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Table 47.Key Question 4: Treatment detailsStudyTreatment ATreatment BTreatment CTreatment DCommentsButler et al., 2007647TAPP, all operations were either performed or were supervised by a surgeon experienced in laparoscopic repairs (did?not report what level of experience or whether this experience was for hernia repair or for other clinical conditions), polypropylene mesh, other?mesh details not reportedTEP, all operations were either performed or were supervised by a surgeon experienced in laparoscopic repairs (did?not report what level of experience or whether this experience was for hernia repair or for other clinical conditions), polypropylene mesh, other?mesh details not reportedLichtenstein, all operations were either performed or were supervised by a surgeon experienced in laparoscopic repairs (did?not report what level of experience or whether this experience was for hernia repair or for other clinical conditions), polypropylene mesh, other mesh details not reportedNAXDedemadi et al., 2006669TAPP, general anesthesia, dissection deep to the obturator vessels in the space of Retzius. mesh crossing the mdline, extending into the space of Retzius, and covring the cord structures extending laterally to the internal ring. mesh anchored to Cooper’s ligament as well as superomedially and superolaterally.TEP, general anesthesia. Balloon dissecting for preperitoneal space. Coopers ligament dissected, exposing of Hesselbach’s triangle posteriorly. Nonabsorbable mesh positioned from the symphysis pubis to the ventral and lateral abdominal wall. mesh is held in place simply by the dorece of the peritoneum lying against the abdominal wall after desufflation.Lichtenstein, general anesthesia. Dissection is not performed in the typical way because of the previous repair. mesh was left in situ in two patients with a previous open Lichtenstein. Direct sacs are inverted and imbricated with a nonabsorbable suture to flatten the posterior wall. Indirect sacs are dissected from the cord up to the extraperitoneal fat, then either excised or inverted, with a mesh cone inserted in the deep inguinal ring. Polypropylene mesh onlay applied to the posterior wall and tucked under the superior leaf of the external oblique, overlapping Poupart’s ligament. Inferomedial corner of the mesh is sutured to the tissues overlying the pubic tubercle. One or two sutures are used where the tails of the mesh cross lateral to the cord.NAXGong et al., 2011701TAPP, four surgeons, all were “experienced with both open and laparoscopic hernioplasty” (did not report the number of prior operations these surgeons had performed), general anesthesia. large Bard polypropylene mesh (Davol) 8.5 cm x 15 cm was placed preperitoneally and attached to Cooper’s ligament and the transverse fascia with the 5mm tacker (Auto?Suture Protack, Tyco Inc). Peritoneum closed with running 3-0 Vicryl Plus suture.TEP, four surgeons, all were “experienced with both open and laparoscopic hernioplasty” (did not report the number of prior operations these surgeons had performed), general anesthesia. Blunt digital dissection made in the preperitoneal space through the ipsilateral anterior rectus sheath. Dissection of hte preperitoneal space was perfomed medially across the midline and laterally cranial to the anterosuperior iliac spine. Hernia sac was reduced and a 8.5?x?13.7?cm Bard 3DMax mesh (preformed knitted polypropylene) placed in the preperitoneal space, covering the inguinal floor. Anterior rectus sheath then closed with a 3-0 Vicryl sutureMesh plug, four surgeons, all were “experienced with both open and laparoscopic hernioplasty” (did not report the number of prior operations these surgeons had performed), regional anesthesia. Procedure as described by Rutkow and Robbins using a large Bard mesh Perfix plug (monofilament knitted polypropylene, Davol Inc.). Plug was secured and the patch fixed with interrupted sutures using 2-0 Prolene (polypropylene, Ethicon). Closure of the external oblique and Scarpa’s fascia with a running 3-0 Vicryl Plus (polyglactin, Ethicon) suture.NAXGunal et al., 2007702TAPP, general anesthesia, all operations performed by two consultant surgeons who were “highly experienced in open and laparoscopic hernia surgery” (authors did not state numbers of prior operations). Carbon dioxide insufflation. 6?x?12?cm Prolene mesh fixed to the posterior abdominal wall using a hernia stapler.TEP, general anesthesia, all operations performed by two consultant surgeons who were “highly experienced in open and laparoscopic hernia surgery” (authors did not state numbers of prior operations). Balloon trocar expansion of the preperitoneal space and carbon dioxide insufflation. 6 x 12?cm Prolene mesh fixed to the posterior inguinal wall using a hernia stapler.Lichtenstein, general anesthesia, all operations performed by two consultant surgeons who were “highly experienced in open and laparoscopic hernia surgery” (authors did not state numbers of prior operations). 6?x?12?cm Prolene mesh fixed to the anterior aspect of the posterior wall.Nyhus, all operations performed by two consultant surgeons who were “highly experienced in open and laparoscopic hernia surgery” (authors did not state numbers of prior operations). 6?x?12?cm prolene mesh to the posterior aspect of the inguinal defectXHamza et al., 2010704TAPP, no other details reportedTEP, no other details reportedLichtenstein, no other details reportedOpen properitoneal mesh, no other details reportedAll operations were performed by one consultant surgeon.Krishna et al., 2011728Peritoneum was incised lateral to the inferior epigastric vessels 2 cm above the deep ring. Adequate space was created to accommodate 15 x 10-cm polypropylene mesh. After the dissection, the mesh was rolled and introduced via a 10-12-mm umbilical port into the space created. The mesh was not fixed in place.The rectus muscle was retracted laterally after incising the anterior rectus sheath and a blunt dissection was done. The dissection proceeded laterally, identifying the inferior epigastric vessels, and further laterally up to correspond to the anterior superior iliac spine.One of the surgeons had more than 15 years’ experience in laparoscopic surgery and the other two had 3-5 years’ experience.Mesci et al., 2011750Not reportedNot reportedStudy did not provide any details of the surgery. All operations were performed by by same surgeon at a university hospitalPokorny et al., 2008791,792TAPP, all surgeons had either performed at least 30 prior laparoscopic repairs (for unreported clinical conditions) or had performed at least 30 prior open repairs (again for unreported clinical conditions), general anesthesia, no local anesthetic, polypropylene mesh (SurgiPro, Autosuture) no other mesh details reported.TEP, all surgeons had either performed at least 30 prior laparoscopic repairs (for unreported clinical conditions) or had performed at least 30 prior open repairs (again for unreported clinical conditions), general anesthesia, no local anesthetic, polypropylene mesh, no other mesh details reported.Lichtenstein, all surgeons had either performed at least 30 prior laparoscopic repairs (for?unreported clinical conditions) or had performed at least 30 prior open repairs (again for unreported clinical conditions). Lichtenstein as described by Amid; general anesthesia, no?local anesthetic, polypropylene mesh, no?other mesh details reported.NAXSarli et al., 1997800 (TAPP?vs. IPOM) TAPP was performed under general anesthesia. The hernia sac was reduced and a 15 x 12 cm piece of polypropylene mesh was placed lying over the spermatic cord and stapled to the Cooper ligament and to the fascia. IPOM technique was performed under general anesthesia. A minimal peritoneal incision was made and a 10 x 7-cm piece of polytetrafluoroethylene mesh was passed through the 11/12-mm trocar into the intraperitoneal space. NANAThe procedures were performed by two surgeons in a general surgery university practiceSchrenk et al., 1996803 (TAPP?vs.?TPP)TAPP. Laparoscopic peritoneal hernia repair with a polypropylene mesh (SurgiPro, Auto?Suture, Vienna,?Austria). TEP. Patients had extraperitoneal repair with a polypropylene mesh (SurgiPro)NANAAll surgeons in the study were experienced and no local anesthetic was used.Zhang et al., 2009837The MR used a midline approach between the rectus muscle and the posterior rectus sheath. A?5-mm port was placed halfway between the umbilicus and the pubic symphysis, and a second 5-mm port was inserted in the midline between the other two ports under direct vision.In the MP group, a transverse incision was made through the linea alba or slightly laterally through both the anterior and posterior rectus sheath.In the LR group, the second and third 5-mm trocar ports were placed at about 3 com proximal to the left and right anterior superior iliac spine, respectively.In the LP group, a transverse incision was made through the linea alba or slightly laterally through both anterior and posterior rectus sheath and at least a 5mm trocar port was not placed midlineSurgery was carried out by three of the authors. A?15 x 10 cm polypropylene mesh was introduced to cover the posterior wall of the inguinal canal, deep inguinal ring, and femoral ring on each side. However, all 99?patients underwent TEP without mesh fixation through 4 surgical approaches. ................
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