Evaluating the complications of adult groin hernia where there is no hernia registry: a systematic review of Nigerian literature.

BACKGROUND: Enumerating the complications of groin hernia repair might help to highlight the need for improvement in the quality of care. This is imperative in a country without a strong post-operative complication surveillance mechanism. Hence, this review aims to determine the complications encountered during the surgical treatment of groin hernias among Nigerian subjects. METHODS: Databases like Google Scholar, Scopus, and PubMed were searched. Out of the 140 papers found during the search, only 20 were included in this review. Bassini repair was the most common type of hernia repair used, and neither laparoscopic repair nor posterior approach was utilized in any of the patients. Emergency presentations constituted about 18.5% of the cases. Meta-analysis of the studies showed that more prevalent complications were wound/scrotal edema (derived from four studies), surgical site infections (derived from 17 studies), and hematoma (from 19 studies). The rates were 23% (CI 0-46%; I2 = 80.9%), 6% (CI 3-10%; I2 = 87.7%), and 5% (CI 2-8%; I2 = 83.7%), respectively. The rate of complication in giant hernias was higher than the non-giant hernias and was statistically significant [p < 0.05; OR 1.5 (CI 0.9-2.4)]. Although the recurrence rate is low, there was insufficient follow-up of patients. CONCLUSION: This review has shown that one-fifth of the patients had emergency repair of hernias and giant groin hernias have higher odds of complications after repair compared to normal-sized ones. The most common complication noted was wound/scrotal edema. None of the hernias was repaired with laparoscopy. Perhaps, establishing a registry might improve the detection of late complications in patients who had groin hernia repair.

Local anesthesia as an alternative option in repair of recurrent groin hernias: An outcome study from the American College of Surgeons NSQIP® database.

INTRODUCTION: There is a dearth of data about the benefits of local anesthesia (LA) and spinal anesthesia (SA) compared to general anesthesia (GA) in patients undergoing repair of recurrent groin (inguinal/femoral) hernias. We hypothesized that patients with recurrent hernias who undergo repair under LA and SA will have a better outcome. METHODS AND PROCEDURES: Using the 2017 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP)® database, patients who underwent open repair of recurrent groin hernias were identified and divided into three groups: GA, SA, and LA. Outcomes evaluated included 30-day mortality and morbidity, operative time, total hospital length of stay (LOS), and reoperation and readmission rates. RESULTS: A total of 2169 patients were identified of which 1847 (85.2%) were in GA, 53 (2.4%) in SA, and 269 (12.4%) in LA groups. Overall, no statistically significant differences in demographics and comorbidities between the three groups were identified. However, patients in GA were younger and healthier with lower ASA Class (I-II) as compared to SA and LA groups. Patients in SA had a higher rate of COPD, and their overall operative time was shorter. However, LA patients had shorter LOS, and most LA patients were discharged home on the same day compared to GA, SA (92.2% vs. 77.9%, and 73.6%, p < 0.001). No differences in 30-day mortality and morbidity or reoperation and readmission rates between the three groups were noted. CONCLUSION: There is an underutilization of LA in patients undergoing open repair of recurrent inguinal hernia despite favorable outcomes, even in high-risk patients, when compared to GA and SA. Further prospective studies are needed to explore the potential barriers and cost-effectiveness of implementing LA as a primary anesthetic technique in inguinal hernia repair.

Laparoscopic Repair for Groin Hernias in Female Patients: A Single-Center Experience in 15 Years.

BACKGROUND: Our objective was to investigate the clinical characteristics of laparoscopic repair for groin hernias in female patients. STUDY DESIGN: The clinical data of 316 female patients (341 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2015 was analyzed retrospectively. The operation-related data were to provide an overview of female groin hernias, preferred surgical approach, and the management of round ligament of uterus. RESULTS: There were 274 transabdominal preperitoneal patch plastic repairs and 67 total extraperitoneal repairs performed on 257 and 59 patients, respectively. The median follow-up period was 48 months. Fifty-eight femoral hernias were noted in 52 patients, of which 18 femoral hernias were incarcerated. Cysts on the round ligament of uterus were found in 39 patients, and most of them underwent laparoscopic resection. Round ligaments of uterus were preserved in 152 patients and transected in 162 patients. The preservation group requires longer operation time and trickier surgical technique. None of the cases was converted to laparotomy. All patients returned to normal activity soon and no recurrence was noted during follow-up. CONCLUSIONS: Laparoscopic inguinal hernia repair is well adopted around the world. Meanwhile, there still remain questions to be discussed in female patients. Based on this study, the round ligament cyst could be resected while the operation. Either "open and suture" or keyhole technique will be available to preserve the round ligament of uterus.

Giant Inguinal Herniae Managed by Primary Repair: A Case Series.

Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications.

Multiple concurrent bilateral groin hernias in a single patient; a case report and a review of uncommon groin hernias: A possible source of persistent pain after successful repair.

INTRODUCTION: The wide use of laparoscopy for groin hernia repair has unveiled "hidden hernias" silently residing in this area. During the open repair of the presenting hernia, the surgeon was often unaware of these occult hernias. These patients postoperatively may present with unexplained chronic groin or pelvic pain. PRESENTATION OF CASE: Rare groin hernias are defined according to their anatomical position. Challenges in the diagnosis and management of occult rare groin hernias are discussed. These problems are illustrated by a unique case report of multiple (six) coexisting groin hernias, whereof five were occult and two were rare. DISCUSSION: Rare groin hernias are uncommon because they are difficult to diagnose clinically and are not routinely looked for. They are often occult and may coexist with other inguinal hernias, thus posing a diagnostic and treatment challenge to the surgeon, especially if there is persistent groin pain after "successful" repair. MRI is the most accurate preoperative and postoperative diagnostic tool, if there is a clinical suspicion that the patient might have an occult hernia. CONCLUSION: Preperitoneal endoscopic approach is the recommended method in confirming the diagnosis and management of occult groin hernias. A sound knowledge of groin anatomy and a thorough preperitoneal inspection of all possible sites for rare groin hernias are needed to diagnose and repair all defects. The preperitoneal mesh repair with adequate overlap of all hernia orifices is the recommended treatment of choice.

Prognostic Factors of Postoperative Morbidity and Mortality of Adult Strangulated Groin Hernia.

The aim of this work is provide the results of the surgical treatment of strangulated groin hernias and determine morbidity and mortality risk factors. It is a retrospective study related to the 288 records of patients aged 15 years and more, who underwent emergency surgery for strangulated groin hernia from January 2007 to December 2012. Postoperative evolution was assessed on the morbidity, mortality, and length of hospital stay. Mortality and morbidity risk factors were studied. The statistical analysis was conducted with the chi-square test and Fischer's exact test with a significance level of 5 %. Strangulated groin hernias account for 42.2 % of the overall groin hernia operations conducted during the study period (288/697). Necroses were present in 59 (20.5 %) patients. The mortality rate was 6.2 % (n = 18). Admission time superior or equal to 48 h (p = 0.002), American Society of Anesthesiologists (ASA) class superior or equal to III (p = 0.002), presence of preoperative strangulated groin hernia complication (peritonitis, occlusion, hernia abscesses) (p = 0.001), bowel necrosis (p = 0.000), and bowel resection (p = 0.000) were statistically related to a high risk of death. Forty-two (n = 42) postoperative complications were recorded in 34 (11.8 %) patients. These complications were outnumbered by postoperative parietal suppuration (n = 26) which led to three cases of evisceration. Bowel necrosis was related to a high risk of postoperative complications (p = 0.002). Reoperation was necessary for 13 patients. The length of stay in hospital was 4 days (range between 1 and 28 days). The average follow-up period was 7 months. No recurrence was noticed during this period. Delay in consultation, high ASA class, and moreover, bowel necrosis requiring bowel resection are the factors of unfavorable postoperative results. Groin hernias are an avoidable death cause provided that early treatment of strangulated hernias and the elective treatment of non-complicated hernias are conducted.

Hérnia de Amyand à Esquerda: relato de caso e revisão de literatura / Amyand's Hernia: case report and literature review

Introdução: A presença de apêndice vermiforme no interior de um saco herniário na região inguinal foi descrita pela primeira vez em 1735, por Claudius Amyand. Desde então a "Hérnia de Amyand" tem sido relatada pela literatura mundial como evento raro, correspondente a cerca de 1% de todas as hernias. Seu aparecimento à esquerda é ainda mais raro, com apenas 5 casos descritos nos útlimos 25 anos. Métodos: Paciente masculino, 68 anos e 11 meses de idade, se apresenta na emergência com quadro de dor em região inguinal esquerda, sintomas de quadro suboclusivo e abaulamento em ambas regiões inguinais. No intra-operatório encontrado Hérnia de Amyand à Esquerda, e realizado orquiectomia e enterectomia segmentar em bloco por aderências encontradas pelo processo crônico. Reparo realizado com uso de Tela de Polipropileno. Alta no 7˚ P.O. sem complicações. Revisão da literatura através de pesquisa ao Medline. Discussão: Durante a revisão de literatura foram encontrados 5 casos descritos de Hérnia de Amyand à esquerda. Foram revisados também séries de casos e relatos com revisão de literatura. Em virtude do raro aparecimento desta hérnia, as condutas tomadas se baseiam na experiência do cirurgião e no achado intra-operatório. Existem na literatura artigos que podem servir como base de conduta através de uma tentativa de classificação das Hérnias de Amyand e padronização de terapêutica cirúrgica. Conclusão: Diante da heterogeneidade das condutas e a raridade do aparecimento deste tipo de hérnia é evidente a necessidade da realização de revisão sistemática para a busca de padronização principalmente da terapêutica cirúrgica.

Background: The presence of an vermiform appendix in a herniary sac on groin area was described for the first time in 1735, by Claudius Amyand. Since then, Amyand's Hernia has been described by the worldwide literature as a rare event, corresponding circa 1% of all hernias. Its appearance to the left is even rarer, with only 5 cases described in the past 25 years. Methods: Male patient, 68 years and 11 months old, comes to the emergency room presenting pain on the left groin area, suboclusive symptoms and lump on both groin areas. In the surgery was found left Amyand's Hernia, and procedure enbloc orchiectomy and segmentar enterectomy from adherences found by the chronic inflammatory process. Repair was made using the Polypropylene Mesh. End of treatment on the 7th P.O. without complications. Literature review through research to the Medline. Discussion: During the literature review there were found 5 cases described of left Amyand's Hernia. There were also reviewed series of cases and reports with the literature. Due to the rare appearance of this hernia, the conducts taken are based in the experience of the surgeon and in surgery founds. There papers in the literature that may serve as conduct base through a trial of classifying of the Amyand's Hernia and standard therapeutic surgery. Conclusion: Facing the heterogeneity of the conducts and rarity of the appearance of this sort of hernia it is evident the necessity of systematic review to find a standard, mainly for the surgery therapeutics.