Abstract


Barbed sutures became available in the mid-1960’s, when a popular bidirectional barbed suture was primarily used by plastic surgeons for skin closure. As laparoscopic surgery became more commonplace, so did the need for intracorporeal sewing, but the challenges of tying sutures under tension became apparent. While surgical devices such as the Endostich™ (Covidien, Dublin, Ireland) aided in overcoming the learning curve for laparoscopic sewing, over time, the introduction of a unidirectional barbed suture helped minimally invasive surgeons overcome the challenges of sewing laparoscopically. It is particularly difficult to secure knots under tension using commonly available monofilament and multifilament sutures. Barbed sutures allow for the distribution of tension along the suture closure without the need for securing knots. However, with the introduction of the daVinci™ robot by Intuitive (Sunnyvale, CA) in 2001, sewing has become easier and more popular with the availability of a 3-dimensional, high-definition view and wristed instruments. As robotic general surgery has become increasingly accepted, it is fitting that the use of a barbed suture in hernia surgery has become critical for primary fascia closure of the hernia defect and various layer closures.

Abstract


Introduction: Patient satisfaction after inguinal hernia surgery is currently underappreciated and not as well studied as other patient-reported outcome measures (PROMs) on this topic. This study aims to review the literature and summarize available data.
Materials and Methods: A literature review was conducted using Medline with focus on patient-reported satisfaction after elective, inguinal hernia surgery in adults. All inguinal hernia repair techniques were considered. Small sample sizes and short follow-up periods were excluded. The methodology and results of the remaining articles were reviewed. Due to heterogeneity of reporting between articles, only a descriptive analysis was performed.
Results: The available data from patient-reported outcome measures regarding satisfaction yields considerable heterogeneity and lacks validation. We found that 53% of all included studies used an asymmetrical response questionnaire. Although there is an overwhelming positive patient satisfaction, wide ranges of satisfaction were seen (78–100% more than averagely satisfied, compared to 0–15% less than averagely satisfied). The number of patients not willing to undergo inguinal hernia repair again ranges from 1–16%.
Conclusion: Our study demonstrates that patient-reported satisfaction after inguinal hernia surgery is not uniformly surveyed and remains unvalidated. Further research on patient-reported satisfaction would benefit from the reported raw data of a standardised, validated, and symmetrical five-point Likert or 11-point NRS scale on regular intervals pre- and postoperatively.

Abstract


Introduction: Rectus diastases (RD) are caused by a weakening of the abdominal musculature and a widening of the linea alba. Some patients are often erroneously told that they are hernias. Despite the fact that they are not true hernias, they are often associated with true hernias and undergo concomitant repairs. Robotic plication of these diastases has been gaining more widespread use in the past few years, but literature regarding outcomes remains limited.
Material and Methods: All patients with RD and concomitant ventral hernia that underwent robotic repair were assessed from 2016 to present. Demographics, perioperative morbidity, and outcomes were reviewed, and descriptive analyses were performed.
Results: This series consists of 14 patients with an average age of 50.7 years (range 33–78 years), 64% female, and 86% Caucasian. All patients had associated umbilical or ventral/incisional hernia with an average defect size of 7.1cm2 and average mesh size of 254cm2. Robotic transabdominal pre-peritoneal (RTAPP) repair was performed in 67% of cases and robotic extended total extraperitoneal (ReTEP) repair was performed in 33%. Two patients (17%) required conversion to open repair. Hospital length of stay was 0.7 days. There was no morbidity in these patients. At an average follow-up of 2.6 years (range 54–2122 days), the hernia/diastasis recurrence rate is 7.1%.
Conclusion: The results of this study suggest that robotic plication with intraperitoneal sublay mesh could be an acceptable surgical approach for RD associated with concomitant ventral hernia repair. Further investigation is required to assess outcomes in a larger group of patients and to determine long-term recurrence and complication rates.