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Introduction: This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in children. Patients and Methods: From December 2017 to November 2018, we recruited 20 children, who were aged 1–6 years old, with indirect inguinal hernia. At the time of admission, the participants had already developed an indirect inguinal hernia for 6 months to 1 year. A simple transection and partial resection of hernia sac was performed at the internal ring on each of the recruited children. The procedure was conducted under laparoscopy. Two 5‑mm trocars were placed on either side of the umbilicus, one for the camera and the other for a surgical instrument. Another trocar was placed on the right abdomen. Laparoscopic camera curved forceps, and scissors were placed. Along the unclosed internal ring, the peritoneum was cut in a circular fashion to transect the hernia sac and dissociate it from the distal end. About 1–2 cm of the hernia sac was resected. Results: The operation was successfully completed in all 20 cases, who did not experience any complications, such as the absence of spermatic cord, vas deferens injury, scrotal swelling and incision infection. The children were discharged 1 day after the operation. In the post‑operative follow‑up for the first 3–4 years, recurrence and testicular atrophy did not occur in the study participants. Conclusion: The short-term results obtained from this study showed that the application of laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia is feasible. Long-term results and further observation are needed for validation. [ABSTRACT FROM AUTHOR]

Background: The current study aims to investigate the superior mesh fixation method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach. Materials and Methods: The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbable tacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All patients were assessed during the hospital stay and 1 month postoperatively to assess the surgery associated complications and days for return to daily activity. Eura Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12 month follow up. Results: The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P < 0.001). Only a patient in Group C represented hematoma (P = 0.494). Seroma incidence was not statistically different between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P < 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P > 0.05); however, a pain subscale was significantly less in Group S (P = 0.002). Conclusion: Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre and postoperative complications. However, the two methods did not differ regarding 1 year follow up QOL. [ABSTRACT FROM AUTHOR]

Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero‑scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell‑tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi‑scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource‑limited setting and poor post‑natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later. [ABSTRACT FROM AUTHOR]

Background Amyand's hernia (AH) is a rare condition due to herniation of an appendix into the sac of the inguinal hernia. There is no consensus concerning the ideal management of AH whether to do appendectomy during herniotomy or not. Methods A retrospective analysis of all patients' data records with AH operated at Minia University pediatric surgery unit from Jan. 2018 to Dec. 2022 was done. Results From 2018 to 2022, 11 cases of AH were operated at Minia University pediatric surgery unit. The appendix alone was found in 7 (63.6%) cases, while it was associated with cecum in 2 (18.1%) cases and with bowel in 1 (9%) case and with both cecum and small bowel in 1 (9%) case. In 5 (45.45%) cases, the appendix was looking normal and was managed by reduction of appendix and herniotomy. In 6 (54.54%) cases the appendix was inflamed and managed by appendectomy and then herniotomy. The postoperative period was uneventful in all cases. Conclusions Appendectomy should be done only for inflamed and/or ischemic appendages. Reduction of the appendix into the abdominal cavity followed by herniotomy in a normally looking appendix is a safe option and appendectomy should not be made for all cases. [ABSTRACT FROM AUTHOR]

Background Surgical repair of giant inguino-scrotal hernia (GIH), based mainly on anatomical considerations and minimal organ resection; without the use of mesh or pneumo-peritoneum. Patients/method Over a-15-year period (2005-2019), all patients managed for GIH were reviewed. They had an elevation of the scrotum, and foot of the bed, to allow for the reducible part of the hernia to gradually return and expand the abdominal cavity. Volume estimations of the hernias were done applying Archimedes' principle followed by a-5-day bowel preparations. Abdomino-inguinal/Inguinal incisions (depending on the size), were made to repair the hernias taking advantage of the special anatomical make-up of the abdominal cavity. Results A total of 20 male patients with GIH were treated; 13 were on the right while seven were left-sided. All the GIHs were repaired successfully without any serious morbidity; one patient had a scrotal hematoma that was managed conservatively and another developed a ventral hernia (5 cm long), which was repaired at a later day. An average of 6 months follow-up revealed no recurrence or any other complications. Conclusion Surgical techniques in the repair of GIH are many and varied but its rarity has made the adoption of any specific technique(s) impossible. A fairly large series like ours over many years might be a fruitful attempt at solving this problem. [ABSTRACT FROM AUTHOR]

Purpose: The presence of an appendix in the inguinal hernia sac is defined as Amyand's hernia (AH). This study intends to present the authors' experience in dealing with this entity and also to present a discussion on possible need of updating its definition, classification, and management. Materials and Methods: A retrospective analysis of records of all pediatric patients undergoing surgery for congenital inguinal hernia in a single unit from January 2017 to March 2021 was done. Patient's demographics, clinical presentation, preoperative investigations, peroperative findings, and postoperative outcomes were recorded and analyzed. Results: AH was found in eight patients. All were boys. The median age of presentation was 20.5 months (range 2 months to 36 months). The mean duration of symptoms was 2 days (range 2 to 4 days). All patients presented with incarcerated inguinoscrotal swelling (right sided = 5, left sided = 3); associated with pain. An abdominal radiograph and ultrasonography were done for all. All patients underwent emergency surgery. Exploration was done for all through an inguinal incision. The appendix was found inflamed for two patients, and appendectomy was done for the same. None of the patients underwent incidental appendectomy. Wound infection, secondary appendicitis, and recurrence were not seen for any of the patients. The authors have also proposed a revised definition and classification of AH. Conclusion: AH is an interesting entity and many questions like the need for incidental appendectomy remain unanswered. An updating of the definition and classification system can probably offer some solution in this regard. However, more research is warranted in this regard. [ABSTRACT FROM AUTHOR]

Aim: A study was conducted to explore the characteristics of the videos on pediatric inguinal hernia repair on YouTube and compare the most popular videos (MPV) with the least popular ones in terms of educative value vis-a-vis their popularity. Materials and Methods: The term "Pediatric inguinal hernia repair" was searched for on YouTube on August 15, 2021, with the filter set to "view rate." Pertinent data were collected from the 50 MPV and the 50 least popular videos (LPV) and then compared. The h-index and affiliation of the surgeon were obtained from the Scopus database, and their affiliation was further categorized as academic or nonacademic. Results: One hundred and seventy-five videos were found with median views of MPV: LPV being 9270 (interquartile range [IQR] – 12099):127 (IQR – 194), respectively (P < 0.0001). Most of the videos in the MPV and LPV groups were uploaded from the United States of America (USA) (MPV – 17 and LPV – 13) and India (MPV – 15 and LPV – 15). The MPV were on YouTube for a median duration of 3.1 (IQR – 5.5) years as compared to 1.2 (IQR – 2.3) years for the LPV (P < 0.0001). Ninety-two surgeons were identified. The median h-index of the surgeons of MPV was 3 (IQR – 12) in comparison to 1 (IQR – 10) of LPV (P = 0.13). The ratio of academic versus nonacademic affiliation among MPV and LPV was almost equal in both the groups. Conclusions: On either end of the spectrum of popularity, the majority of the pediatric inguinal hernia videos on YouTube were surgical videos uploaded from the USA and India. The educative value of these videos was found to be low and widely dispersed. Surgeons from both academic and nonacademic affiliations had contributed similarly. [ABSTRACT FROM AUTHOR]

Background Preserving the round ligament during Trans Abdominal Pre Peritoneal laparoscopic hernia repair (TAPP) surgery may be unfeasible or prolong the duration of surgery because of the adhesions between the round ligament and hernial sac, so the benefit of preserving or cutting the round ligament during dissection and spreading the mesh is a matter of debate. Patients and methods A case series study was conducted on 20 adult female patients over 6 months, and the transabdominal (TAPP) approach was used for all patients. After identifying the round ligament and dissecting it carefully from the adherent peritoneum trying not to tear the peritoneum, the mesh was fashioned to cover the areas of weakness that can develop hernia and cover the round ligament without making a keyhole for it. Results Follow-up was done for at least 6 months with no evident recurrence. No complications were recorded except for residual swelling postoperatively in six cases, sometimes with skin ecchymosis. This situation was managed conservatively and resolved within 2 weeks. Overall, seven patients complained of mild pain (1–2) score, and only one patient was still complaining after 6 months; the pain was mild and well tolerated by the patient and generally did not affect patient satisfaction Conclusion TAPP laparoscopic repair of female inguinal hernia preserving the round ligament is feasible, although can be trickier and more difficult than scarifying it. The recurrence rate is low with good patient satisfaction. It seems there is no evident superiority of preserving the ligament, but we recommend more studies with longer follow-up and more cases to figure out the long-term effect of preserving the ligament. [ABSTRACT FROM AUTHOR]

Amyand's hernia is a rare presentation accounting for about 1% of all inguinal hernias. It is usually a per-operative diagnosis, but may be picked up on preoperative ultrasound. Although rare, it is usually right-sided. We present here 3 cases of Amyand's hernia, out of which one was on left side. [ABSTRACT FROM AUTHOR]

Introduction and purpose Risk factors and causes of recurrence following inguinal hernia repair in the pediatric age group are not well understood. In this work, we aimed to describe a cutoff value of internal ring diameter in male children who presented with large inguinoscrotal hernia above which internal ring narrowing (plication of inguinal canal floor) may affect the rate of hernia recurrence. Patients and methods A prospective study was conducted on male children who presented clinically with large unilateral or bilateral inguinoscrotal hernias. Preoperative ultrasound was performed for all of them to assess the diameter of the internal inguinal ring. Cases were categorized into two groups: group 1, internal ring diameter less than 12 mm, and group 2, internal ring diameter 12 mm and more. Patients in either group were blindly selected to be operated upon by one of the two operative techniques, either just high ligation of the sac or high ligation of the sac followed by plication of the floor of the inguinal canal (narrowing of the internal ring). The recurrence rate was compared between the two operative techniques, and the results were statistically analyzed. Results This study included 204 inguinoscrotal hernias divided into two groups: group 1 included 142 cases in which the internal ring diameter was below 12 mm. Half of them were operated upon by just high ligation of the sac, and the other half were operated upon by high ligation of the sac and internal ring narrowing. We encountered no recurrence in either group. Group 2 included 62 cases in which the internal ring diameter was 12 mm or more. A total of 31 patients were operated upon by high ligation of the sac only, and we encountered three (10%) recurrent cases. The other 31 cases were operated upon by high ligation of the sac and narrowing of the internal ring, with no recurrence. Conclusion Narrowing of the internal ring if dilated above 12 mm or more may decrease the recurrence rate in such cases. [ABSTRACT FROM AUTHOR]

The Kugel procedure resulted in extensive adhesion in the preperitoneal space. Performing a transabdominal preperitoneal repair (TAPP) for recurrent hernia after Kugel procedure is extremely difficult. In this case report, we present the case of a 81-year-old male who presented with recurrent inguinal hernia after Kugel procedure 8 years ago. Transabdominal laparoscopy was performed first. Indirect hernia formed inferior to the lateral edge of the previous mesh was diagnosed under laparoscopy. The patient’s medial umbilical ligament (MUL) was big enough and could be completely released by separating the Retzius space. Finally, TAPP was successfully performed by using the MUL to create and close the preperitoneal space. No perioperative complications or hernia recurrence was observed 1 year after the surgery. Using the MUL to deal with preperitoneal problems was practical and feasible. [ABSTRACT FROM AUTHOR]

Background: The enhanced view totally extra-peritoneal (eTEP) repair is a useful modification of the classic TEP operation which offers a more panoramic view of the operative field with greater flexibility in port positioning. It can offer greater ease of surgery in large, irreducible or bilateral inguinal hernias due to its improved ergonomics. Misunderstanding the myo-fascial anatomy, incorrect positioning or sequence of trocar insertion can lead to inadvertent peritoneal injury with pneumoperitoneum, impeding the operating surgeon. Methods: We describe our method for the surface marking of the semilunar and arcuate lines which guides the site of initial optic access. After blunt/balloon dissection of the pelvic extra-peritoneal space, the lateral trocar is inserted first to clear the peritoneum off the posterior aspect of arcuate line, allowing us to divide it near its medial attachment. The second working trocar is inserted at the umbilicus after visually confirming the extent of dissection. Additional trocars are inserted depending on bilaterality or size of the hernia. Results: We have operated 124 cases of bilateral inguinal hernia between April 2017 and February 2020, where we suffered peritoneal injury in only four cases, without leading to the conversion of the procedure. The widely dissected space with the division of the arcuate line further increased the ease of laying down a large prosthetic mesh. Conclusion: The exact sequence of trocar insertion and their positioning described by us improves ergonomics and ensures a safe division of the arcuate line with minimal risk of damage to underlying peritoneum. [ABSTRACT FROM AUTHOR]

Background: Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years.Methods: The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed.Results: Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair.Conclusion: Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications. [ABSTRACT FROM AUTHOR]

Introduction: Since the inception of laparoscopy, it has been explored in many fields of surgery, like in the abdomen, hernia, thorax, etc., Laparoscopic hernioplasty in adults is being practiced by many surgeons nowadays. However, the role of laparoscopic inguinal hernia repair in pediatric patients is not well-established, even though it is being explored as an alternative to open herniotomy procedure. In the present study, laparoscopic needlescopic hernia repair was compared with the conventional open herniotomy procedure. Material and Methods: The study was a case-control study conducted in a tertiary care hospital in northeast India during 2018–2021. A total of 25 patients underwent needlescopic hernia repair, the outcome of which was compared by collecting data of 25 more patients who earlier underwent open herniotomy repairs. Results: The laparoscopic needlescopic repair took a longer operative time as compared to the open technique with a smaller-sized incision. Conclusion: Laparoscopic needlescopic hernia repair is a safe and feasible procedure with a similar outcome to open herniotomy but with a smaller scar. [ABSTRACT FROM AUTHOR]

The ProGrip™ laparoscopic self-fixating mesh provides advantages such as low cost and reduced pain following tack-free fixation in laparoscopic hernia repair through a transabdominal preperitoneal approach. Obturator hernia repair needs adequate fixation around the hernial orifice without the use of tacking, and ProGrip™ mesh provides options for secure fixation. However, it is often difficult to adequately adjust the mesh placement to cover the obturator hernia orifice with a ProGrip™ mesh, due to adhesion of the grips to the surrounding tissues. We introduce our technique to avoid unintentional adhesion during ProGrip mesh repair and discuss its utility in the treatment of obturator hernias. We repaired seven obturator hernia lesions in five patients using this technique without any complications. The biggest advantage of our technique is that the position of the mesh can be adjusted after it is expanded, unless the sheet is completely removed, allowing the surgeons to fix the mesh without any unintended adhesion to surrounding tissue. [ABSTRACT FROM AUTHOR]

Background The most difficult and tedious step in total extraperitoneal (TEP) laparoscopic hernia repair is the dissection of the sac from the cord structures, especially in large inguinal hernias reaching the bottom of the scrotum. The possibilities of bleeding, vas injury, and missing part of the sac lie mostly in this step. We introduced this modification to the procedure to accomplish this step through a small incision at the neck of the scrotum with sparing the second operator port. Aim The aim of this study is to evaluate this new technique of assisted totally extraperitoneal (ATEP) laparoscopic hernioplasty in the management of patients with large inguinal hernias. Patients and methods This study was conducted on 192 male patients with large inguinal hernias who were randomly arranged into two equal groups: group I included 96 patients who underwent the classical TEP laparoscopic hernioplasty, and group II included 96 patients who underwent the new modification ATEP laparoscopic hernioplasty. The two groups were compared regarding the operative time, intraoperative and postoperative complications, and the hospital stay. Results There were statistically significant reductions in the operative time; the incidence of intraoperative bleeding, vas injury, and incomplete sac excision; and postoperative massive scrotal edema in group II compared with group I, with more or less similar cosmetic results. Conclusion ATEP laparoscopic hernioplasty is a safe and effective procedure to manage patients with large inguinal hernias and achieved better control with lower morbidity than the classic TEP laparoscopic hernioplasty. [ABSTRACT FROM AUTHOR]

Over the past three decades, the practice laparoscopic inguinal hernioplasty has gained momentum. Mesh migration after laparoscopic inguinal hernia repair is an uncommon mesh-related delayed complication which is more common after transabdominal preperitoneal repair as compared to total extraperitoneal (TEP) repair. We report the first case of mesh migration into the sigmoid colon after TEP presenting 10 years after surgery. A 72-year-old male presented with left iliac fossa pain and diffuse lump. His computed tomogram scan showed sigmoid colon adherent to internal oblique at the site of hernia repair with a collection containing air specks and calcification. A colonoscopy revealed mesh within the sigmoid colon. He had to undergo a sigmoidectomy with Hartmann's surgery for the same. Here, we discuss the implicated pathophysiology, management and prevention of mesh migration after laparoscopic inguinal hernioplasty with literature review. [ABSTRACT FROM AUTHOR]

Background: The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%. Objective: The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unilateral inguinal hernia patients using USG as diagnostic modality and to compare the clinical outcomes of unilateral TEP vs. bilateral TEP with respect to pain, duration of hospital stay, time for return to normal work, and postoperative complications. Setting and Design: This was a prospective observational, single-center study. Materials and Methods: A total of 30 male patients were included in the study who was having clinically diagnosed unilateral hernia. All patients were assessed by USG for contralateral occult inguinal hernia. Results: Incidence of COH was 10%, two (6.7%) had indirect defect, and 1 (3.3%) had direct defect. Two (6.7%) patients underwent bilateral TEP and 28 (93.3%) underwent unilateral TEP. No significant difference was observed in terms of mean duration of hospital stay, duration of surgery, and visual analog scale score for pain in both unilateral and bilateral TEP. The mean for resuming daily work in unilateral TEP was 4.86 ± 0.833 days and in bilateral TEP the mean was 7.50 ± 0.70 days and this showed statistically significant difference (P < 0.001). Conclusion: Patients with COH should be counselled for synchronous repair as there is no significant difference in clinical outcomes of unilateral and bilateral TEP. On the basis of this pilot study, it can be concluded that preoperative USG is mandatory for diagnosis and simultaneous management of preexisting contralateral hernia. [ABSTRACT FROM AUTHOR]

Context: Laparoscopic hernia repair, despite its safety and effectivity is related to some drawbacks. Testicular complications are uncommon but serious among them. Testicular atrophy occurs in 0% to 2% of patients after hernioplasty. Aim: In this study, we tried to evaluate the effects of laparoscopic total extraperitoneal (TEP) repair on testicular blood flow in Indian population by comparing the testicular perfusion in preoperative and postoperative status. Settings and Design: A prospective study. Subjects and Methods: A prospective study was conducted among adult male patients having an uncomplicated inguinal hernia. Preoperative and postoperative CDUS evaluation of testicular blood flow was done for each patient. Statistical Analysis Used: Data were analyzed using the SPSS (SPSS, Chicago, IL, USA) software program. Results: The resistive indexes of testicular, capsular, and intratesticular arteries of the operated and nonoperated side were similar preoperatively and did not differ ominously postoperatively. Conclusion: Laparoscopic hernia surgery does not have any significant effect on testicular blood supply and can be advocated safely without any added risk of testicular atrophy. [ABSTRACT FROM AUTHOR]

Purpose: Among laparoscopic surgeries in inguinal hernias, totally extraperitoneal (TEP) repair has demonstrated favourable results in reduction of post‑operative pain and mean operative times with early return to physical activity. We have done a prospective comparative study on two different techniques of mesh fixation, i.e., transfascial suture and tack fixation. Materials and Methods: It was a prospective, non‑randomised comparative study done on inguinal hernia patients operated by TEP repair from October 2014 to September 2016. These data were compared in two techniques of mesh fixation (tack and transfascial sutures) in terms of post‑operative complications, pain scores by visual analogue scale (VAS) and cost analysis of the procedure. Results: Our study on 69 total patients (44 tack fixation and 25 suture fixation group) revealed that mean VAS scores for post‑operative pain were not having any statistically significant difference in the tack group versus suture group (2.42 ± 0.24 vs. 2.2 ± 0.24) at 24 h, but VAS scores in the follow‑up period at 1 week, 1 month, 3 months and 6 months were 1.14 ± 0.33 versus 0.67 ± 0.27; 0.78 ± 0.24 versus 0.07 ± 0.06; 0.42 ± 0.17 versus 0.07 ± 0.06 and 0.5 ± 0.11 versus 0.07 ± 0.06, respectively, which showed significant difference at 1 and 3 months, suggesting less pain in the suture group. No significant difference was noted in other post‑operative complications. Conclusion: Transfascial suture fixation of mesh in TEP repair of inguinal hernia can be a cost‑effective procedure with a comparable safety profile as compared to tack fixation. [ABSTRACT FROM AUTHOR]

Background The two standard methods for inguinal hernioplasty is open and minimal access laparoscopic technique. Most laparoscopic surgeons use a transabdominal preperitoneal approach but totally extraperitoneal (TEP) approach potentially offers several advantages. Objective The aim in this study was to assess the learning curve, cost value, safety, and feasibility of TEP approach. Patients and methods Prospectively collected data on 185 consecutive patients submitted to laparoscopic TEP hernioplasty for inguinal hernia from 2016 to 2018 in Theodor Bilharz Research Institute Hospital. This study involved repair of primary, recurrent inguinal hernia and femoral hernia. The prolene mesh was used for groin hernia repair in all cases with and without fixation. Results All 185 cases started with the laparoscopic TEP technique with only four cases converted to transabdominal preperitoneal technique (2.1%). In 110 (60.7%) cases the mesh was placed without fixation. In 71 cases the mesh was fixed by Tackers or Histoacryl. In unilateral hernia, the mean operating time was 45 min, while in bilateral hernia it was 61 min. Intraoperative complications included three cases of inferior epigastric vessel injury which were managed by metallic clips of 5 mm. The mean pain score was 7.5, while the mean satisfaction score was 5.4. The mean hospital stay was 16.4 h. Regarding postoperative complications, 10 (5.5%) patients developed a postoperative seroma, four (2.1%) patients developed a hematoma, two (1.1%) patients developed a hydrocele, and five (2.7%) patients experienced neuropathic pain. There were three (1.1%) recurrent cases; all these cases were managed by open hernioplasty. Conclusion In this study, the laparoscopic TEP approach is found to be an effective, and safe technique regarding primary, recurrent open inguinal and femoral hernias with good learning curve to laparoscopic surgeon who started with transabdominal preperitoneal technique technique. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, laparoscopic hernia repair was the most performed operation in our department. Equally, it compromises 15% of all pediatric operations performed. We aim, in this study, to review all the cases performed and extrapolate important information like reoccurrences, the incidence of metachronous inguinal hernia, complications amongst other information. Material and Methods: All patients under the age of 18 whom underwent elective laparoscopic hernia repair between 03/01/2007 till the 18/05/2016 were included in our study. We recorded important clinical features and studied their post-operative follow up. Equally reoccurrences, the incidence of metachronous inguinal hernia, complications and other parameters were recorded and studied. Results: A total of 916 patients were operated on during the defined study period. There was a 0.17% reoccurrence rate and a 0.46% incidence of metachronous inguinal hernia. Equally a contralateral patent processus vaginalis was diagnosed and closed in 17.10%. There were no postoperative complications and we had a 0% postoperative hydrocele rate. Conclusion: Laparoscopic hernia repair is safe and carries all the benefits of minimally invasive surgery. We recommend that it is offered to patients and would like to refute previously claimed reports that it carries a higher reoccurrence rate or takes a long time to perform. Our reoccurrence rate of 0.17% is actually lower than many published reoccurrence rates after open repair. [ABSTRACT FROM AUTHOR]

Transmesocolic and transomental hernias (TOHs) are rare types of internal hernia. Both these hernias occurring concurrently in a patient are even rarer. We report a patient with signs of recurrent small-bowel obstruction who was found to have a dual transmesocolic, TOH. Computed tomography imaging and subsequent laparoscopic exploration identified small-bowel loops passing through a defect in the transverse mesocolon behind the stomach to emerge through the gastrohepatic omentum. This was treated successfully by laparoscopy. To the best of our knowledge, this is the first reported case of a combined transmesocolic, TOH undergoing successful laparoscopic repair. [ABSTRACT FROM AUTHOR]

Aim: Laparoscopic inguinal hernia repair (LIHR) is gaining widespread acceptance, but its role in the management of incarcerated cases is not well outlined. This review analyses the outcomes of laparoscopic repair of incarcerated inguinal hernia in children. Patients and Methods: Literature was searched on PubMed® using terms 'laparoscopic', 'incarcerated', 'inguinal', 'hernia' and 'children'. Age, sex, side, sac content, operative technique, follow-up period, complication and recurrence rate were analysed. Results: Fifteen articles with 689 paediatric incarcerated inguinal hernias were identified between 1998 and 2018. Median age of patients was 22.4 months (2 weeks-16 years; M:F = 2.2:1). Side was mentioned in n = 576: n = 398 (69.1%) right and n = 178 (30.9%) left. In n = 355 (51.5%) manual reduction and delayed surgery (MRDS), in n = 34 (4.9%) manual reduction in general anaesthesia (MRGA) followed by emergency LHR and in n = 300 (43.5%) intraoperative reduction (IOR) was necessary. Incarcerated contents were documented in n = 68: intestine n = 36 (52.9%), ovary n = 14 (20.6%), omentum n = 11 (16.2%), appendix n = 5 (7.4%) and Meckel's diverticulum n = 2 (2.9%). Among the n = 18 girls in IOR group, n = 14 (77.8%) had ovaries incarcerated. For LHR, the hook method was used in 376 (54.6%) and purse-string suture in 313 (45.4%), with two conversions in IOR group. Mean followup was 15 months (3-80 months), with one (0.15%) testicular atrophy, and 4 (0.58%) recurrences in MRDS and 1 (0.15%) in IOR. All five cases were closed with pursestring technique. Total recurrence rate was 0.73%; significantly higher (P = 0.014) with pursestring (n = 5, 1.6%) than with the hook (none). Conclusion: Hook and purse-string methods are equally popular in LHR for paediatric incarcerated hernias, with 50% hernia reductions possible at the time of surgery. Recurrence rate is low and comparable with non-incarcerated hernias; however, it is significantly higher in purse-string method than hook technique. [ABSTRACT FROM AUTHOR]

Background: Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature. Methods: A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were ('laparoscopic' OR 'laparoscopy') AND ('inguinal' OR 'groin' OR 'hernia') AND 'prostatectomy'. Results: The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85–4.97), conversion to open surgery (RR 3.91; 95% CI 0.85–18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39–4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05–18.64), due to an injury of the inferior epigastric vessels. Conclusions: Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP. [ABSTRACT FROM AUTHOR]

Objective: We systematically reviewed the literature and pooled data for a meta-analysis to compare the efficacy and safety of mesh fixation and nonfixation in laparoscopic total extraperitoneal (TEP) hernia repair. Materials and Methods: We performed a systematic search of PubMed® and a Cochrane review for all randomized controlled trials that compared the efficacy and complications of mesh fixation versus nonfixation in TEP hernia repair. The evaluated outcomes included perioperative (operative time and conversion rate) and postoperative parameters (pain scores, duration of hospital stay, surgical complications including seroma, delayed return of bladder function, chronic pain, and recurrence). Cochrane Collaboration Review Manager Software (RevMan®, version 5.2.6) was used for statistical analysis. Results: Ten trials met the inclusion criteria and were included in a pooled analysis. In total, 1099 patients (1467 hernias) had received TEP hernia repair (748 and 719 hernia defects in the nonfixation and fixation groups, respectively). The nonfixation group required shorter operative time (weighted mean difference [WMD] = −2.36 min, P= 0.0006) and had less pain on postoperative day 1 (WMD = −0.44, P= 0.04) than the fixation group. No significant differences were observed between groups with regard to conversion rate, hospital stay, recurrence rate, or complication rate. However, the incidence of postoperative urine retention was higher in the fixation group (odds ratio = 0.26, P= 0.03). Conclusion: For patients with a nonrecurrent uncomplicated hernia defect with the size <3 cm, nonfixation yielded comparable efficacy with mesh fixation, but less short-term postoperative pain, and a lower risk of urine retention. In addition, the nonfixation method involved a shorter operative time and lower costs. However, no difference in the incidence of chronic pain was observed. [ABSTRACT FROM AUTHOR]

Background Hernia is a common problem of the modern world with an incidence ranging from 5 to 7%. Of all groin hernias, around 75% are inguinal hernias. Recently with the advancement in laparoscopy, endoscopic repairs seem to offer better quality of life, decreasing hospital stay and early return to work. Aim of the work To compare between self-fixating mesh and fixation of non-self-fixating mesh with absorbable tacks in laparoscopic inguinal hernia repair transabdominal preperitoneal approach as regards intraoperative time, complications, postoperative pain, return to normal activity, and incidence of recurrence. Patients and methods Our study is a randomized, prospective study. It was conducted in El Demerdash, Ain Shams University Hospital on 30 patients with inguinal hernia who were operated upon between September 2018 and December 2018 with a minimal follow-up of 3 months. Statistical analysis used Data were collected, revised, coded, and entered to the Statistical Package for the Social Sciences (IBM SPSS), version 23. The quantitative data were presented as mean, SDs, and ranges when their distribution was found parametric. Also qualitative variables were presented as number and percentages Results Our study demonstrates that laparoscopic inguinal hernia repair using the transabdominal preperitoneal technique with implantation of a new Parietex ProGrip laparoscopic self-fixation mesh is a fast, effective, and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of chronic pain and the recurrence rate. Conclusion After this comparative study, both the use of self-gripping mesh and fixation of mesh by absorbable tacks approaches are similarly effective in terms of operative time, the incidence of recurrence, complications, and chronic pain coinciding with all the available literature. [ABSTRACT FROM AUTHOR]

Background Is to evaluate the sensitivity and specificity of pre-operative inguinal ultrasonography in detection of CPPV after comparing its results with that found during surgical exploration, and to assess if this policy will be helpful in decreasing the incidence of metachronous inguinal hernia development. Patients and methods A prospective study of children presented clinically with unilateral inguinal hernia, Pre-operative US was performed to all of them to assess the contralateral groin; if the contralateral groin proved to have patent processus vaginalis (PPV) by US, bilateral groin exploration was done. Surgical findings were reported in two categories: Normal groin (no contralateral sac found) or Positive finding (if contralateral hernia sac found), the surgical finding was compared to the US finding. If the contralateral groin has no PPV by US those patients were strictly followed up for at least 18 months to detect the possible development of metachronous inguinal hernia. False positive and false negative cases were recorded and compared to true positive and negative cases and statistically analyzed, US sensitivity and specificity were calculated. Results 137 children diagnosed clinically with unilateral inguinal hernia were included in this study, Ultrasonography detected the presence of contralateral patent processus vaginalis (CPPV) in 52 patients (38%), while 85 patients have no CPPV (62%), After surgical exploration of the clinically negative 52 groin, hernia sac were found in 50 of them (96.2%) , false positive US finding was about 3.8%.The incidence of CPPV was much more common in patients diagnosed with left sided unilateral hernia (54.5%), No contralateral groin exploration was performed in 85 patients, those patients were strictly followed up for the development of metacronous inguinal hernia(MCIH) , only one of them developed MCIH 6 months post-operatively, the incidence of developing a MCIH after negative US finding was 1.17 %.The US proved to have 98% sensitivity and 97.7% specificity in diagnosing the CPPV after comparing its results with that found during surgical exploration. Conclusion pre-operative inguinal US detect the presence of CPPV correctly in almost all cases, contralateral surgical exploration of those patient significantly decreased the incidence of MCIH in our follow up period. [ABSTRACT FROM AUTHOR]

Background Laparoscopic hernial repair is increasingly adopted even for neonates and has achieved a high success rate with low recurrence rate with long-term follow-up. The main advantages of laparoscopy are no incision of the fascia, exploriation of the other side in case of bilateral hernia, and visualization and safeguarding of the vas deferens and the spermatic vessels. Moreover, it is advantageous over open technique in case of recurrent hernia. Different modalities of techniques have been used for repair such as needlescopic disconnection of hernia sac, flip flap technique, muscular arch repair, and ring closure. Aim The aim of this study was to evaluate the feasibility, advantages, and the outcome of laparoscopic ring closure for repair of the inguinal hernia in children as a preliminary experience in our institution. Patients and methods This prospective study included 30 patients with unilateral and bilateral congenital inguinal hernia who were subjected to laparoscopic repair in the age group of 6 weeks up to 4 years. We use ring closure technique. Results Thirty children met our inclusion criteria; among them, 26 were boys, in whom indirect inguinal hernia sacs were closed (18 right, five left, three bilateral), and in the four girls, all indirect inguinal hernia sacs were closed. Currently, the median operating time for a unilateral hernia is 23 min (range: 19–40 min) and for bilateral hernias is 28 min (range: 25–55 min). There were no complications. Postoperative hydroceles occurred in three boys. Recurrence encountered in two (6.7%) cases. Conclusion The current series shows the feasibility of laparoscopic hernia repair in pediatric patients. Further technical refinement is needed to facilitate its applicability. Even if not used routinely, laparoscopy is a valuable tool for the objective evaluation and management of congenital inguinal hernia in children with advantage of being exploratory and curative with low recurrence and complications rate. [ABSTRACT FROM AUTHOR]

Background Inguinal hernia repair is one of the most commonly performed operations in general surgery departments. Open Lichtenstein procedure is the gold standard in managing such cases. Mini-invasive approaches have gained popularity in the recent few decades by achieving better cosmetic results, shorter hospital stay, less postoperative pain, and earlier return to normal activities. Transabdominal preperitoneal (TAPP) mesh repair is one of the most accepted procedures among surgeons and patients. Aim To compare open Lichtenstein with TAPP mesh repair techniques in unilateral inguinal hernia in male patients regarding perioperative outcome and complications. Patients and methods This is a randomized comparative prospective study conducted from October 2016 to February 2017 on 71 cases presented with unilateral inguinal hernia and divided randomly into two groups: laparoscopic group (28 cases) and open group (43 cases). Both groups were studied and followed up for 1 year postoperatively, detecting intraoperative and early and late postoperative outcomes. Results The mean age was 36±15 years, and comorbidities were present in 32.4% of cases. Left, oblique, and funicular type were the most frequent cases. Operation time was 111±22 min in TAPP group and 75±16 min in open group. Occult hernia was detected in five (17.9%) cases, indirect hernia in three cases, and direct hernia in the other two cases of TAPP group. Intraoperative and postoperative complications were encountered in 10.7 and 28.6% of TAPP group, respectively, and in 9.4 and 20.9% of open group, respectively. Postoperative hospital stay was 2±1 day in both groups. Conclusion TAPP procedure can be performed safely in unilateral inguinal hernia in males with no serious complications. Moreover, it increases the ability to detect and repair the occult hernia in the same session. Longer operation time is the only drawback. [ABSTRACT FROM AUTHOR]

Aim This work aimed to identify the outcomes of mesh fixation using cyanoacrylate in open inguinal hernia repair with regard to long-standing groin pain, operative time, rate of recurrence, degree of postoperative pain, and other complications. Patients and methods This was a prospective cross-sectional analytic study on 54 patients complaining of unilateral inguinal hernia that evaluated the usage of cyanoacrylate in open inguinal hernioplasty as a material for mesh fixation. The study was conducted in the General Surgery Department between November 2016 and February 2018. Male patients with denovo unilateral inguinal hernia suitable for elective open mesh repair were involved in the study and gave informed consent. Follow-up was carried out during a period ranging from 1 to 6 months. The primary outcome was early complications including early postoperative pain, bleeding, infection, seroma, and operative time. Secondary endpoints were long-standing groin pain and recurrence rate. Results About 48 cases of 54 (88.9%) needed less than 4 min for mesh fixation in open inguinal hernia repair. An overall 44% of cases have reported no early postoperative pain. Only 5.6% of cases have reported a status of chronic groin pain, and no cases have been reported for recurrence. Conclusion The results have led us to recommend the usage of cyanoacrylate for fixation of mesh in inguinal hernia repair to decrease the occurrence of postoperative complications in inguinal hernioplasty, generally, and the long-standing groin pain particularly, especially in patients who are more prone to experience pain. [ABSTRACT FROM AUTHOR]

Internal hernia through an iatrogenic defect in the hepatic falciform ligament and acquired jejunal atresia in a 8-day-old neonate was reported. The PubMed, MEDLINE, CNKI, Wanfang and Weipu databases were searched The literature about the hepatic falciform ligament iatrogenic defect causing internal hernia was analysed. Ten other cases were collected from the world literature. Herniated intestinal necrosis was found in four cases. All cases were recovered uneventfully after operation. Internal herniation through an iatrogenic defect in the hepatic falciform ligament is extremely rare. However, the case reports are increasing, especially in the era of laparoscopic surgery. Adequate closure or open the defect is essential to prevent internal hernia occurrence. [ABSTRACT FROM AUTHOR]

Testicular ischemia caused by inguinal hernia repair, and even the presence of the hernia itself, has been recognized in the medical literature, with the latter more commonly in children, but such an event after manual reduction has never been reported before. We present the case of a 67-year-old man who presented to the emergency department with a painful left groin lump. A left inguinoscrotal hernia was diagnosed and reduced "en masse" with manual pressure at the bedside. The patient was discharged but developed acute-onset left scrotal pain as soon as he got home and then re-presented 2 days later with increasing severity of the pain and swelling ever since the hernia reduction. On examination, he was febrile, with a hard, tender, and swollen left testis. Serum inflammatory markers were elevated. Conservative management with intravenous antibiotics and analgesia was commenced. An ultrasound of the testes demonstrated lack of Doppler flow to the left testis, suggestive of acute ischemia. Three days later, there were persistent temperature spikes and significant pain; therefore, the patient underwent an acute left scrotal exploration where a necrotic, black left testis was discovered and excised. He was discharged on the 1st postoperative day; histological analysis confirmed testicular infarction. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair has been a controversial area in surgical practice. Its complexity is reflected by the fact that numerous different procedures including both open and laparoscopic techniques are in use today. Laparoscopic totally extraperitoneal (TEP) repair is preferred over transabdominal pre-peritoneal repair as the peritoneum is not breached and also due to fewer intra-abdominal complications. This is the most elegant technique but rather difficult to perform. Aim: The purpose of this study was to describe Dulucq's technique for inguinal hernia repair and the use of three-dimensional mesh without fixation in laparoscopic TEP inguinal hernioplasty. Methods: Surgical technique of laparoscopic TEP inguinal hernia repair is detailed in the text. Results: A total of 945 hernia repairs were included in the study. The hernias were repaired by Dulucq's technique. Mean operative time was 45 min in unilateral hernia and 65 min in bilateral hernia. There were no serious complications. Conclusion: The laparoscopic TEP hernioplasty by Dulucq's technique is feasible with fewer intra-abdominal complications. The dissection must always be done with the same stages with minimal monopolar diathermy and patient in a slight Trendelenburg position. [ABSTRACT FROM AUTHOR]

Background: Bulk of published data support the efficacy of dexmedetomidine for prolongation of peripheral nerve block; but most of the studies are in adults. Ample data regarding use of dexmedetomidine in setting of paediatric peripheral nerve blocks is scarce. Aim and Objective: To determine whether adding dexmedetomidine to ropivacaine in ilioinguinal-iliohypogastric nerve block prolongs postoperative analgesia in children undergoing inguinal hernia repair. Material and Methods: Sixty children of American Society of Anesthesiologist (ASA) grade I – II aged between 2-11 years scheduled for elective hernitomy were randomly allocated to receive an ultrasound guided ilioinguinal-iliohypogastric nerve block (IINB) with 0.2 ml/kg dose of plain ropivacaine 0.2% (group R; n = 30) or ropivacaine 0.2% with adjunct dexmedetomidine 1 μg/kg (group RD; n = 30).Time to first post-operative need for supplemental analgesia triggered by pain score ≥4 according to Children's and infants postoperative pain scale (CHIPPS scale) was the primary end point of study. Number of analgesic doses during first 24 hours; intraoperative hemodynamic changes; sedation; postoperative adverse effects were noted. Results: The mean duration of analgesia was significantly prolonged in group RD (970.23 ± 46.71minutes) as compared to group R (419.56 ± 60.6 minutes). Children in group RD had significantly lower CHIPPS score, and less number of rescue analgesic requirements during first 24 hours postoperatively. No adverse effects were recorded in any group. Conclusion: The present study concluded that combined use of ropivacaine and dexmedetomidine in IINB provided profound prolongation of post operative analgesia in children following inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background: The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis. Materials and Methods: This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015. Results: Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups. Conclusion: S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to document clinical features of inguinal hernia (IH) in the pediatric population. It provides data to evaluate associated risk factors of incarcerated hernia, its recurrence as well as the occurrence of contralateral metachronous hernia. Materials and Methods: We report a retrospective analytic study including 922 children presenting with IH and operated from 2010 to 2013 in our pediatric surgery department. Results: We managed 143 girls (16%) and 779 boys (84%). The mean age was 2 years; the right side was predominantly affected (66.8%, n = 616). Incarcerated hernia was documented in 16% of cases with an incidence of 33% in neonates. The incarceration occurrence was 15.5% in males versus 2.09% in females. The surgical repair was done according to Forgue technique. Postoperatively, four cases of hernia recurrence were documented, and contralateral metachronous hernia was reported in 33 children with 7.7% females versus 2.8% males. Forty-five percent of them were infants. The mean follow-up period was 4 years. We think that incarceration can be related to several risk factors such as feminine gender, prematurity, and the initial left side surgical repair of the hernia. Conclusion: IH occurs mainly in male infants. Prematurity and male gender were identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia. [ABSTRACT FROM AUTHOR]

Introduction Indirect inguinal hernia has incidence of 0.8-4.4%. In female children, the hernia sac contains an ovary in approximately 20-25% of cases, and some also contain a fallopian tube. Different forms of injury to ovaries and fallopian tubes were reported in female children who had herniotomy. Patients and methods Prospective study to evaluate incidence and surgical importance of sliding ovary and fallopian tube in congenital inguinal hernia in female children at Menoufia university hospitals between March 2012 and August 2015 included 118 female children with 31 cases with bilateral hernia with total of 149 hernias. Results Hernias were bilateral in 31 (26.2%) children, 52 hernias were on the right side (44.1%), and 35(29.7%) were on the left. 18 cases (15.2%) presented with irreducible hernia; 15 of them were sliding hernia and the other 3 reduced spontaneously with induction of anesthesia. Overall sliding hernias with ovary and or fallopian tube were 52 of the 149 hernias (34.8%). Conclusion Sliding ovary and fallopian tube is not uncommon finding and it is found in nearly one third of congenital inguinal hernia in female children, so from a clinical point of view, it is of utmost importance to keep in mind this fact while dealing with hernia sac. Hernia sac should be opened in all cases to exclude the presence of sliding ovary and tube; and if present the sliding ovary and tube should be carefully dissected and reduced before ligation of the sac in order to avoid their injuries. [ABSTRACT FROM AUTHOR]

Inguinal hernia is frequent and reaches up to 8% of the population. It was reported that over 20 million inguinal hernia repairs are performed annually. The bladder may herniate in 1%–3% of the cases through the inguinal canal that can be responsible for various symptoms. The most specific is the classic "two-stage micturition." However, the diagnosis usually remains unspecific, and a surgeon can fall in the trap of a "simple" inguinal hernia and cause accidental damages to an undiagnosed bladder hernia. Therefore, a clear diagnosis must be assessed based on clinical and radiological findings to avoid complications. In these two presented cases, the patients presented cystolithiasis complicating the bladder herniation. One of the patients also developed a bladder tumor which appeared to be urothelial carcinoma. [ABSTRACT FROM AUTHOR]

We describe the original technique used for the treatment of a patient who presented with pain and bulging in the abdomen, who was diagnosed with Spigelian hernia (SH) using ultrasound. In this case, the hernia occurred in the anterolateral abdominal wall with herniation of the distal ileum and mesentery, in addition to a large right inguinal hernia. A mini‑laparoscopic approach was proposed; due to Child‑A hepatic cirrhosis, it was done by a hybrid technique, using a harmonic scalpel. The primary closure of the hernia defects was performed, followed by the placement of a polypropylene mesh in the preperitoneal space. The mesh was fixed. In this case, the inguinal hernia was homolateral to the SH. Following the surgery, the patient had no further complications, being discharged the day after the procedure. [ABSTRACT FROM AUTHOR]

Giant inguinal hernia is a very rare event nowadays and occurs after years of neglect. We reported an unusual case of an elderly man with a giant left-sided inguinoscrotal mass containing not only the urinary bladder but also the small bowel loops and the omentum. We managed the hernia just by inguinal incision with extension to the internal ring, using the combined Bassini and Lichtenstein hernioplasty technique. As the hernia was giant and contained the major part of the bowels and the urinary bladder, we considered the risks of various hernia repairs and conducted combined Bassini and Lichtenstein technique to repair the posterior wall of the inguinal canal due to higher stability. After performing this method, the patient had a satisfactory postoperative status and we did not observe any specific problems or complications. Lichtenstein method has been approved to be a safe and efficient method to repair the hernia and is extensively used by surgeons. We suggest combined Bassini and Lichtenstein method in giant inguinoscrotal hernias, especially in those with great adhesions. However, we recommend further studies to compare this method with other techniques. [ABSTRACT FROM AUTHOR]

Introduction: Amyand's hernia is defined as the herniation of the whole or a part of appendix vermiformis into an inguinal hernia sac. Amyand's hernia is very rare, constituting about 1% of all inguinal hernia patients and 0.1% of all acute appendicitis patients. In one-quarter of Amyand's hernia patients, inflammatory changes are detected in appendix vermiformis. Detecting an appendiceal tumor in an Amyand's hernia sac is extremely rare, with only eight cases having been reported so far in the English literature. Case presentation: A 64-year-old man with an appendiceal carcinoid tumor inside an incarcerated Amyand's hernia sac. As the tumor was localized to the radix of the appendix, resection was carried out with the help of a linear-cutter stapler in a way to contain a part of the cecal wall. As the pathology examination revealed a carcinoid tumor infiltrating the periappendicular fatty tissue, right hemicolectomy was performed in a second session, in compliance with the oncological principles. No metastasis was present at the 24th month. Case reports published in the English literature regarding the Amyand's hernia with an appendiceal tumor were also analyzed in this study. Conclusion: Amyand's hernia containing an appendiceal tumor is an extremely rare clinical entity. Clinical manifestations mostly mimic the incarcerated hernia and thus accurate diagnosis is made incidentally during hernia surgery. The basic oncological principles apply for the approach to tumors inside a hernia sac. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair. Materials and Methods: In a randomized clinical trial, 66 neonates and infants (weight <5 kg) undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 µg adrenaline (group C) or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 µg adrenaline (group S). Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation. Results: Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05). The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03). Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001). Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04). Conclusion: More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair. [ABSTRACT FROM AUTHOR]

BACKGROUND: Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifi ce endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure. PATIENTS AND METHODS: All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal fl aps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded. RESULTS: All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period. CONCLUSIONS: SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time signifi cantly. [ABSTRACT FROM AUTHOR]

Fournier's gangrene and inguinal hernia, both are common diseases. However, inguinal hernia in a case of Fournier's gangrene is rarest of rare cases. Only one such case is reported in literature. We present one such rare case. A 50-year–old man presented with blackish discoloration of scrotum with inguinoscrotal swelling. It was associated with pus discharge and foul smell. There were noassociated co morbidities. The patient was a chronic smoker from 40 years. Serial debridement was done until the wound became healthy and free of infection. After infection control, the patient was operated and hernioplasty was done. [ABSTRACT FROM AUTHOR]

Hernia of canal of Nuck is an extension of peritoneal fold through the inguinal canal up to the labia majora. Defective obliteration of this peritoneal fold leads to herniation of abdominal content into the inguinal canal. Incidence of ovary and fallopian tube as contents of henia is rare overall and very rare in middle age women. This hernia would require surgical intervention once diagnosed, but type of intervention may vary. Although mesh repair is acceptable worldwide with low recurrence rate, nonmesh repair still has a place specifically in developing countries wherein cost consideration without significantly affecting outcome will be an important factor. Two cases treated with nonmesh repair are reported. [ABSTRACT FROM AUTHOR]

The 45-year-female patient came with complaints of bilateral groin pain since 1-year. Clinical examination revealed bilateral groin swelling with cough impulse. Ultrasonography (USG) revealed Mullerian dysgenesis with two separate noncommunicating uterine tissues and two ovaries. USG showed bilateral inguinal hernia with herniation of right ovary in right inguinal canal and left fallopian tube in left inguinal canal. Exploration of both inguinal canal revealed underdeveloped uterus, fallopian tube and ovary. Patient underwent bilateral hernioplasty. [ABSTRACT FROM AUTHOR]