Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

INTRODUCTION: Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. MATERIAL AND METHODS: A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. RESULTS: Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). CONCLUSIONS: DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Comparison of low and standard pneumoperitoneum pressure in laparoscopic pediatric inguinal hernia repair.

Introduction: The effectiveness and safety of low pneumoperitoneum in laparoscopic pediatric inguinal hernia repair is unclear and required to explore. Aim: To evaluate the benefits of low (LPP) vs. standard pneumoperitoneum pressure (SPP) in laparoscopic pediatric inguinal hernia repair. Material and methods: We performed a retrospective cohort analysis of patients with pediatric inguinal hernia. The patients were divided into LPP and SPP groups. Anesthesia and postoperative characteristics were analyzed. Results: We enrolled 169 eligible patients in this study. Anesthesia and postanesthesia care unit times in the LPP group were lower than those in the SPP group (p = 0.00, p = 0.01, respectively). The LPP group had lower values for peak partial pressure of end-tidal carbon dioxide (PETCO2; mm Hg) (33.37 ±4.09 vs. 36.56 ±4.08), trough PETCO2 (38.33 ±5.04 vs. 40.46 ±4.14), and PETCO2 at the end of surgery (35.29 ±4.59 vs. 38.76 ±4.22). The LPP group required less sufentanil citrate (8.76 ±4.07 ml vs. 18.03 ±16.04 ml) and midazolam (1.56 ±0.45 ml vs 1.79 ±0.59 ml) vs. the SPP group, respectively. There was no significant difference between the groups regarding postoperative complications. Conclusions: LPP was associated with shorter anesthesia and postanesthesia care unit times, and lower PETCO2 values compared with SPP. Compared with the SPP group, the LPP group had comparable operation times and postoperative complications. However, long-term outcome studies are needed.

Clinical application of the dissection of the preperitoneal space without electrocoagulation in laparoscopic transperitoneal inguinal hernia repair throughout of the whole process.

Introduction: The dissection of the preperitoneal space is performed using a monopolar instrument to prevent bleeding in laparoscopic transabdominal preperitoneal hernia repair (TAPP). It may also cause energy injuries and nerve damage. Aim: To assess the effectiveness and safety of dissection of the preperitoneal space without electrocoagulation (DPSWE) in TAPP throughout the process. Material and methods: A retrospective analysis of data of 134 patients was made. The electrocoagulation group (EG) relied on monopolar instruments. In the non-electrocoagulation group (NEG) mainly scissors were used without electrocoagulation. The patients were followed for up for 3 months. Intraoperative and postoperative conditions and other complications were observed. Results: The VAS scores in the NEG were lower than those in the EG (p < 0.05). The operation time in the NEG was shorter than that in the EG (p < 0.05). Hospitalization expenses, scrotal seroma formation, and rupture of hernia sac in the NEG were lower than those in the EG (p < 0.05). The intraoperative bleeding volume above 20 ml in the NEG was higher than that in the EG. There was no significant difference in the incidence of postoperative bleeding, vas deferens injury, intestinal injury, surgical site infection, length of hospital stay, urinary retention and hernia recurrence in the NEG and the EG (p > 0.05). There was no significant difference in the incidence of surgical site infections (SSIs) in the NEG and the EG. Conclusions: DPSWE is effective and safe. DPSWE may reduce postoperative pain and have no significant increase in postoperative bleeding.

Construction and validation of a predictive model for the risk of contralateral patent processus vaginalis in children with unilateral inguinal hernia or hydrocele.

To develop a nomogram model for predicting contralateral patent processus vaginalis in children with unilateral inguinal hernia or hydrocele. A retrospective analysis was conducted on 259 children with unilateral inguinal hernia or hydrocele who underwent laparoscopic surgery at the Southern Hospital of Southern Medical University from January 2021 to December 2023. The patients were randomly divided into a training set (n = 207) and a validation set (n = 52) in an 8:2 ratio to analyze the characteristics of CPPV. Multivariate logistic regression analysis was used to screen for independent risk factors for CPPV, and a nomogram prediction model was constructed. The predictive ability, calibration, and clinical net benefit of the model were evaluated by plotting receiver operating characteristic (ROC) curves, calibration curves (HL), and clinical decision curves (DCA). Among children under 1 year old, the laparoscopic exploration revealed a CPPV incidence rate of 55.17%. The incidence rates for children aged 2-10 years ranged from 29.03 to 39.13%, and the incidence rate for children aged 11-14 years was 21.21%. Multivariate logistic regression analysis showed that age (OR = 0.9, 95%CI 0.82-0.99, P = 0.035) and female gender (OR = 2.42, 95%CI 1.21-4.83, P = 0.013) were independent risk factors for CPPV, and the incidence of CPPV decreased with age. The area under the ROC curve (AUC) for the training set of the constructed model was 0.632, and the AUC for the validation set was 0.708. The Hosmer-Lemeshow goodness-of-fit test indicated good model fit (training set P = 0.085, validation set P = 0.221), and the DCA curve suggested good clinical benefit.The nomogram model developed in this study demonstrates good clinical value. Children with unilateral inguinal hernia or hydrocele who are younger in age and female gender should undergo careful intraoperative exploration for the presence of CPPV. What is Known: • The probability of developing inguinal hernia in children with CPPV is 11%-25%, and redo surgery can increase surgical risks and financial burden. • The risk factors of unilateral inguinal hernia combined with CPPV are controversial. What is New: • Age and female gender are independent risk factors for CPPV. • A nomogram prediction model was constructed to provide a theoretical basis as well as an assessment tool for preoperative evaluation of whether children with unilateral indirect inguinal hernia are susceptible to CPPV.

Laparoscopic totally extraperitoneal repair for recurrent inguinal bladder hernia: A case report.

We present a case of a recurrent inguinal bladder hernia that was previously unsuccessfully operated on three times and was repaired using totally extraperitoneal repair (TEP). A 79-year-old man presented with a right inguinal swelling that had been treated three times on the same side with anterior approaches. Computed tomography confirmed a recurrent inguinal bladder hernia. TEP was performed after identifying the bladder hernia preoperatively, with previous surgeries that used a plug-and-patch technique through an anterior approach. The extraperitoneal approach allowed the bladder to be reduced without injury and the hernia to be safely repaired using a 3D Max® Light Mesh. The postoperative recovery was uneventful, with no recurrence after 1 year. TEP facilitates the diagnosis and repair of bladder hernias, emphasizing the importance of preoperative diagnosis and the efficacy of endoscopic procedures in bladder hernia repair, even in recurrent cases.

Amyand's Hernia: An Uncommon Encounter of an Appendiceal Presence in an Inguinal Hernia.

Amyand's hernia is a rare variant of inguinal hernia characterized by the presence of the vermiform appendix within the hernia sac. It represents a unique diagnostic and management challenge for surgeons due to its low incidence and varied clinical presentations. Here, we present a case of a 45-year-old man with a one-year history of right inguinoscrotal swelling, diagnosed as a right indirect inguinal hernia. Preoperative imaging revealed the presence of omentum within the hernia sac. Intraoperatively, both the omentum and the vermiform appendix were found within the sac without evidence of inflammation. The patient underwent successful Lichtenstein meshplasty without appendicectomy. This case highlights the importance of considering Amyand's hernia in the differential diagnosis of inguinal hernias and the significance of intraoperative findings in guiding surgical management. Further studies and case reports are needed to enhance our understanding of this rare clinical entity and optimize patient outcomes.

Major Complication Caused by Inguinal Hernia Recurrence After Percutaneous Internal Ring Suturing Procedure in a Patient With Loeys-Dietz Syndrome: A Case Report.

Inguinal hernia repair is one of the most frequently performed procedures in pediatric surgery. Treatment methods include classical open repair and laparoscopic approach. In this report we analyze a case of a 14-month-old boy with Loeys-Dietz syndrome treated for an inguinal hernia with laparoscopic percutaneous internal ring suturing (PIRS). Two weeks post-operatively the patient was diagnosed with a recurrence of the hernia complicated by an intestine strangulation. As a re-operation of the hernia, the Lichtenstein method was applied successfully. We analyzed the literature to determine the safety and possible contradictions of the PIRS procedure, with particular emphasis on patients with comorbidities such as connective tissue disorders. We conclude that in the PIRS procedure, despite its safety, feasibility and low complication rate in healthy patients, too few studies were made to draw similar conclusions for patients with comorbidities such as connective tissue disorders.

Diet and risk for hernia: a Mendelian randomization analysis.

Background: The relationship between dietary factors and hernias is currently unclear. Methods: The UK Biobank was used to extract dietary factors that were used as exposures, including intake of alcohol, non-oily fish, beef, fresh fruit, oily fish, salad/raw vegetables, dried fruit, coffee, cereal, salt, tea, water, cooked vegetables, cheese, Lamb/mutton, pork, poultry, processed meat, and bread. The FinnGen biobank was used to obtain GWAS data on hernias as outcomes. The main analysis of this study was performed using the weighted median, MR-Egger, and IVW methods. Cochran's Q test was utilized to assess heterogeneity. To find potential outliers, the MR-PRESSO method was used. Leave-one-out analysis was employed to assess the IVW method's robustness. Results: Alcoholic consumption per week (OR: 0.614; p = 0.00614) reduced the risk of inguinal hernia. Alcohol intake frequency (OR: 1.309; p = 0.0477) increased the risk of ventral hernia (mainly including incisional hernia and parastomal hernia). The intake of non-oily fish (OR: 2.945; p = 0.0214) increased the risk of inguinal hernia. Salt added to food (OR: 1.841; p = 0.00267) increased the risk of umbilical hernia. Cheese intake (OR: 0.434; p = 0.000536) and dried fruit intake (OR: 0.322; p = 0.00716) decreased the risk of ventral hernia, while cooked vegetable intake (OR: 4.475; p = 0.0380) increased the risk of ventral hernia. No causal relationships were found with hernias from other dietary factors. Conclusion: Inguinal, umbilical, and ventral hernias are all related to dietary factors.

An Unusual Postoperative Complication Following Bilateral Inguinal Hernioplasty: A Pocket Hernia Case Report.

Inguinal hernias are the most common type of hernias in the groin, affecting 27% of the population, with a nine to 12 times higher incidence in men. The primary treatment for this condition typically involves a surgical procedure, with most surgeons opting for mesh placement through a laparoscopic approach. While this procedure is generally associated with low complication rates (primarily hematomas, seromas, and scrotal edema), there are some highly infrequent complications reported such as postoperative small bowel obstruction (SBO), estimated to occur in approximately 0.1%-0.5% of cases, most commonly during transabdominal preperitoneal (TAPP) repair. It is crucial to emphasize the importance of using skilled surgical techniques and adhering to established guidelines in postoperative patient care to minimize the risk of these complications. We describe a case of a 47-year-old male patient who underwent bilateral TAPP repair for inguinal hernias and subsequently experienced postoperative complications, including the development of a hematoma and SBO, requiring a re-intervention that evidenced a peritoneal pocket hernia.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles.

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children's Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

The inguinal lymph nodes as regional lymph nodes in anal canal adenocarcinomas: a nationwide database analysis in Japan.

PURPOSE: To establish if it is appropriate to treat the inguinal lymph node (LN) of anal canal adenocarcinoma (ACA) as the intermediate LN according to the Japanese classification. METHODS: The characteristics of 346 ACA patients were examined from the nationwide registry. The effect of LN dissection was evaluated using the therapeutic value index (TVI). Furthermore, the prognostic classification ability of N factors and stage was evaluated using Akaike's information criterion (AIC), the concordance index (C-index), and the 5-year overall survival (OS) rate. RESULTS: The rate of metastasis of the inguinal LN was 7.5% and the TVI was 3.05. Evaluation using AIC and the C-index showed better results when the inguinal LN was treated as the intermediate LN. The 5-year OS rate for 66 patients with perirectal or intermediate LN metastasis, 7 with inguinal LN metastasis, and 13 with inguinal and perirectal or intermediate LN metastasis were 49.2%, 68.6%, and 47.6%, respectively. When inguinal LN metastases were treated as N3, the 5-year OS rates were 66.7% for those with T1N3 and T2N3 disease, and 49.2% for those with T3N3 disease. CONCLUSIONS: The inguinal LN of ACA was evaluated and staged as the intermediate LN to devise an appropriate treatment strategy.

Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study.

INTRODUCTION: Evidence about the advantage of Lichtenstein's repair, the guidelines' recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques. METHODS: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications. RESULTS: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein's repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84). CONCLUSION: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.

Characteristics of pantaloon inguinal hernia and evaluation of added laparoscopic iliopubic tract repair to transabdominal preperitoneal hernioplasty: a retrospective observational study.

Purpose: Pantaloon hernia (PH), defined as concurrent ipsilateral direct and indirect inguinal hernias, is known for its high postoperative recurrence rate. This study retrospectively investigated the characteristics of PHs and evaluated the safety and efficacy of incorporating laparoscopic iliopubic tract repair (IPTR) into transabdominal preperitoneal (TAPP) hernioplasty. Methods: A total of 3,355 patients who underwent TAPP hernioplasty for groin hernias between October 2014 and December 2021 were analyzed. These patients were divided into 2 groups: PH (97 patients) and non-PH (3,258 patients). The PH group was further subdivided based on the surgical technique used: TAPP hernioplasty without IPTR (TAPP group, 39 patients) and TAPP hernioplasty with IPTR for defect closure (TAPP + IPTR group, 58 patients). Results: The study included 93 male and 4 female patients with PH. Patients with PH were generally older and predominantly male compared to the non-PH group. The recurrence rate in the PH group was notably higher than in the non-PH group (2.1% [2 of 97] vs. 0.2% [6 of 3,258], respectively; P = 0.007). Among the PH group, reoperations were more frequent in the TAPP group compared to the TAPP + IPTR group (10.3% [4 of 39] vs. 0% [0 of 58], respectively; P = 0.048). The reasons for reoperation in the PH group included recurrences (2 patients), mesh bulge (1 patient), and chronic seroma (1 patient). Conclusion: TAPP + IPTR hernioplasty is an acceptable approach in PH treatment, reducing reoperation.

Comparative analysis of different surgical approaches for recurrent inguinal hernia: a single-center observational study.

Purpose: Managing recurrent inguinal hernias is complex, and choosing the right surgical approach (laparoscopic vs. open) is vital for patient outcomes. This study compared the outcomes of using the same vs. different surgical approaches for initial and subsequent hernia repairs. Methods: We retrospectively analyzed patients who underwent recurrent inguinal hernia repair at Seoul National University Bundang Hospital between January 2014 and May 2023. Patients were divided into the "concordant" and "discordant" groups, comprising patients who underwent same and different approaches in both surgeries, respectively. Preoperative baseline characteristics, index surgery data, postoperative outcomes, and recurrence rates were analyzed and compared. Results: In total, 131 patients were enrolled; the concordant and discordant groups comprised 31 (open, n = 19; laparoscopic, n = 12) and 100 patients (open to laparoscopic, n = 68; laparoscopic to open, n = 32), respectively. No significant differences were observed in the mean operation time (50.5 ± 21.7 minutes vs. 50.2 ± 20.0 minutes, P = 0.979), complication rates (6.5% vs. 14.0%, P = 0.356), or 36-month cumulative recurrence rates (9.8% vs. 9.8%; P = 0.865). The mean postoperative hospital stay was significantly shorter in the discordant than in the concordant group (1.8 ± 0.7 vs. 1.4 ± 0.6, P = 0.003). Conclusion: Most recurrent inguinal hernia repairs were performed using the discordant surgical approach. Overall, concordance in the surgical approach did not significantly affect postoperative outcomes. Therefore, the selection of the surgical approach based on the patient's condition and surgeon's preference may be advisable.

Transinguinal preperitoneal (TIPP) versus minimally invasive inguinal hernia repair: a systematic review and meta-analysis.

PURPOSE: The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for groin hernia repair. SOURCE: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of TAPP and TEP techniques separately. Statistical analysis was performed with R Studio. PRINCIPAL FINDINGS: 81 studies were screened and 19 were thoroughly reviewed. Six studies were included, of which two compared TIPP with TEP technique, two compared TIPP with TAPP, and two compared TIPP with both TEP and TAPP techniques. We found lower recurrence rates for the TEP technique compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). Also, we found lower seroma rates for TIPP group on the overall analysis (RR 0.21; P = 0.002). We did not find statistically significant differences regarding overall recurrence (RR 1.6; P = 0.19), chronic pain (RR 1.53; P = 0.2), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.29; P = 0.76) between MIS and TIPP. No statistically significant differences were found in the subgroup analysis of TAPP technique for all the outcomes. CONCLUSION: Our systematic review and meta-analysis found no differences between TIPP and MIS approaches in the overall analysis of recurrence, SSI, and chronic pain rates. Further research is needed to analyze individual techniques and draw a more precise conclusion on this subject. PROSPERO REGISTRATION: ID CRD42024530107, April 8, 2024.

Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia repair under local anesthesia with sedation in the outpatient clinic: a feasibility study.

BACKGROUND: The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. METHODS: Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. RESULTS: No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5-45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8-42.5) minutes vs. 54.0 (IQR: 46.0-62.0) minutes, P < 0.001) was significantly shorter for TREPP. CONCLUSION: This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions.

Laparoscopic Repair of a Large Incarcerated Intraparietal Inguinal Hernia Mimicking Acute Appendicitis: A Case Report.

Inguinal hernia is common. However, only a few cases have been reported in the literature of inguinal interparietal hernia, in which the herniated sac exits the intraperitoneal cavity through the deep inguinal ring and then protrudes into one of the anatomical planes of the anterior abdominal wall. Only one of the reported inguinal interparietal hernia cases was managed laparoscopically. We report the case of a right inguinal interparietal hernia in a young, healthy adult with a herniated cecum, terminal ileum, and appendix. He presented with right iliac fossa pain. On investigation, he was found to have an interparietal hernia in the inguinal region. Diagnostic laparoscopy showed a clear herniated cecum through the internal inguinal ring into the anterior abdominal wall. The patient was treated with regular laparoscopic hernioplasty and was discharged on the second postoperative day with no complications. Although the diagnosis might be difficult for interparietal hernias, laparoscopic diagnosis and management provide precise assessment and less invasive management.

A multicenter randomized controlled trial comparing short- and medium-term outcomes of novel biologics and lightweight synthetic mesh for laparoscopic inguinal hernia repair.

INTRODUCTION: The use of biological graft in laparoscopic inguinal hernia repair (LIHR) has been controversial, and there is a lack of high-level evidence to confirm the value of biological graft in LIHR. The purpose of this study is to evaluate the effectiveness of a novel composite biologics in LIHR. METHODS: A multicenter, single-blinded, randomized controlled clinical trial was designed. Fifty patients with unilateral primary inguinal hernia were randomly assigned to the experimental and control group (1:1). The experimental group was repaired with a non-crosslinked composite extracellular matrix from porcine urinary bladder matrix and small intestinal submucosa (UBM/SIS). The control group was repaired with a lightweight, large-pore, synthetic mesh. The primary endpoint was the effectiveness rate of hernia repair. RESULTS: The patients were followed up for four years. No significant difference was found between the experimental group and the control group in the effective rate of hernia repair (24/24[100%] vs 21/22[95.45%], RR, 0.4667; 95%CI, 0.3294-2.304; P = 0.4783). There was no fever, seroma, infection, groin pain, foreign body discomfort or recurrence in the experimental group during the follow-up. In the control group, there were 2 cases of seroma 14 days after operation, 1 case of groin discomfort 60 days after operation and one case of recurrence 410 days after surgery. CONCLUSION: Compared with the lightweight synthetic mesh, the novel UBM/SIS graft has comparable short-term and medium-term effectiveness in LIHR, and the incidence of postoperative complications such as seroma groin discomfort is lower. Trial registration Clinical Trials Registry: ChiCTR1800020173.

Usefulness of laparoscopic inguinal hernia repair using the Endoscope Manipulator Robot (EMARO).

PURPOSE: This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO). METHODS: This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups. RESULTS: Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77-87) and 70 min (range, 60-94), respectively, and the median blood loss was 5 mL (range, 1-5) and 2 mL (range, 1-5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5-12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042). CONCLUSION: Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed.

Lichtenstein technique for inguinal hernia repair: ten recommendations to optimize surgical outcomes.

PURPOSE: Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. METHODS: PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. RESULTS: Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. CONCLUSION: The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique.