Randomized clinical trials

Fafaj A, Krpata D, Petro CC, Prabhu AS, Rosenblatt S, Tastaldi L et al.

Ann Surg 2022; 276: 224-232.

In this three-way study that included 164 procedures, opioid requirement at 72h was similar with and without local anaesthesia.

Comment: A transversus abdominis block was inadequate to affect analgesia requirement after this surgery.

Fafaj A, Lo Menzo E, Alaedeen D, Petro CC, Rosenblatt S, Szomstein S et al.

JAMA Surg 2022; 157: 667-674.

Routine use of a urinary catheter did not reduce the risk of postoperative retention in this study that included 491 procedures: 9.6 versus 8.5 per cent, P=0.79.

Comment: It’s time to stop using a catheter routinely in those who can void urine spontaneously preoperatively.

Rosen MJ, Krpata DM, Petro CC, Carbonell A, Warren J, Poulose BK et al.

JAMA Surg 2022; 157: 293-301.

Synthetic mesh significantly reduced the risk of hernia recurrence after two years compared to biological mesh (5.6 versus 20.5 per cent, P=0.01), as well as being cheaper, in this study of 253 procedures.

Comment: No need for biological mesh in this situation; does it have a role at all?

Krpata DM, Petro CC, Prabhu AS. Tastaldi L, Zolin S, Fafaj A et al.
JAMA Surg 2021; 156: 1085-109

This study evaluated two different weights of hernia mesh in 350 procedures. Compared with standard mesh, medium weight polypropylene mesh did not reduce postoperative pain, quality of life or hernia recurrence after one year: 7 versus 8 per cent.

Comment: The weight of mesh seems unimportant.

Aiolfi A, Cavalli M, Ferraro SD, Manfredini L, Bonitta G, Bruni PG et al.
Ann Surg 2021; 274: 954-961.

Some 35 trials covering the three main methods of inguinal hernia were included, with a total of 7777 patients. Hernia recurrence rates were similar across all methods. Pain within 48 hours of surgery, and chronic groin pain were reduced with minimally invasive methods, as were wound complications.

Comment: Minimally invasive hernia repair has short term advantages, but whether the additional costs over open repair are justified remains unknown.