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Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the feasibility, efficacy, and safety of laparoscopic transabdominal preperitoneal (TAPP) repair in the treatment of inguinal hernia in patients on peritoneal dialysis, and the optimal timing for initiating postoperative peritoneal dialysis. Methods: We conducted a retrospective analysis of the clinical data pertaining to patients on peritoneal dialysis with inguinal hernias treated with TAPP repair in the First Affiliated Hospital of Shandong First Medical University from July 15, 2020 to December 15, 2022. Follow-up observations of the treatment effect were also analyzed. Results: A total of 15 patients underwent TAPP repair with success. Contralateral occult hernias were found in 3 cases intraoperatively and were treated simultaneously. During the operation, it was found that the peritoneal dialysis tube was completely wrapped in the omentum majus in 1 case and incompletely wrapped in 5 cases and was separated smoothly under laparoscopy. Conclusion: For patients on peritoneal dialysis with inguinal hernia, TAPP repair has the advantages of less trauma, simultaneous treatment of contralateral occult hernias, adjustment and fixation of peritoneal dialysis tubes, lower incision complication rates, and lower recurrence rates, compared with open surgery. With the gradual resumption of peritoneal dialysis 7 days postoperatively, TAPP repair can be performed safely and effectively in this population group; thus it is a procedure worth promoting. [ABSTRACT FROM AUTHOR]

Purpose: In children, pediatric inguinal hernia (PIH) is a prevalent condition. PIH is currently more frequently managed by laparoscopic closure of the hernia sac. We improved this minimally invasive technique; that is, laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure. Safety and effectiveness were evaluated by comparing the differences between laparoscopic repair (LR) and open repair (OR) in terms of operation time, surgical complications, contralateral metachronous hernia incidence, and recurrence rate. Methods: A retrospective clinical data analysis was performed on pediatric patients who had hernia surgery utilizing the LR or OR method between June 2019 and June 2021. Medical records of all of the children were gathered, and clinical traits, information about the procedure, and follow-up were all analyzed. Results: A total of 370 patients' inguinal hernias were repaired. For 136 patients undergoing OR and 234 patients undergoing LR, all procedures were completed satisfactorily. There were 98 cases of bilateral hernias and 272 cases of unilateral hernias (180 on the right side and 92 on the left). In the LR group, 58 patients who had been initially diagnosed with unilateral hernias developed contralateral occult hernias intraoperatively. Inguinal hernia operations took an average of 13.82 (LR) and 32.07 (OR) minutes for unilateral cases, and 21.00 (LR) and 54.85 (OR) minutes for bilateral cases. For LR and OR, the average follow-up time was 22.41 months and 23.10 months, respectively. The perioperative complications included peritoneal rupture in 3 patients, scrotal edema or hematoma in 5, hydrocele in 3, and groin pain in 6. In the LR group, 1 patient experienced the postoperative recurrence, whereas 8 individuals in the OR group did. Conclusions: Our initial research showed that laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure inguinal hernia repair is a safe and effective procedure. The LR method has the benefits of concealing the incision, a quicker procedure, having a lower risk of complications, and finding contralateral patent processus vaginalis. Therefore, promoting and using this surgical technique in clinical practice are merited. Clinical Trial Registration number: Medical Association of Xiangtan (2022-xtyx-28) [ABSTRACT FROM AUTHOR]

Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone. [ABSTRACT FROM AUTHOR]

Background: Percutaneous internal ring suturing (PIRS) is a laparoscopic procedure that has demonstrated its safety and efficacy as a method of hernia repair in younger children but without evidence among the adolescent population. The aim of this study was to determine the success of PIRS outcomes for hernia repair in the adolescent population. Methods: All adolescents who were operated on using the PIRS method for inguinal repair during the 5-year study period in a single center were included in a prospective cohort study. The main outcome of the study included treatment outcomes in a term of recurrence rate. The secondary outcomes include other treatment outcomes such as complications, conversion to an open procedure, and reoperation rates, as well as duration of anesthesia and surgery, duration of hospital admission, and the level of carbon dioxide pneumoperitoneum. Results: In 51 adolescents (72.5% males) with a median age of 13 years and median follow-up of 44 months, a total of 57 PIRS procedures were performed. There were 30 (58.8%) right hernia repairs, 15 (29.4%) left hernia repairs, and 6 (11.8%) bilateral hernia repairs. The median surgical time was 10 minutes for unilateral and 18 minutes for bilateral hernia repair. The median length of hospital stay was 24 hours. Only one (1.95%) intraoperative complication occurred during surgery, an inferior epigastric vein injury. No complications or recurrences were observed during the follow-up period. Conclusions: PIRS has proven to be simple, safe, and effective method for groin hernia repair in adolescent population. This method provides excellent overall and cosmetic outcomes. There is a low incidence of complications and recurrences. According to our results, PIRS could be considered to become a possible approach for groin hernia repair in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the safety and efficacy of performing minilaparoscopy compared with standard laparoscopy in the treatment of cryptorchidism with an ipsilateral inguinal hernia. Materials and Methods: In total, 46 patients with cryptorchidism and an ipsilateral inguinal hernia were admitted to the Urology and Hernia and Abdominal Wall Surgery Departments of Beijing Chaoyang Hospital between October 2009 and July 2019. They were assigned to two groups: Group M and Group S. In Group M, 24 patients underwent herniorrhaphy and orchiopexy using minilaparoscopy, and in Group S, 22 patients underwent herniorrhaphy and orchiopexy using standard laparoscopy. Surgeons chose the procedure at random, and the patients were blinded to the selected procedure. Results: Postoperative painkiller demand (P = .043) and first postoperative day Numerical Rating Scale scores (P = .032) were lower in Group M than Group S, and the average hospital stay was shorter (P = .041) in Group M. Furthermore, 21 of the 24 procedures in Group M were successful, 3 procedures of Group M were converted from mini- to standard laparoscopy, and all 22 procedures in Group S were successful. The Observer Scar Assessment Scale questionnaire results of Group M were significantly higher than for patients in Group S (P = .038). Conclusion: Our findings suggest that treatment of cryptorchidism with ipsilateral inguinal hernia using minilaparoscopy is as safe and effective as standard laparoscopy. [ABSTRACT FROM AUTHOR]

Background: The Lichtenstein repair has long been heralded as the gold standard for unilateral primary inguinal hernias. However, minimally invasive surgery (MIS) repairs have gained popularity over the past decades given its advantages in recurrent, bilateral, and now even in primary inguinal hernias. We aim to further explore the perception of different techniques among surgeons internationally. Methods: A questionnaire was posted in three closed groups for surgeons and residents on Facebook® and surgical groups on WhatsApp®. It was also e-mailed to members of the following surgical societies: Mexican Society of Surgery, Brazilian Hernia Society, Asia Pacific Hernia Society, and European Hernia Society. Descriptive and basic comparative statistical analyses were performed. Results: In total, 874 surgeons answered the survey: 759 (86.9%) were male and 418 (47.8%) were from North America, 735 (84.1%) had completed training and 605 (69.2%) considered themselves hernia specialists. If safety profiles of inguinal herniorrhaphy were equal, 533 (61%) would choose MIS. Laparoscopic transabdominal preperitoneal ranked first among preferred techniques if the cost of all techniques was the same. Safety of the procedure followed by experience of the surgeon is the most influential factors. Lastly, hernia specialists were more likely to choose an MIS technique (P < .0001). Conclusion: When an international sample of 874 attending and trainee surgeons were surveyed about what technique they would prefer to repair their own uncomplicated unilateral inguinal hernia, most chose MIS. Safety of the procedure and the surgeon's experience were the most important factors in choosing a surgical technique. [ABSTRACT FROM AUTHOR]

Background: The objective of the study is to determine the safety and efficiency of the modified laparoscopic percutaneous extraperitoneal closure (LPEC) to treat pediatric patients with inguinal hernia or hydrocele. Methods: From January 2014 to July 2018, the patients with inguinal hernia or hydrocele who were operated on using modified LPEC were included. We modified LPEC with a sledge-shaped needle and reinforcement flag. By means of medial umbilical fold, the reinforcement surgery should be performed on the patients with huge internal rings (diameter >1.5 cm). Operative time, complication rate, incidence of reinforcement, and contralateral patent processus vaginalis were described between inguinal hernia and hydrocele. Results: In this study, 764 patients with inguinal hernia and 435 patients with hydrocele were successfully performed by the modified LPEC. The 383 (50.1%) patients with inguinal hernia and 266 (61.1%) patients with hydrocele were identified with a contralateral patency of internal ring and underwent simultaneous prophylactic surgery. During surgical procedures, the medial umbilical fold reinforcement (inguinal hernia/hydrocele = 50/1) was performed on 51 patients. Hernia recurrence occurred in 2 cases. All patients had a good cosmetic appearance without additional dissection. Conclusion: Modified LPEC using a sledge-shaped needle and applying the medial umbilical fold reinforcement is a safe and effective surgical procedure. [ABSTRACT FROM AUTHOR]

Background: It is unclear if a history of mesh explantation for infection is predictive of future microbiology after subsequent hernia operations. We investigated how often the same causative organism is cultured in the initial explantation and subsequent repairs. Patients and Methods: We obtained data on patients undergoing ventral/incisional, umbilical, and inguinal hernia repairs from the Veterans Affairs Surgical Quality Improvement Program during 2008-2015. Manual review was performed for all patients with an administrative code indicative of mesh explantation and those with explantation for infection were retained. We then obtained data on cultured organisms from the mesh site at the time of index explantation and at any re-repair or subsequent explantation during a follow-up period ending in December 2020. Results: We identified 332 patients undergoing mesh explantation because of infection (64.8% ventral, 18.7% umbilical, 16.6% inguinal). Mean age was 60.3 years (standard deviation [SD], 9.7) and 93.9% were male. The same organism was cultured at re-infection in 23 of 59 (39%) cases. Gram-positive micro-organisms were the most prevalent in 20 of 23 (87%). Among the gram-positive, Staphylococcus aureus was the most common pathogen and was cultured in 18 of 20 (90%) cases, of which 14 of 18 (77.8%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 4 of 18 (22.2%) were methicillin-resistant Staphylococcus aureus (MRSA). Three of 23 (13%) gram-negative organisms were the same at both re-infection and index explantation consisting of Escherichia coli in 2 of 3 (66.7%), and Pseudomonas aeruginosa in one of three (33.3%). Conclusions: Identification of organisms at time of prosthetic infection is helpful not only in treating the initial infection, but also in prevention of infection with the same organisms after subsequent repairs. Same organism re-infection should not be underestimated, particularly when Staphylococcus aureus is isolated. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this report is to present our technique and outcomes of single incision laparoscopic percutaneous extraperitoneal closure of internal ring (SILPEC) for incarcerated inguinal hernia (IIH) in children. Patients and Methods: The medical records of all children undergoing emergency SILPEC for IIH after unsuccessful attempted manual reduction between June 2016 and September 2020 at our center were reviewed. For SILPEC, two trocars 3.5-6 mm were placed through a single umbilical incision. A 17G epidural needle and a small wire-lasso were used for extraperitoneal closure of the internal ring. Results: From a total of 2904 consecutive patients with inguinal hernia (IH) undergoing SILPEC, 104 patients (3.6%) had IIH. There were 84 boys and 20 girls with a median age of 18.5 months (ranged 1 month to 11 years). At the time of surgery under general anesthesia IIH was found to be spontaneously reduced in 26.9%; the hernia contents were bowel in 52.9%, great omentum in 13.5%, and ovary in 6.7% of the patients. All hernias were successfully reduced without additional ports or conversion to open surgery. Patent contralateral processus vaginalis (PCPV) was detected intraoperatively in 44.2% of the cases. The median operative time was 24 minutes for unilateral and 30 minutes for bilateral procedures. The median postoperative stay was 1 day. At a median follow-up of 28 months, there was no case of hydrocele, testicular atrophy, or iatrogenic cryptorchism. The postoperative cosmesis was excellent as all patients were virtually scarless. Recurrence occurred in 1.9% with no significant difference (P = .669) compared to the 1.4% recurrence rate of the 2800 patients with ordinary IH undergoing elective SILPEC during the same study period. Conclusions: SILPEC for IIH in children is feasible, safe, with excellent postoperative cosmesis, and no significant difference in hernia recurrence between emergency SILPEC for IIH and elective SILPEC for ordinary IH. [ABSTRACT FROM AUTHOR]

Background: Infected hernia mesh is a cause of post-operative morbidity. Nitric oxide (NO) plays a key role in the endogenous immune response to infection. We sought to study the efficacy of a NO-releasing mesh against methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that a NO-releasing polyester mesh would decrease MRSA colonization and proliferation. Materials and Methods: A composite polyester mesh functionalized with N-diazeniumdiolate silica nanoparticles was synthesized and characterized. N-diazeniumdiolate silica parietex composite (NOSi) was inoculated with 104,106, or 108 colony forming units (CFUs) of MRSA and a dose response was quantified in a soy tryptic broth assay. Utilizing a rat model of contaminated hernia repair, implanted mesh was inoculated with MRSA, recovered, and CFUs were quantified. Clinical metrics of erythema, mesh contracture, and adhesion severity were then characterized. Results: Methicillin-resistant Staphylococcus aureus CFUs demonstrated a dose-dependent response to NOSi in vitro. In vivo, quantified CFUs showed a dose-dependent response to NOSi-PCO. Treated rats had fewer severe adhesions, less erythema, and reduced mesh contracture. Conclusions: We demonstrate the efficacy of a NO-releasing mesh to treat MRSA in vitro and in vivo. Creation of a novel class of antimicrobial prosthetics offers new strategies for reconstructing contaminated abdominal wall defects and other procedures that benefit from deploying synthetic prostheses in contaminated environments. [ABSTRACT FROM AUTHOR]

Background: Skin and soft tissue infection (SSTI) after hernia surgery is infrequent yet catastrophic and is associated with mesh infection, interventions, and hernia recurrence. Although hernia repair is one of the most common general surgery procedures, uncertainty persists regarding incidence of long-term infections. Our goal is to develop a machine learning regression model that detects the occurrence of long-term hernia-associated SSTI. Patients and Methods: The data set consisted of veterans receiving hernia repair with implanted synthetic mesh during 2008-2015. The outcome of interest was occurrence of SSTI related to the index hernia surgery over a five-year follow-up. A neural network regression was fit on a medical record reviewed sample, then applied to the study population. Results: The study population was 96,435 surgeries, of which 76,886 (79.7%) were inguinal, 11,177 (11.6%) were umbilical, and 8,372 (8.7%) were ventral. In the training set, 40 patients had SSTI probability ≥90%, of whom 38 (95%) had a true SSTI. In 249 patients with SSTI probability <10%, only five (2%) patients had a true SSTI. In the testing set, nine patients were assigned a probability >90% and all were true-positives. In 100 patients with probability <10%, only two (2%) patients had a true infection. C-statistics were 0.929 in the training set and 0.901 in the testing set. Conclusions: The model showed excellent discrimination between those with and without infection and had good calibration. The model could be used to reduce the cost of detecting long-term infections. [ABSTRACT FROM AUTHOR]

Purpose: This is the first study to investigate clinical outcomes after robotic emergent inguinal hernia repair (rEIHR). Methods: Data were retrospectively analyzed from patients who underwent rEIHR from 2013 to 2020. Any patients who underwent concomitant nonabdominal wall procedures were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCI®) scoring systems. Results: Out of 616 patients who underwent inguinal herniorrhaphy throughout the study period, 23 rEIHRs were identified among 19 patients. The median Acute Physiology and Chronic Health Evaluation-II score was 6, and the average skin-to-skin time was 75.9 minutes. The average length of stay (LOS) was 1.4 days. During the mean follow-up period of 31.7 months, a total of three complications (CD-grades I, II, and IVa) in two patients were observed. The median CCI score was 0 (max = 43.3). Conclusion: rEIHR is a feasible option for surgeons to utilize, with a short LOS and low complication rate, given the sufficient experience and support as well as the appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background: Morgagni hernias (MHs) are rare anteromedial congenital diaphragmatic hernias. This study describes the effectiveness of a laparoscopic approach for these defects. Methods: A prospectively collected institutional database at a tertiary referral center was queried for patients (≥18 years) with MHs. Results: Fifteen adults underwent laparoscopic MH repair. Abdominal pain was the most common presentation (71.5%), and 2 patients (13.3%) presented with acute obstruction. Laparoscopic bridged mesh repair was the most common approach (66.7%) and was achieved by suturing a bridged synthetic mesh to the diaphragmatic portion of the defect and fixing it with transfascial sutures and/or tacks to the anterior abdominal wall. Primary suture repair was utilized for smaller defects. No mortalities or recurrences occurred after 20.2 months median follow-up. Conclusions: Laparoscopic synthetic mesh repair of adult MHs offers an effective hernia repair with minimal complications and no detected recurrences in long-term follow-up of this patient sample. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) is a well-recognized and potentially catastrophic complication of abdominal wall reconstruction (AWR). The authors present a review of the literature surrounding SSI in AWR, exploring prevention and treatment strategies as well as risk factors. Methods: A comprehensive review of the current literature was undertaken. Evidence was reviewed and summarized with particular focus on prevention and treatment strategies available to hernia surgeons. Results: Patient risk factors for SSI are well described in the literature and include obesity, smoking, and other comorbidities. Contaminated hernias and cases involving enterocutaneous fistulae are also at higher risk of SSI. Surgical decisions such as type of mesh, plane of mesh placement, and fascial release may all contribute to SSI risk. To treat established mesh infection, conservative management with antibiotic agents and negative pressure therapy is a reasonable option in some cases. Removal of prosthesis appears to provide favorable results, however, repeat surgery can be problematic Conclusions: Surgical site infection remains an important pathology in the world of AWR. Surgeons have a wealth of tools in their arsenal to prevent and treat SSI and should be aware of the emerging evidence in the fast-moving specialty of hernia surgery. Complex cases should be handled by surgeons and centers with expertise in treating such patients. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence. [ABSTRACT FROM AUTHOR]

Background: Single-port, laparoscopic, needle-assisted, inguinal hernia repair (LNAR) in children intends to reduce surgical trauma and enables contralateral assessment and closure of contralateral patent processus vaginalis if necessary. The aim of the present study was to demonstrate that laparoscopic inguinal repair can be performed safely and cost-effectively in a developing country where laparoscopy is not yet commonly used. Methods: In this single-center study, we included all children undergoing LNAR between January 2017 and December 2018. Intraoperative and postoperative complications and hospital costs were assessed. Results: We performed 148 hernia repair operations in 117 children (age range 1 month to 15 years). Mean operative time was 20.8 ± 9.4 minutes. Mean length of hospital stay amounted to 10 ± 7.6 hours, with 77.7% of patients discharged within 6 hours. No intraoperative complications occurred in any patient. Complications occurred in six (5.1%) patients. Three (2.5%) patients experienced residual hydrocele, two (1.4%) patients suffered wound site seroma, and one (0.67%) patient experienced recurrent inguinal hernia 6 months after the initial repair. All complications occurred during the first year of the study period. Likewise, operative time (P < .0001) as well as duration of hospital stay (P < .0001) was significantly shorter in the second year. Total costs for complete treatment were below USD 80 per patient, which is comparable with the costs associated with open herniotomy at the same institution. Conclusion: Single-port LNAR and hydrocele repair in children were established safely and cost-effectively in a developing country. Nevertheless, the procedure was associated with a steep learning curve. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic repair has been recommended as the method-of-choice of groin hernia repair among women. Whether the round ligament of uterus should be divided to facilitate mesh placement remains controversial. This study aims to review the outcomes of laparoscopic total extraperitoneal (TEP) groin hernia repair in women and to evaluate the impact of division of round ligament. Methods: Consecutive female patients with inguinal or femoral hernias who underwent elective laparoscopic TEP repair at a single institution from 2006 to 2017 were included for retrospective analysis. Primary outcomes were postoperative pain, genital prolapse, and recurrence. Outcomes of patients who had the round ligament divided were further compared with those with round ligament preserved and multivariable adjusted analysis was performed. Results: Sixty-eight patients with a total of 77 TEP repairs were included in the 12-year study period. The mean age was 45 ± 16 years old. Incidental femoral hernia was identified in 4 patients (5.9%). There was 1 (1.3%) recurrence upon mean follow-up of 42.9 ± 37.3 months. The round ligament was divided in 67.5% of patients, and upon multivariable adjusted analysis, there were no statistically significant differences in outcomes in terms of chronic pain (odds ratio [OR] = 2.210, P = .357), paresthesia (OR = 0.241, P = .149), and genital prolapse (OR = 0.327, P = .415) when compared with patients with preserved round ligament. Conclusion: Laparoscopic groin hernia repair in women is associated with low recurrence. Division of round ligament intraoperatively facilitates mesh placement and has minimal impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Although inguinal hernia repair is common in infants, few studies have focused on the condition in female infants. In female infantile inguinal hernia, there is a risk of oophorectomy when torsion and strangulation occur due to ovarian prolapse. We aimed to evaluate the risks of ovarian incarceration and torsion in single-ovary versus multiple-reproductive organ prolapse in female infantile inguinal hernia. Methods: Females ≤12 months old who underwent laparoscopic transabdominal inguinal hernia repair from September 2012 to December 2019 were retrospectively analyzed. If manual reduction failed at initial diagnosis, surgery was performed within 24 hours in all incarceration cases. The clinical characteristics and surgical outcomes were compared between those with single-organ versus multiple-organ prolapse. Results: Of 510 patients, 465 (91.2%) had single-organ prolapse, most commonly a single ovary (381/465), followed by intestine (84/465). Forty-five patients (8.8%) had multiple-organ prolapse, most commonly a single ovary plus intestine (27/45), followed by both ovaries plus the uterus (10/45). The manually irreducible incarceration rate was higher in patients with multiple-organ prolapse (57.8%) than single-organ prolapse (23.4%; P < .000). In patients with ovarian incarceration, the ovarian torsion rate was higher in the single-ovary group (38/109, 34.9%) than the multiple-organ group (1/26, 3.8%; P < .000). There was no significant difference between the two groups in recurrence or oophorectomy rate. Conclusion: Most female infantile inguinal hernias involve ovarian prolapse. There is a high risk of incarceration in multiple-organ prolapse and a high risk of ovarian torsion in single-ovary prolapse. [ABSTRACT FROM AUTHOR]

Background/Purpose: Many techniques have been described for the treatment of pediatric inguinal hernia (PIH). Some authors emphasized the importance of disconnecting the sac, to create a scar, and to close the peritoneum mimicking the open approach. Others stated that peritoneal disconnection alone is enough for treatment of PIH regardless of the size of the internal ring. In this study, we compare the short-term results of laparoscopic disconnection of PIH sac versus disconnection and peritoneal closure. Patients and Methods: The study was carried from March 2016 to March 2017, on 34 patients with 40 PIH. Patients were randomly divided into two groups: group A, subjected to laparoscopic hernia sac disconnection and group B, subjected to laparoscopic hernia sac disconnection with peritoneal closure. Both groups were compared regarding the operative details, including complications and conversion, postoperative complications and recurrence. Results: Group A included 20 hernias in 15 patients, whereas group B included 20 hernias in 19 patients. The age ranged from 1 to 23 months. In group A, the mean operative time (OT) was 34.6 and 39.4 minutes, for unilateral and bilateral cases, respectively, whereas in group B, it was 45.1 minutes for unilateral cases and 65 minutes for 1 bilateral case. The OT was significantly shorter in group A for unilateral cases. There was no conversion and no intraoperative complications. Three recurrences occurred in group A (15% of hernias/20% of cases) with no recurrences in group B; difference was statistically insignificant. All 3 recurrences occurred in hernias with an internal ring diameter (IRD) >10 mm. Hospital stay was statistically shorter in group B. Conclusion: Both laparoscopic sac disconnection with internal ring closure and sac disconnection only are safe and effective treatments of PIH. However, the latter technique is not recommended for cases with IRD >10 mm because of the unacceptable high recurrence with rings >10 mm. [ABSTRACT FROM AUTHOR]

Background: The injection of tissue adhesives has been proposed as an alternative to standard laparoscopic inguinal hernia repair but no evidence is available in the pediatric population. This study aimed to evaluate safety, efficacy, and feasibility of injection of tissue adhesives for inguinal hernia repair in a rabbit model. Materials and Methods: Thirty-six New Zealand White male rabbits underwent laparoscopic inguinal hernia repair. In each animal, the hernia defect was repaired using glue on the right side and purse-string suture on the left side. The animals were divided in 3 groups, each 1 of 12 animals, according to the glue used: Glubran 2® (cyanoacrylate), Histoacryl® (cyanoacrylate), and BioGlue® (bovine serum albumin-based). For each group, 6 animals were sacrificed at 7 days postoperatively, and 6 animals at 90 days postoperatively. Histopathological exam of testis and spermatic bundle was performed. Results: The hernia defect was successfully closed on both sides in all cases. The injection of glue was faster than suture repair (P = .001). Postoperative complications (epiploon-parietal adhesions, spermatic vessel ectasia, and hydrocele) rate was significantly higher on the right side compared to the left side at both short- and long-term follow-up (P = .001). Furthermore, a lower maturity of testicles treated by adhesive compared with suture was histologically demonstrated at both short- and long-term follow-up (P = .001). Conclusions: The present experimental study confirmed the feasibility and efficacy of inguinal hernia repair by injection of tissue adhesive. However, several critical issues emerged about the safety of this technique. The use of glue was associated with higher incidence of postoperative complications and significant decrease of testicular maturity compared with standard suture repair. Based upon these preliminary results, repair using suture remains the standard of care for inguinal hernia in children. Further experimental studies are needed to assess the safety of injection of tissue adhesives for pediatric inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair (IHR) is one of the most commonly performed general surgery operations. Currently, an inguinal hernia can be repaired through an open, laparoscopic, or robot-assisted approach. Herein, we detail our perioperative evaluation and management of patients with a groin hernia as well as our surgical technique for the performance of the laparoscopic transabdominal preperitoneal IHR. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias (IHs) are common in infants and children. The key step in inguinal hernia repair is high ligation of the hernia sac. The current main treatment methods for IHs are open and laparoscopic surgery. Over the past two decades, laparoscopic herniorrhaphy has increased in popularity. Herein, we introduced a new method to laparoscopically treat IHs. The goal of this study was to investigate the clinical effects and advantages of this new operation technique for IHs, which is called the "hernia sac ligation by single-incision laparoscopic surgery with a double-line band method." Patients and Methods: We retrospectively reviewed the records of all children who underwent initial laparoscopic herniorrhaphy at our center over a 1-year period. A single surgeon performed all surgeries using the modified single-incision laparoscopic technique. Intraoperative findings and complications, operative times, and postoperative complications were reviewed for all children. Results: All 119 surgeries were successfully completed (58 bilateral and 61 unilateral). In total, 54 out of 58 children had contralateral openings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. This clinical study included 99 boys patients and 20 girls patients (boy-to-girl ratio was 4.95:1). The age range at the time of surgery was 0.5 to 10 years, and the average age was 2.63 years. No patient had any intraoperative complication. Postoperative complications occurred in 1 boy (0.56%) who had a hernia recurrence that required open repair. The addition of auxiliary operating forceps was required for 8 boys (6.72%). No child had scrotum edema, wound infection, stitch granuloma, or iatrogenic cryptorchidism. Overall, a 93.3% operative success rate was noted with the modified technique. Conclusions: The modified technique is a safe and effective operation method, which can significantly shorten the operation time, reduce recurrence rates, and result in minimal scarring. Additionally, the procedure is expected to be less expensive. [ABSTRACT FROM AUTHOR]

Background: Reports on preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) for managing giant inguinoscrotal hernias are limited. Hence, we report our experience with these preoperative techniques in patients with this condition. Materials and Methods: Observational study of 8 consecutive patients with giant inguinoscrotal hernias between January 2018 and December 2018. All patients were treated preoperatively with BTA injection to the lateral abdominal wall muscles and PPP for passive abdominal cavity expansion. Length of abdominal wall muscles, volume of inguinal hernia (VIH), volume of the abdominal cavity (VAC), and VIH/VAC ratio were measured before and after PPP and BTA using abdominal computed tomography. All hernias were repaired laparoscopically using transabdominal preperitoneal (TAPP) repair techniques. Results: The mean insufflated volume of air for PPP was 5625 ± 845 mL for 15.4 ± 1.6 days. An average reduction of 5.3% of the VIH/VAC ratio after PPP and BTA was obtained (P < .01). The length of lateral abdominal muscles with a mean gain of 3.3 cm/side (P < .01) and complications associated with PPP were 12.5% and with surgical technique, 25%. Laparoscopic TAPP repair was achieved in all cases, with no clinical evidence of postoperative abdominal hypertension. The mean follow-up was 22 months; no hernia recurrences have been reported. Conclusions: Combination of PPP and BTA is feasible and useful for surgically managing giant inguinoscrotal hernias, which can avoid abdominal compartment syndrome after laparoscopic TAPP repair of giant inguinoscrotal hernias. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is one of the more common procedures performed in the United States. The optimal surgical approach, however, remains controversial. We aimed to compare the postoperative outcomes and costs between laparoscopic and open inpatient inguinal hernia repairs in a national cohort. Materials and Methods: We performed a retrospective analysis of the National Inpatient Sample during the period 2009-2015. Adult patients (≥18 years old) undergoing laparoscopic and open inguinal hernia repair were included. Multivariable logistic, generalized logistic, and linear regression were used to assess the effect of the laparoscopic approach on postoperative complications, mortality, length of stay, and hospital charges. Results: A total of 41,937 patients undergoing open inguinal hernia repair (N = 36,575) and laparoscopic inguinal hernia repair (N = 5282) were included. Patients undergoing laparoscopic inguinal hernia repair were less likely to have postoperative wound complications (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.41-0.98), infection (OR: 0.34, 95% CI: 0.27-0.42), bleeding (OR: 0.72, 95% CI: 0.63-0.82), cardiac failure (OR: 0.72, 95% CI: 0.64-0.82), renal failure (OR: 0.54, 95% CI: 0.47-0.62), respiratory failure (OR: 0.70, 95% CI: 0.58-0.85), and inpatient mortality (OR: 0.27, 95% CI: 0.17-0.40). On average, the laparoscopic approach reduced length of stay by 1.28 days (95% CI: -1.58 to -1.18), and decreased hospital costs by $2400 (95% CI: -$4700 to -$700). Conclusion: Laparoscopic hernia repair is associated with significantly lower rates of postoperative morbidity and mortality, shorter length of hospital stays, and lower hospital costs for inpatient repairs. The laparoscopic approach should be encouraged for the management of appropriate patients with inpatient inguinal hernias. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the perioperative and postoperative respiratory complications between laryngeal mask (LM) airway and tracheal intubation (TI) in children undergoing percutaneous internal ring suturing (PIRS) for inguinal hernia. Patients and Methods: From October 2015 to February 2019, 135 pediatric patients (97 males and 38 females) with median age of 4 years, who underwent PIRS for inguinal hernia, were included in study. Patients were divided in two groups. In group I (n = 94) LM airway was used, and in group II (n = 41) TI was performed. Demographic data, surgical and anesthesia times, American Society of Anesthesiologists (ASA) classification, muscle relaxation, level of pneumoperitoneum, and complications of anesthesia were compared between the groups. Results: No significant differences among compared groups regarding age (P = .435), sex (P = .306), body mass index (P = .548), ASA classification (P = .506), level of pneumoperitoneum (P = .968), and duration of surgery (P = .968) were found. Duration of anesthesia was significantly shorter when LM was used compared to TI (25 minutes versus 36 minutes; P < .00001). During recovery from anesthesia, the incidences of desaturation (n = 1 versus n = 5; P = .003), laryngospasm (n = 2 versus n = 5; P = .015), and cough (n = 0 versus n = 4; P = .002) were significantly lower when LM airway was used for securing of the airway. Postoperative incidences of sore throat (P = .543), bronchospasm (P = .128), and aspiration (P = .128) did not differ between LM and TI. Conclusions: The use of LM in pediatric anesthesia results in a decrease in a number of common complications and significantly shortened patient anesthesia time. It is therefore a valuable device for the management of the pediatric airway for laparoscopic hernia repair in children. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic inguinal hernia repair (LIHR) is increasingly widely accepted in pediatric surgery. However, reoperation risks remain unknown. We summarized our single-center experience with reoperations after laparoscopic percutaneous extraperitoneal closure (LPEC) and single-incision LPEC (SILPEC). Materials and Methods: We retrospectively reviewed reoperation cases of hernia repair greater than or equal to two times between 2000 and 2018, wherein the first hernia repair was performed laparoscopically. Primary outcomes were recurrence type and screening sufficiency for contralateral patent processus vaginalis (cPPV). Secondary outcomes were associated with details of recurrences. Results: Of the 2112 patients who underwent LPEC/SILPEC, 14 (recurrence rate = 0.7%) showed recurrences after treatment and 8 (incidence rate = 0.4%) showed contralateral metachronous inguinal hernia (CMIH). Concerning the primary outcome of recurrence type, the orifice was inside the previous ligation (Inside group), suggesting loosened first ligation, in 6 (42.9%) patients and outside the previous ligation (Outside group) in 7 (50.0%); and 1 (7.1%) patient showed no orifice. Regarding CMIH, 3 (37.5%) patients were suspected of insufficient screening for cPPV, 1 (12.5%) underwent sufficient screening, and 1 (12.5%) had cPPV but treatment was deemed unnecessary. Concerning secondary outcomes, 4 (66.7%) and 6 (85.7%) patients from the Inside and Outside groups were treated with single ligation, respectively. One patient from the Outside group (14.3%) had a massive peritoneum injury during the first operation. Conclusions: Some preventable factors, such as loosened ligation, torn peritoneum, and use of single ligation in recurrences and insufficient screening for cPPV in CMIH, were observed. These should be taken care to prevent reoperations in LIHR. [ABSTRACT FROM AUTHOR]

Introduction: Although laparoscopic inguinal hernia repair in children has gained popularity in the last decades, this approach remains uncommon in preterm infants. The aim of this study was to compare the characteristics and the outcomes of indirect inguinal hernias in term and preterm infants. Material and Methods: From January 2002 to November 2015, all charts of the pediatric patients who underwent laparoscopic indirect inguinal hernia repair in one single institution within the first 6 months of life were revised. The data of 156 patients were analyzed retrospectively. Patients were divided in two groups: group I, including the preterm patients, and group II, including the term patients. Results: A total of 90 preterm infants and 66 term infants were included. In the group I, preoperative diagnosis was right-sided inguinal hernia in 20% of patients, left sided in 22.2%, and bilateral in 57.5%; while in the group II, preoperative diagnosis was right-sided inguinal hernia in 42.4% of infants, left sided in 15.2%, and bilateral in 42.4% (P = .01). In group I intraoperative diagnosis was right-sided inguinal hernia in 10% of patients, left sided in 16.7%, and bilateral in 73.3%; while in the group II, intraoperative diagnosis was right-sided inguinal hernia in 25.8% of infants, left sided in 12.1%, bilateral in 60.6%, and there was no hernia in one patient (P = .02). However, there was no statistically significant difference in the correct intraoperative diagnosis between both groups (P = .59). No statistical significance was observed between the two groups regarding postoperative complications. Conclusions: Bilateral inguinal hernia is more frequent in preterm infants compared to term infants, whereas the incidence of right-sided inguinal hernia is higher in term patients. Laparoscopic inguinal hernia repair in preterm infants seems to be safe and effective. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic repair has become the preferred option for the treatment of pediatric hernias. Recently, laparoscopic operations have also been conducted in pediatric recurrent hernia cases. Laparoscopic percutaneous extraperitoneal closure (LPEC) is a simple and reliable minimally invasive procedure for pediatric inguinal hernia repair. However, it is still unclear whether LPEC is an ideal procedure for recurrent inguinal hernias in children. The aim of this study is to evaluate the efficacy of LPEC in the treatment of pediatric recurrent inguinal hernias. Patients and Methods: We retrospectively reviewed all children with primary inguinal hernia repairs in our hospital from 2016 to 2017 and analyzed the outcomes of recurrent inguinal hernia repairs with LPEC. Results: There were 1703 children with 1985 indirect inguinal hernias: 1549 were laparoscopic (91.0%) and 154 open (9.0%). Thirty-five (2.1%) of these children had recurrent inguinal hernia with no difference in prevalence between laparoscopic and open (P = .24). One case was bilateral. LPEC was performed successfully in all children with recurrent inguinal hernias. There were no severe intra- or postoperative complications in any of the recurrent cases. No children had inguinal hernia recurrence at follow-up (8 months-2 years). Conclusions: LPEC of the internal ring is a reliable and effective minimally invasive technique for the treatment of recurrent inguinal hernia in children. [ABSTRACT FROM AUTHOR]

Background: In the treatment of inguinal hernias, there is little hard evidence concerning the economic reimbursement in the diagnosis-related group (DRG) era. Factors that affect whether a hospital may earn or lose financially depending on open or laparoscopic approach is still underexplored. The aim of this study was to provide a reliable analysis of in-hospital costs and reimbursements in inguinal hernia surgery. Methods: This retrospective study analyzed the 1-year experience in inguinal hernia repair in patients undergoing open Lichtenstein (OL), laparoscopic totally extraperitoneal unilateral (UTEP), or bilateral (BTEP) hernia repair. Demographics, results, costs, and DRG-based reimbursements were recorded and analyzed. Results: During the study period, 39 patients underwent OL, 82 patients UTEP, and 16 patients BTEP. The average total cost amounted to 4126 EUR in OL, 5134 EUR in UTEP, and 7082 EUR in BTEP groups (P < .001). The hospital reimbursement amounted to 5486 EUR, 5252 EUR, and 6555 EUR in the OL, UTEP, and BTEP groups, respectively (P < .001). Finally, the mean hospital earnings were 1360 EUR, 118 EUR, and -527 EUR for each patient in OL, UTEP, and BTEP, respectively (P < .001). Conclusions: In-hospital costs were higher in UTEP and BTEP as compared with OL. The DRG-based reimbursement provided adequate compensation for patients with unilateral inguinal hernia, whereas hospital earnings were profitable in OL group only, and led an overall financial loss in the BTEP group. Surgeons should be conscious that clinical advantages of the laparoscopic approach are not adequately compensated for, from an economic point of view. [ABSTRACT FROM AUTHOR]

Background: Sliding indirect inguinal hernias containing ovary are not uncommon in girls. We reported our experience with laparoscopic treatment of inguinal ovarian hernias in female infants and children with the aim to standardize the surgical technique.Methods: The medical records of all girls who underwent laparoscopic inguinal hernia repair in our unit over the past 5 years were retrospectively reviewed. Only patients with an ovary found intraoperatively in the hernia sac were included in the study. All patients younger than 1 year received preoperatively a bowel preparation with simethicone and enemas.Results: A total of 289 girls (median age 3.2 ± 0.5 years) underwent laparoscopic inguinal hernia repair during the study period. Thirty-seven patients (12.8%) had an ovarian hernia and were included in the study. Of these 37 girls, 9 (28.1%) were younger than 1 month, 20 (62.5%) ranged in age from 2 months to 1 year, and 3 (9.4%) were from 1 to 7 years. The average operative time was 23.7 minutes (range 18-43 minutes). No necrotic ovary was found intraoperatively, and all the procedures were accomplished laparoscopically. Neither intraoperative nor postoperative complications were reported. A patency of the contralateral canal of Nuck was found in 16 of the 37 patients (43.2%) and repaired during the same procedure. The average length of hospitalization was 21.8 hours (range 18-36 hours). No hernia recurrence or ovarian atrophy was recorded at a mean follow-up of 36 months (range 1-60 months).Conclusions: On the basis of our experience, laparoscopy should be considered the gold standard for the treatment of inguinal ovarian hernias in girls. Key points for standardization of the technique are as follows: bowel preparation in children younger than 1 year, use of 5-mm umbilical balloon trocar, correct positioning of 3-mm working screw trocars, section of the abnormal attachment of ovarian suspensory ligament, section of the periorificial peritoneum, and use of nonresorbable sutures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this report was to evaluate the safety and efficacy of the simple laparoscopic percutaneous extraperitoneal closure (LPEC) method for treating ovarian hernia patients, including newborns and low-birth-weight infants.Methods: We retrospectively reviewed the cases of ovarian hernia that were treated in our institution from May 2012 to September 2017.Results: Thirty-four infants were included in this study (right side, n = 8; left side, n = 22; bilateral, n = 4). The mean corrected age was 2.3 ± 2.8 months and the mean body weight was 4.4 ± 1.6 kg. The contralateral positive rate was 53%, and 34% of the cases showed sliding of the fallopian tube. Umbilical hernias were observed in 24 cases (71%). The mean operative time was 53 ± 20 minutes. The LPEC procedure was successful in 32 cases; two cases were converted to open surgery.Conclusion: Small infants with ovarian hernia have some specific features such as a shortened round ligament and the presence of peritoneum cavities that require skillful techniques when being surgically repaired. The simple LPEC procedure can be performed safely with a low risk of recurrence, even in infants with sliding of the fallopian tube. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the surgical outcomes of single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) and modified transumbilical two-port laparoscopic suturing (M-TTLS) of the hernia sac for the treatment of pediatric inguinal hernia (PIH) and determine whether one approach was superior to another.Methods: From January 2014 to June 2017, a total of 599 children had undergone SLPEC or M-TTLS in our department. SLPEC and M-TTLS were the most frequently performed single-site laparoscopic procedures for PIH in our department, which represented the extraperitoneal and intraperitoneal approaches, respectively. All patients were followed up at the out-patients' clinics and the medical records were reviewed with respect to all operative outcomes.Results: There were 412 patients undergoing SLPEC and 187 patients undergoing M-TTLS, of which 358 hernias were on the right side, 172 on the left and 69 bilaterally. Two hundred and thirty-one unilateral hernias with contralateral patent processus vaginalis underwent contralateral repair at the same session. Mean operation time was 10.81 minutes in unilateral repair and 17.00 minutes in bilateral repairs, respectively. The perioperative complications included minor extraperitoneal hematoma in four (0.44%) patients, recurrence in one (0.11%), hydrocele in five (0.56%), and contralateral metachronous inguinal hernia in three (1.00%). No other complication developed in either group. There was no significant difference of complications between the two approaches except for the longer operation time in M-TTLS.Conclusions: Both SLPEC and M-TTLS were the safe and effective methods for PIH. The complications were comparable for M-TTLS and SLPEC, but operation time was significantly longer in M-TTLS than in SLPEC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Conventional laparoscopic surgeries of direct inguinal hernia include two methods, transabdominal preperitoneal hernioplasty (TAPP) and totally extraperitoneal hernioplasty. Both methods are performed using synthetic mesh without suturing the hernia defect and require extensive mesh coverage for not only Hesselbach's triangle but also indirect ring. For minimally invasive operation, suture of direct hernia defect was devised and performed. The purpose of this study is to evaluate the efficacy of defect wall suture of laparoscopic herniorrhaphy for direct inguinal hernia patients.Methods: We evaluated 210 direct inguinal hernia patients who received TAPP in Damsoyu Hospital, Seoul, Republic of Korea from September 2012 to December 2015. The patients were categorized into two groups according to TAPP techniques; cTAPP group had conventional TAPP without defect wall suture, and rTAPP group had defect wall suture TAPP. There were 99 patients in a cTAPP group and 111 patients in rTAPP group.Results: Operation time and postoperative hospital stay showed no difference between two groups. The postoperative pain score within the first week was significantly lower in rTAPP group than in cTAPP group (P < .001). The mean timing of a return to normal activities for rTAPP group was 3.8 days, which was shorter than 4.6 days of cTAPP group (P < .001). There was no difference in complication and recurrence rates between two groups.Conclusions: Defect wall suture for direct inguinal hernia had shorter operation time, faster recovery time, reduced pain, and an acceptable rate of recurrence and complication. This TAPP surgery with hernia defect wall suture that requires smaller dissection area is an effective method for treating direct inguinal hernia. [ABSTRACT FROM AUTHOR]

Aim: Inguinal hernias may be direct or indirect, and supravesical hernias, a subtype of inguinal hernias, are often mistaken as direct hernias as their symptoms are similar. The purpose of this study was to describe the characteristics of supravesical hernias and to introduce a minimally invasive surgical method as a treatment for supravesical hernias.Materials and Methods: Thirty-seven patients with supravesical hernias were treated using laparoscopic herniorrhaphy and wall defect suture with a mesh implant from September 2012 to December 2016 at Damsoyu hospital, Seoul, Korea. Patient characteristics and surgical outcomes were retrospectively evaluated.Results: All 37 patients were men with external supravesical hernias. The mean age was 55.3 (range 32-79) years; 23 patients had right-sided, 12 had left-sided, and 2 had bilateral hernias. Comorbidities included lipoma (7/37), contralateral indirect hernia (1/37), and contralateral direct hernia (14/37). No recurrences were reported at the end of the study period.Conclusions: Laparoscopic transabdominal defect closure with a mesh implant herniorrhaphy seems to be an effective, minimally invasive treatment option for supravesical hernia. [ABSTRACT FROM AUTHOR]

Purpose: Our previous work demonstrated that intentional peritoneal injury reduces the incidence of recurrence of a patent processus vaginalis even after removal of the suture. Therefore, the necessity of permanent suture has been brought into question because of the risk of suture granuloma formation. The purpose of this study was to evaluate the efficacy of absorbable, braided versus permanent, braided suture in a rabbit survival model of laparoscopic percutaneous ligation of the processus vaginalis with intentional peritoneal injury.Materials and Methods: Eighteen New Zealand White rabbits underwent bilateral subcutaneous endoscopically assisted ligation (SEAL) of the internal ring. Before SEAL, peritoneal injury was caused with endoscopic shears. Each animal was randomized to receive absorbable braided suture on one side and permanent braided suture on the contralateral side. The rabbits were survived for 8 weeks to allow for complete hydrolysis of the absorbable suture. Necropsy was performed during which the integrity of the repair was assessed with insufflation of carbon dioxide up to 30 mm Hg. McNemar's test for paired data was performed for statistical analysis.Results: Seventeen rabbits survived 8 weeks. One rabbit died in the early postoperative period because of urinary tract obstruction. After insufflation, four (24%) recurrences were present in the absorbable group and two (12%) recurrences were present in the permanent group. This difference was not statistically significant (P = .50). Both rabbits with a recurrence on the side with permanent suture also had a recurrence with absorbable suture on the contralateral side. In all rabbits, the permanent suture was identified, whereas there was no visual evidence of absorbable suture.Conclusions: A trend toward a higher recurrence rate with the use of absorbable braided suture was present, although, in this study, the finding was not statistically significant. Caution should be used when considering implementation of absorbable suture for laparoscopic inguinal hernia repair. [ABSTRACT FROM AUTHOR]

A case study of a 70-year-old male is presented diagnosed with spermatic cord abscess after coronary angiography via femoral artery mimicking incarcerated inguinal hernia. Topics discussed include presence of irreducible mass in the spermatic cord, use of antibiotic therapy for removal of S. aureus bacteria with cloxacillin and gentamicin, and methods for diagnosis of inguinoscrotal swellings such as hernias and hydrocoeles.