-013-1057-z

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