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Giant Amyand hernias are exceptional inguinal hernias because they extend below the middle of the thigh in the standing position and contain the cecal appendix. We present a patient with an irreducible giant Amyand hernia, who underwent surgical repair, using a combination of techniques for its resolution. The treatment of giant inguinal hernias is quite a challenge, due to the existing anatomical distortion, and the loss of the right to domicile of the organs that it can cause. We consider that the combination of the Bassini and Lichtenstein techniques associated with the Ombrédanne and Camay maneuvers is an appropriate strategy to successfully repair grade I giant inguinal hernias. Appendectomy in Amyand type I hernia is a treatment alternative when a risk of acute appendicitis exists. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Bilateral inguinal hernioplasty by endoscopic totally extraperitoneal approach (TEP) seems to increase the probability of complications and early postoperative pain compared to unilateral endoscopic hernioplasty. In this work we also try to determine if bilaterality increases the risk of conversion and recurrence during the learning curve. Methods: Between January 2017 and February 2020, 140 patients underwent TEP surgery by 2 surgeons in a single Center, establishing 2 groups: learning curve (LC) and mastery of the technique (MT). Conversion, intraoperative and postoperative complications, chronic pain, and recurrence were retrospectively analyzed. Logistic regression was performed to assess the effect of bilaterality on the results obtained. Results: 211 procedures were performed (CA: 80; SD: 131). The mean follow-up was 26.7 months (11-70, SD 1.9). The LC group presented an increase in conversion (5 % vs 3.05 %, p = 0.41), postoperative complications (16.2 % vs 10.7 %, p = 0.11) and recurrence (12.8 % vs 0 %, p < 0.001) compared to the MT group. In the LC group, bilaterality associated a non-significant increase in conversion (9.7 % vs 0 %, p = 0.94), complications (29 % vs 25 %, p = 0.76) and recurrence (19.3 % vs 18.7 %, p = 0.96). All the cases of conversion and recurrence took place in the second operated hernia. Conclusions: During the learning curve, bilateral inguinal hernioplasty by TEP increases the risk of conversion and recurrence of the hernia operated on second, and it is advisable not to include bilateral hernias in the initial training period. Studies with a larger number of cases could reach statistical significance. [ABSTRACT FROM AUTHOR]

Introduction: Spiegel-Casseri’s hernia (HSC) is an infrequent entity that represents about 2 % of abdominal wall herniary defects, but frequency could be increased due to its subdiagnosis. The diagnosis of HSC is usually diffi cult and unsuspected and it presents high risk of jamming and strangulation so its surgical management is imperative. A TC is essential for diagnosis. Case report: Male, with pathological antecedents of myasthenia gravis, who consults about bilateral inguinal hernia and left Spiegel-Casseri’s hernia. Due to his clinical history, an open preperitoneal surgical approach with Lichtenstein plastic to repair all the three defects is done. During the postoperative, he had a bruise on the dropped hernial sac, treated with conservative measures and control and didn’t require drainage. Discussion: Most series of notifi ed cases of HSC in the literature show variable incidence of attendant abdominal wall’s defects. In this case, myasthenia gravis, a chronic and weakening disease, prompted three associated parietal defects and limited anesthesiologist options and surgical approaches. HSC is an unusual entity and its association with others hernias even more, but it exists and must be taken into account to achieve an optimal treatment for the patient. [ABSTRACT FROM AUTHOR]

The article describes a clinical case of a patient with a deep supraforaminal hernia, a rare variant of interparietal hernia in the inguinal region. During surgery, an indirect inguinal hernia type IIIB and a lobulated and pedunculated preperitoneal lipoma were found. The hernia was repaired using the plug technique and the region was reinforced with another mesh using the Lichtenstein technique. The patient recovered successfully and there have not been many reports on this variant of hernia. [Extracted from the article]

Introduction: Despite the important advances made in recent decades in the prevention of adverse events, foreign body abandonments continue to occur in the surgical fi eld (“never events”). Although the retained objects can occur asymptomatically, the potential complications are numerous, requiring in most cases a reoperation for their removal. Case report: We present the exceptional case of a patient who had to be reoperated to remove a surgical drain migrated to an inguinal hernia sac after accidental and inadverted rupture during its removal in the postoperative period of a previous surgery. Discussion: Most of the safety measures and prevention of these adverse events try to guarantee a correct count of surgical material during surgery. Correct actions must also be ensured in the removal of surgical drains to avoid this type of complications. [ABSTRACT FROM AUTHOR]

Introduction: The e-TEP approach has traditionally been used for the management of inguinal hernias and since 2017 has also been indicated for the treatment of ventral hernias. We present a modification to the e-TEP Rives-Stoppa, with technical and ergonomic advantages for the surgeon, better cosmetic results and low complications rate. Method: We present a prospective, multicenter cohort of patients with ventral hernias, primary hernias associated with diastasis recti abdominis, operated by modified endoscopic technique in two tertiary care hospitals. We analyzed demographic information, perioperative characteristics, complications, and the Carolina Comfort Scale (CCS) was applied. Results: We included 35 patients, 68.6 % had previous hernia repair, average defect area of 71.5 cm2, large meshes were used, without fixation, minimal intraoperative bleeding, minimal length of hospital stays, short disability, and low postoperative morbidity. We applied CCS preoperative, at 30, 90 and 180 postoperative days, showing improvement in the items evaluated. Follow-up was 310 ± 115 days with no recurrences, readmissions, or additional surgeries. Conclusions: The eTEP-SA approach offers technical and ergonomic improvements, excellent cosmetic results, reduces costs and operative time, compared to the classic technique, in selected cases. We suggest its implementation in the treatment of ventral hernias M1, M2, M3, L1, L2 and primary midline hernias associated with diastasis recti abdominis. We believe that eTEP-SA is a valuable option to consider. [ABSTRACT FROM AUTHOR]

Introduction: In the last decade, groin pain has become the main complication of hernioplasty and a major public health problem. This problem can only be controlled by ensuring adequate knowledge of lumbar neuroanatomy. The objective of this work is to review the history of inguinal neuroanatomy in relation to hernia pathology and the specialty of the abdominal wall. Method: Literature review of PubMed, LILACS, Cochrane Library databases; supplementary search using Google (Google Play), of university libraries. As keywords have been used: “lumbar plexus”, “inguinal nerves”, “ilioinguinal nerve”, “iliohipogastric nerve”, “genitocrural nerve”, “hernia”, “anatomy” and “surgery”. A critical analysis of published articles, theses, books and monographs is carried out. Manuscripts obtained from any country, by any institution or researcher and in any language, without time limit, are stored in pdf format. Results: The study of the history of the inguinal nerves with current methodology shows the succession of knowledge until reaching the current anatomical terminology and in parallel, the development of surgical techniques until neural pathology is considered of interest. Conclusions: Schmidt’s study offers us the most recognized descriptive topography with the first advice on clinical problems associated with neural injury during a hernia operation. His classification is the one adopted as official anatomical terminology. The concepts of the intramuscular plexus of the psoas and the iliac fossa anastomotic system were introduced by the Spaniard Gómez Durán (1923). A clear disconnection between the advances in hernia and neural anatomical-surgical knowledge is demonstrated, with a delay of two centuries in its topographical application to the abdominal wall specialty. [ABSTRACT FROM AUTHOR]

The Amyand hernia was described by Claudius Amyand in 1735 and is currently considered a rare entity that occurs in 1 % of all inguinal hernias in adults. This pathology consists of the finding of a rare presentation of hernias, where the cecal appendix is located within the inguinal hernial sac, without inflammatory characteristics in most cases. Evidently, a key concept associated with the hernia in question is acute appendicitis or also known as the most frequent surgical abdominal pathology predominantly in young people with a lifetime incidence of 7 %, presenting in patients over 60 years of age in a 5-10 % of cases. In the present review, we report the case of a male in the ninth decade of life who comes to a hospital with a symptomatic inguinal hernia, with signs of incarceration and associated intestinal obstruction, with intraoperative finding of Amyand hernia type 3 in the Losanoff and Basson classification, constituting a rare case of incarcerated Amyand hernia. [ABSTRACT FROM AUTHOR]

Amyand's hernia is a rare type of inguinal hernia presentation whose content is the cecal appendix, with reports of an incidence lower than 1%. Due to the low frequency in the presentation of this type of hernia, it is interesting to analyze the case of an 80-year-old male patient with a clinical case of sudden onset right inguinal pain, with CT scan compatible with a complicated right inguinal hernia. The finding of the cecal appendix in the hernial sac comes on as a surprise, where finally it was decided to perform a hernioplasty associated with an appendectomy. It is known that hernioplasty is among the most frequent procedures with standardized surgical techniques. However, in the literature, we find disagreements about the proper management of an Amyand-type hernia. Therefore, after a review of the bibliography that was motivated by the case, it is possible to consider that for the final repair of an Amyand hernia, the clinical and pathological presentation of each patient, the experience of the surgeon and the supplies available in the operating room must be taken into account for a greater benefit that will guide the best therapy for the patient. [ABSTRACT FROM AUTHOR]