Clinical trials in hernia surgery

Abstract

Hernia surgery is becoming a high specialised speciality with numerous journals published every day. Target of our research is aiming at improving the outcomes of our operations yet minimising the surgery related morbidities and enhancing the quality of life of our patients. On the other hand, because of the standardisation of clinical management of hernia, it is getting more and more difficult to get our research work being published in Internationally recognised journal. To start with, it is more encouraging for our trainees to write up interesting clinical case reports at the initial step, it is fast and a good opportunity for them to familiarised with the submission procedures and is encouraging for them as it’s likely to be accepted in local journals. E.g. we reported the use of robotic arms to repair inguinal hernia during concurrent surgery for robotic prostatectomy dated back 8 years ago[1]; the rare angiomyolipoma in the inguinal canal which diagnosed pre-operatively by MRI and resected by open approach[2]; the 2 cases of rare presentation of incarcerated omental fibromatosis at the inguinal canal in HKU affiliated hospitals over 20 years[3]; use of double mesh in repair of ventral hernia[4], etc. Retrospective analysis helps to monitor the outcome of our services and implement changes if needed. We explored the feasibility of using dual fixations in laparoscopic TEP (NBCG, n-butyl cyanoacrylate glue and titanium tacks) compared with synthetic NBCG glue alone, yet it coincides with findings of most published articles with similar operative outcome, yet patients reported slightly more painful in tack added group. However the added messages are 1. dual fixation can minimise recurrence to less than 1% despite there were more than 8 junior surgeons as chief surgeons; 2. NCBG glue is safe in TEP[5]. Clinical review of the use of Trans-abdominal Partial Extra-peritoneal (TAPE) and modified TAPE technique in the treatment of lower abdominal ventral hernia was published – which previously considered as “difficult hernia” in the past. With this technique, in general, larger mesh’s are used and longer operating time with comparable outcomes to conventional IPOM technique for usual ventral hernia[6]. Our randomised study on using self-fixation mesh was started more than 10 years ago, although few randomised studies showed the safety and comparable outcome with this new innovated mesh, we are the first group to report the long-term outcomes of this approach – by using this new mesh, a significantly shorter operating time can be achieved, which can be translated into more patients can be operated in the same session, hence shorten the waiting time for operation. Although slight more patients with parathesia in the self-fixating mesh group, the long term outcomes are comparable in both group when comparing with polypropylene mesh group[7]. Having special interest in seroma formation after hernia surgery, we studied the use of preperitoneal drain in TEP – a new concept of an old surgical approach. It helps to significantly reduce the incidence of seroma formation both clinically and ultrasonically, and potentially decrease pain experienced after surgery, and this is the World first level I evidence in the use of drain after laparoscopic TEP[8]. With more innovations in research, the relation with blunt and monopolar dissection in TEP and seroma is currently being studied by using homemade counter device. In conclusion, we are enthusiastic in hernia research and innovations are important which benefits our patients with better outcomes and quality of life.