A comparative study of smooth muscle cell characteristics and myofibroblasts in processus vaginalis of pediatric inguinal hernia, hydrocele and undescended testis.

BACKGROUND: Congenital inguinal hernia, hydrocele and undescended testis (UDT) are associated with patent processus vaginalis. The smooth muscles present in the processus vaginalis aid in the descent of the testis and undergo programmed cell death after testicular descent leading to obliteration. The persisting amount of smooth muscle in the processus vaginalis influences the clinical outcome as inguinal hernia, hydrocele or UDT. Therefore, a study was conducted to evaluate the processus vaginalis in these three conditions to observe the presence and phenotype of smooth muscle cells and the presence of myofibroblasts. MATERIALS AND METHODS: The processus vaginalis sacs in patients with inguinal hernia, hydrocele and UDT were examined using light microscopy for the presence and distribution of smooth muscle cells and immunohistochemical staining for vimentin, desmin, and α-smooth muscle actin (SMA) to identify the smooth muscle phenotype. Transmission electron microscopy was also performed in all the sacs to observe the presence of myofibroblasts. RESULTS: Seventy-eight specimens of processus vaginalis (from seventy-four patients), distributed as 47%, 27%, and 26% as inguinal hernia, hydrocele and UDT respectively, were included in the study. The sacs from inguinal hernia and hydrocele had significantly more presence of smooth muscles distributed as multiple smooth muscle bundles (p < 0.001). Desmin and SMA staining of smooth muscle cells was observed in significantly more sacs from hydrocele, followed by inguinal hernia and UDT (p < 0.001). The sacs from UDT had a significant presence of striated muscles (p = 0.028). The sacs from inguinal hernia had a significant presence of myofibroblasts, followed by hydrocele and UDT (p < 0.001) and this significantly correlated with the light microscopy and immunohistochemical features. The processus vaginalis sacs from four female patients did not differ statistically from the male inguinal hernia sacs in any of the above parameters. CONCLUSION: The processus vaginalis sacs in pediatric inguinal hernia, hydrocele and undescended testis differ in the presence, distribution and phenotype of smooth muscles and the presence of myofibroblasts. The clinical presentations in these entities reflect these differences.

Liposarcoma of spermatic cord mimicking an inguinal hernia A case report and review of the literature.

AIM: Liposarcoma of the spermatic cord (LSC) is a tumour often mistaken for common inguinal swelling as hernia and the aim of this work is to present our case with a review of the Literature to define the management of this rare condition. MATERIAL OF STUDY: A systematic review has been realised, considering English language articles published on Pubmed, between 1956 and 2022, using as key words "Liposarcoma of the spermatic cord". RESULTS: 160 studies described 420 cases of LSC and in 40 cases the patient had undergone surgery with an initial diagnosis of inguinal hernia. DISCUSSION: LSC is a very rare entity of genitourinary malignancies, occurring more often in the spermatic cord and diagnosis can be difficult. Our case and Literature data confirm the role of imaging in not conventional inguinal swelling, to avoid diagnostic mistakes and to define preoperatively the correct surgical management. CONCLUSIONS: Imaging is mandatory in case of diagnostic doubt. The recommended treatment is a radical high orchiectomy with clear margins. A long follow-up period is necessary to detect a local recurrence which may occur even several years after the primary therapy. KEY WORDS: Inguinal swelling, Liposarcoma, Spermatic cord.

Evaluación del dolor crónico postoperatorio en hernioplastia TAPP versus Lichtenstein por Residentes / Evaluation of chronic postoperative pain in hernioplasty Tapp versus Lichtenstein by residents

La incidencia de la hernia inguinal a lo largo de la vida es variable, pero con una mayor prevalencia en los hombres. Hoy en día no existe una técnica superior en términos de reducir el dolor postoperatorio crónico, que es la mayor morbilidad que afecta a los pacientes. Es por eso que realizamos un breve análisis comparativo, donde evaluamos la incidencia de dolor crónico entre el ensayo convencional versus laparoscópico de la patología de la hernia

The incidence of inguinal hernia throughout life is variable, but with a higher prevalence in males. Today there is no superior technique in terms of reducing chronic postoperative pain, which is the greatest morbidity that afflicts patients. That is why we carried out a brief comparative analysis, where we evaluated the incidence of chronic pain between conventional versus laparoscopic rehearsal of hernia pathology

[A Case of Inguinal Hernial Sac Metastasis of Cecal Cancer Resected with TAPP Approach].

Malignant tumor occurring in the inguinal region are relatively infrequent, and metastatic tumor is extremely rare. We report a case of inguinal hernial sac metastasis of cecal cancer resected with TAPP approach. The case is a 80's man. One year and 6 months after cecal cancer surgery, contrast-enhanced computer tomography(CT)examination revealed a solitary tumor in the right inguinal canal. We diagnosed inguinal hernia sac metastasis of cecal cancer and performed surgery. The mass in the hernia sac was resected with the TAPP approach. Histopathological findings were consistent with peritoneal metastasis directly to the inguinal hernia sac. The patient has been alive without 2 years after metastasectomy. It is necessary to treat patients with a history of malignant disease with keeping the possibility of inguinal hernia sac metastasis in mind.

Arteriovenous malformation of the spermatic cord mimicking reducible inguinal hernia.

Arteriovenous malformations are a vascular anomaly most often found in the central nervous system; however, they can present ubiquitously in any organs or tissues. We present the case of a 55-year-old man who developed a tender, reducible inguinal bulge and underwent laparoscopic transabdominal preperitoneal inguinal hernia repair under the clinical diagnosis of an inguinal hernia. Intraoperative observation revealed no hernia sac, but a poorly defined spermatic cord mass, appearing to be responsible for the patient's symptoms, was found and removed. The pathology of the mass was consistent with the diagnosis of an arteriovenous malformation of the spermatic cord. Surgeons should keep in mind the small possibility of arteriovenous malformations in patients with clinical presentation of an inguinal hernia, as they may cause massive bleeding during and after the operation unless handled appropriately.

John Hunter and the Descent of the Testis.

The descent of the testis and the development of an inguinal hernia were the earliest published scientific work by John Hunter, the Scottish surgeon and anatomist who is acknowledged as the father of scientific surgery. Hunter's anatomic descriptions are the ones we use today to describe the prenatal descent of the testis and to explain the pathogenesis of an undescended testis and inguinal hernia in infancy. His work appeared in print in 1762, not as a formal publication but as an addendum to a screed written by his older brother William publicly accusing Percival Pott of pirating John's observations on the pathogenesis of an inguinal hernia and publishing them as his own, an early example of scientific rivalry.

Recidiva de hernias inguinales. Estudio de 52 casos / Recurrence of Inguinal Hernias. Study of 52 cases

Las hernias inguinales son una patología para tratamiento quirúrgico frecuente, afecta entre un 3 a 5 % de toda la población en general, su reparación resulta difícil y peligrosa en caso de recurrencia; un paciente sometido a cirugía tiene entre19 ­ 39 % de probabilidades de recidiva, y esto aumenta con cada nuevo procedimiento. Objetivo: caracterizar la prevalencia de recidivas de hernias inguinales en pacientes intervenidos quirúrgicamente en el Servicio de Cirugía General del Hospital Universitario de Caracas entre los años 2015-2020. Métodos: estudio retrospectivo, descriptivo y analítico. Resultados: se estudiaron 52 casos de recidivas de hernias inguinales, 43 % de un total de 120 pacientes sometidos a hernioplastia inguinal, las técnicas quirúrgicas con mayor número de recidivas fueron: la de Bassini con 14 %, la de Rutkow-Robbins con 10 % y la de Linchtenstein con 9 % de los casos; con un tiempo de recidiva posterior a la primera intervención el cual fue mayor al año de la primera intervención. Conclusiones: la recidiva resultó un poco mayor al promedio, el tiempo en el cual ocurrió es mayor al año de la intervención y las técnicas más involucradas fueron, enorden decreciente: Bassini, Rutkow-Robbins, y Linchtenstein(AU)

Inguinal hernias are a pathology for frequent surgical treatment, affecting between 3 to 5 % of the entire population in general, their repair is difficult and dangerousin case of recurrence; a patient undergoing surgery has a19-39 % chance of recurrence, and this increases with eachnew procedure. Objective: to characterize the prevalence of recurrences of inguinal hernias in patients undergoing surgery at the General Surgery Service of the Hospital Universitario de Caracas between the years 2015-2020. Methods: retrospective, descriptive and analytical study. Results: 52 cases of inguinalhernia recurrences were studied, 43 % of a total of 120 patients undergoing inguinal hernioplasty, the surgical techniques with the highest number of recurrences were: Bassini with 14 %,that of Rutkow-Robbins with 10 % and that of Linchtensteinwith 9 % of the cases; with a recurrence time after the first intervention which was greater than a year after the first intervention. Conclusions: the recurrence was a little high erthan the average, the time in which it occurred is greater than a year othehe intervention and the techniques most involved were,in decreasing order: Bassini, Rutkow-Robbins, and Lichtenstei(AU)

Cyst of the canal of Nuck: an atypical course with cyclic changing of size.

As the canal of Nuck normally obliterates before birth, a patent canal is a rare anatomic variant in adult women analogue to the patent processus vaginalis in men. In a patent canal of Nuck, pathologies such as hernias and cyst can build within time. Such cysts themselves are so uncommon that they are mostly described in case reports. Normally, cysts of the canal of Nuck present as a consistent, inguinal swelling with or without pain. Interestingly, in our case, the painful swelling was cyclic changing from the size of a plum to being clinically undetectable within the course of a day. To the best of our knowledge, this is the first description of such an unusual course. The cyst was removed operatively via an open approach. The spasms declined shortly after the operation. At 1 year postoperatively, the patient was still asymptomatic.

Incidental Diagnosis of Metastatic Prostate Cancer Post-Inguinal Hernia Repair.

This report discusses the case of an 83-year-old male who was incidentally found to have a diagnosis of metastatic prostate cancer on pathology from elective inguinal hernia repair. The medical record, radiology, operative reports, and pathology of the patient were reviewed and a literature search was subsequently performed. A new cancer diagnosis is a very rare finding during routine hernia surgery. Moreover, the decision of whether to send a hernia sac for routine pathology is often dependent on individual surgeon practices and institutional guidelines. However, this case demonstrates the potential for an unexpected finding on routine pathology to significantly alter the clinical course of a patient's care as the patient subsequently underwent both medical and palliative surgical treatment for prostate cancer.

Ovarian inguinal hernia - a possibility in MURCS syndrome.

BACKGROUND: Inguinal hernia containing ovary and fallopian tube can be found in paediatric population and is a rare finding in women of reproductive age group. Most of the cases are associated with congenital abnormalities of the female genital tract. CASE PRESENTATION: A 20 year old female presented with right reducible inguinal hernia, primary amenorrhea and normal secondary sexual characteristics. Clinical examination revealed scoliosis with convexity towards left side, prominence of left rib cage with Sprengel deformity and right sided heart sounds. Ultrasound of the inguinal swelling revealed right ovary within the hernial sac, Chest X-ray revealed right lung collapse and dextrocardia. Further Magnetic resonance imaging (MRI) of pelvis revealed inguinal hernia with right ovary as its content, normal left ovary and absent uterus. Computed tomography (CT) revealed complete collapse of right lung with compensatory left lung hyperinflation and absent right kidney. Karyotyping of the patient was normal, 46XX. A diagnosis of MURCS syndrome with right ovarian hernia was made. The hernia was surgically managed with repositioning of ovary and fallopian tube into the pelvis. DISCUSSION: Ovary in inguinal hernia is rare in women of reproductive age group. MRKH syndrome, a mullerian duct anomaly, is the congenital aplasia of uterus and upper two-thirds of vagina in a female with normal ovaries, fallopian tube, secondary sexual characteristics and 46XX karyotype. MURCS is a subtype of MRKH type 2 having mullerian duct agenesis with renal, cardiac, muscular & vertebral defects. General physical examination and primary investigations if yields abnormal findings; the patient must undergo an array of investigations to rule out MRKH/MURCS, or other congenital abnormality. Early diagnosis is essential to prevent its incarceration or torsion. The primary treatment of ovary in inguinal hernia is repositioning the ovary and fallopian tube back to pelvis to preserve fertility and repair of inguinal hernia. A multidisciplinary team is required to deal with various abnormalities present in a patient with MURCS.

Laparoscopic-assisted percutaneous herniorrhaphy as an alternative to open surgery technique in farm swines.

BACKGROUND: Despite numerous experimental studies presenting laparoscopic treatment of inguinal hernia in a pig model so far no described technique has been used in clinical patients of this species. Minimal invasiveness and the simplicity of closure of the inguinal canal using the Percutaneous Internal Ring Suturing (PIRS) technique makes it the world's first technique for laparoscopic treatment of inguinal hernia in pigs as clinical patients. AIM: This study aims to assess the applicability and effectiveness of the laparoscopic PIRS technique in the treatment of inguinal hernia in pigs as clinical patients and to compare the PIRS technique with the open surgery technique, which is currently being used. METHODS: The study was conducted on 22 non-castrated male pigs with inguinal hernia (clinical patients), divided into two equal groups: PIRS and open surgery (OS). In the PIRS group, the inner inguinal ring was closed with an optical trocar inserted at the umbilicus level and an injection needle with a suture material inserted percutaneously over the inguinal canal. The suture material was threaded through the inner inguinal ring and then tied, leaving the knot under the skin. As a result to this the inguinal canal was closed. In the OS group the procedure was performed with open access above the inguinal canal where, after dissection of the vaginal processus and reducing the contents of the hernia to the abdominal cavity, it was ligated as close to the inguinal canal as possible, and the wound was then closed in layers. RESULTS: All operated pigs returned to full fitness immediately after recovery from anesthesia. There was one case of hernia recurrence in the PIRS group. In the OS group all the operated pigs had a temporary swelling of the postoperative wound and the scrotum on the side of the operated inguinal hernia, which was not found in the PIRS group. CONCLUSIONS: The effectiveness of the PIRS technique is comparable to that of open surgery. Considering the simplicity of the PIRS procedure and its minimal invasiveness, this technique may be used as an alternative to the open technique in the treatment of inguinal hernias in pigs not subjected to surgical castration.

Inguinoscrotal hernias containing stomach: risk of emergency presentation.

INTRODUCTION: Inguinoscrotal hernias are the commonest form of abdominal wall hernia, but for them to contain stomach is extremely rare. The management of these hernias can be very challenging owing to their acute nature of presentation and distortion of anatomy. Our aim was to systematically review the literature for all reported cases of inguinoscrotal hernias containing stomach. In turn we analysed patient demographics, site of hernia, presentation and treatment. Outcomes were reviewed where available. METHOD: We conducted a systematic search of the PUBMED, Embase and Medline databases with a combination of keywords: Hernia AND (inguin* OR scrot*) AND (gastric OR gastro*). An author's own case has also been included. RESULTS: There were 20 case reports included in the review, plus the author's own case. They ranged in publication date from 1942 to 2020. Mean age at presentation was 71 years (range 49 to 87). All cases were male. In total, 62% (n = 13) of cases presented with combined symptoms of abdominal pain and vomiting, 48% (n = 10) presented with gastric outlet obstruction (GOO) and 48% (n = 10) presented with gastric perforation. All successfully treated cases with gastric perforation required a midline laparotomy approach, whereas 56% (n = 5) of patients in the GOO group were successfully treated conservatively. There were three deaths reported in this review, all in the gastric perforation group. CONCLUSION: Stomach as a content of inguinoscrotal hernias is extremely rare. These hernias predominantly present acutely in the form of GOO or gastric perforation. All patients with gastric perforation will require a midline laparotomy. Patients with GOO can be successfully managed either surgically or in selective cases with conservative management.

Evaluation Of Darn Repair For Recurrence Rate In The Management Of Indirect Inguinal Hernia.

BACKGROUND: Management of Inguinal Hernia had long been remained an enigma & various method had been employed for its management till date. Recent trend is towards the preferential use of mesh in open as well as Laparoscopic approaches where its advocates almost always undermine the role of raphys in the management of inguinal hernia but Darning repair despite all this critique is still a valid & viable option for the management of Indirect inguinal hernia. METHODS: This descriptive study was designed & carried out at the surgical units of Ayub Teaching Hospital Abbottabad from February 01, 2016 to October 31, 2018. A total of 117 patients with indirect inguinal hernia (primary) were included in study, managed with Darn Repair & were later followed for 2 years for the evidence of recurrence. RESULTS: None of the included patients (followed till last) whom underwent Darning Repair for Indirect Inguinal Hernia were found with the complication of recurrence till 02 years of follow-up although few patients were lost to follow-up for the whole duration 02 years and few others had suffered other early complications like wound infection, seroma, haematoma formation, scrotal swelling or comparatively longer lasting post-operative pain. The Darn Repair was also found cost-effective as compared to Mesh repair. CONCLUSIONS: Darn Repair despite criticism is a viable & effective option for Indirect Inguinal Hernia Repair (where its role indeed is prophylactic {NOT curative} against the future false recurrence), having no recurrence rate (as per our study results) like mesh repair (as per published literature) besides being reasonably cost-effective.

Primary inguinal subcutaneous endometriosis accompanied with an inguinal hernia: A case report.

RATIONALE: We report a case with inguinal subcutaneous endometriosis without typical cyclic dysmenorrhea and accompanied with a hernia sac treated with resection of the tumor and herniorrhaphy. PATIENT CONCERNS: A 40-year-old woman had a painless enlarged inguinal nodule for 3 months. DIAGNOSES: Subcutaneous endometriosis accompanied with a hernia sac. INTERVENTIONS: Ultrasonography showed a hypoechoic lesion (3.0 cm × 2.0 cm), and an inguinal subcutaneous tumor was first suspected. After surgical exploration, a cystic lesion was excised and the hernia hole was repaired by herniorrhaphy. The immunohistochemical analysis of the small endometriotic cyst-like lesion revealed calretinin (-) in epithelial cells and CD10 (+) in stromal cells, indicative of subcutaneous endometriosis accompanied with a hernia sac. OUTCOMES: The patient was followed up for 1 year and without recurrence. LESSONS: Cutaneous endometriosis accompanied with a hernia sac can be presented without typical endometriosis-associated symptoms such as dysmenorrhea. Inguinal endometriosis might be the differential diagnosis of inguinal painless nodules.

La hernia ureteroinguinal: una condición infrecuente a tener en cuenta / The ureteroinguinal hernia: An infrequent condition to keep in mind

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Outcomes of open versus single-incision laparoscopic totally extraperitoneal inguinal hernia repair using propensity score matching: A single institution experience.

PURPOSE: The aim of the current study was to compare the outcomes between open and single-incision laparoscopic totally extraperitoneal (SILTEP) inguinal hernia repair. METHODS: To compare the outcomes between the open and SILTEP groups, we performed propensity score matching to adjust for significant differences in patient characteristics. The outcomes were compared between the matched groups. RESULTS: Record review identified 477 patients who had undergone inguinal hernia repair from November 2016 to November 2018. Seventy-one patients were excluded from the propensity score matching because of age <18, femoral hernia, conventional 3-port laparoscopic repair, incarcerated hernia, and combined operation. SILTEP in 142 and open repair in 264 patients were identified. After propensity score matching, these individuals were grouped into 82 pairs. Spinal anesthesia was administered more often in the open group than in the SILTEP group. Operation time was significantly longer in the SILTEP group than in the open group (49.6 ± 17.4 vs. 64.8 ± 28.4 min, p < 0.001). However, urinary retention rates of the open group were significantly higher than that of the SILTEP group (11.0% vs. 0%, p = 0.003). The SILTEP group showed significantly lower pain scores at postoperative 6, 12, and 24 hours, and significantly lower rates of intravenous analgesic requirements through postoperative day 1 (30.5% vs. 13.4%, p = 0.008) compared with the open group. CONCLUSION: The outcomes of SILTEP repair were comparable to those of open repair. SILTEP repair may have advantages over open repair for reducing immediate postoperative pain (≤24 hours).

Resection of a giant retroperitoneal lipoma herniating through the inguinal canal.

Retroperitoneal lipomas are extremely rare with few cases reported so far in the literature. They can reach different sizes and present with a variety of symptoms. The differential diagnosis is mainly with well-differentiated liposarcoma (WDLPS). We present a 34-year-old woman with a retroperitoneal lipoma herniating through the inguinal canal into the proximal thigh. The patient underwent complete oncological resection using a Karakousis's abdominoinguinal incision. Retroperitoneal lipomas are a very rare condition and sometimes require resections technically challenging. MDM2 amplification is critical for its differential diagnosis with WDLPS.

Sonographic appearance of a large lipoma of the spermatic cord presenting clinically as an inguinoscrotal hernia.

Lipoma of the spermatic cord or the round ligament is called inguinal canal lipoma. It may present as an inguinal herniating mass of fat tissue, with or without an accompanying herniating sac. There are few reports about large lipomas of the spermatic cord. We describe a case of a large spermatic cord pure lipoma, initially suspected to be an inguinal hernia upon physical examination. We diagnosed the lipoma with ultrasound and magnetic resonance imaging. The patient subsequently underwent left orchiectomy.

Amyand's hernia associated with mesenteric chylous cyst in infant: a rare case report.

BACKGROUND: Amyand's hernia is a rare condition approximately 0.4-0.6% of all inguinal hernias. Although rare, the Amyand's hernia is worthy of discussion since the variable presentation that make clinical challenge to diagnose especially in infant. A mesenteric chylous cyst is rare disease and has not been reported in Amyand's hernia. CASE PRESENTATION: We report an unusual case of Type II Amyand's hernia with an enlarging chylous mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. A-2-months old infant presented with enlarging mass in the right scrotal. During laparotomy exploration, we found inguinal sac with intestinal and appendix content in the sac. In the edge site of the sac we found enlarging of mesenteric cyst on the retrocaecal in the anulus into canalis inguinalis. Based on the histopathology examination, the morphological feature is suitable for mesenteric chylous cyst appearance. CONCLUSION: Presentation of mesenteric chylous cyst is rare, and there was no report about it in Amyand's hernia. This unusual presentation should be considered by the surgeon, especially pediatric surgeon, in Amyand's hernia cases.