Search

Robotic-assisted abdominal wall repair (RAWR) has seen an exponential adoption over the last 5 years. Skepticism surrounding the safety, efficacy, and cost continues to limit a more widespread adoption of the platform. We describe our initial experience of 312 patients undergoing RAWR at a large academic center. A retrospective review of all patients undergoing any RAWR from July 1, 2016 to March 18, 2020 was completed. Patient specific, operation specific, and 30-day outcomes specific data were collected. Univariate analysis and multivariate logistic regression were used to assess factors associated with 30-day complications. There was a steady adoption of RAWR over the study period. A total of 312 patient were included, 138 (44%) were abdominal wall repairs and 174 (56%) were inguinal repairs. The mean age of the cohort was 54.2 years (SD 16), 69% were males, and the mean BMI was 29 kg/m 2 (SD 4.8). There were two reported intraoperative events and nine operative conversions. 60 patients had at least one complication at 30-days. These include: 52 seromas, 4 hematomas, 2 surgical-site infections, 1 deep venous thrombus, and 1 recurrence at 30-days. BMI, type of hernia, and sex were not associated with complications at 30-days. The use of absorbable mesh, longer hospital stay, operative conversion, previous repair, and expert hernia surgeon were significant predictors of 30-day complications. Age, operative conversion, and previous repair were the only predictors of 30-day complications on multivariate regression. Our initial experience of 312 patients demonstrates the adoption and comparable short-term outcomes for a wide variety of robotic-assisted hernia repairs., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria., Methods: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia., Results: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010)., Conclusion: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS part of Springer Nature.)

The aim of this nationwide population-based case-control study was to assess the incidence of inguinal hernia (IH) among patients with congenital abdominal wall defects. All infants born with congenital abdominal wall defects between Jan 1, 1998, and Dec 31, 2014, were identified in the Finnish Register of Congenital Malformations. Six controls matched for gestational age, sex, and year of birth were selected for each case in the Medical Birth Register. The Finnish Hospital Discharge Register was searched for relevant diagnosis codes for IH, and hernia incidence was compared between cases and controls. We identified 178 infants with gastroschisis and 150 with omphalocele and selected randomly 1968 matched, healthy controls for comparison. Incidence of IH was significantly higher in gastroschisis girls than in matched controls, relative risk (RR) 7.20 (95% confidence interval [CI] 2.25-23.07). In boys with gastroschisis, no statistically significant difference was observed, RR 1.60 (95% CI 0.75-3.38). Omphalocele was associated with higher risk of IH compared to matched controls, RR 6.46 (95% CI 3.90-10.71), and the risk was equally elevated in male and female patients.Conclusion: Risk of IH is significantly higher among patients with congenital abdominal wall defects than in healthy controls supporting hypothesis that elevated intra-abdominal pressure could prevent natural closure of processus vaginalis. Parents should be informed of this elevated hernia risk to avoid delays in seeking care. We also recommend careful follow-up during the first months of life as most of these hernias are diagnosed early in life. What is Known: • Inguinal hernia is one of the most common disorders encountered by a pediatric surgeon. • Prematurity increases the risk of inguinal hernia. What is New: • Children with congenital abdominal wall defects have a significantly higher risk of inguinal hernia than general population. • Families should be informed of this elevated hernia risk to avoid delays in seeking care., (© 2021. The Author(s).)

Trocar placement and camera-dissection in the midline is the most commonly applied method for total extraperitoneal inguinal hernia repair (TEP), for which the theory of membrane anatomy has guiding significance. We hereby applies the theories and concepts, such as "fascia lining", "multi-layer", "inter-fascial planes", "combined inter-fascial plane" and "plane transition", to elucidate the key steps of TEP, for instance, space creation, hernia sac dissection, mesh flattening. Camera-dissection is performed along the posterior sheath of the rectus abdominis. Firstly, the camera enters retro-rectus space locating between the rectus abdominis and the transversalis fascia (TF). There are inferior epigastric vessels and their branches in the retro-rectus space, thus over-dissection should be avoided. Secondly, the camera goes downward through the TF into the pre-peritoneal space. The pre-peritoneal space is divided into the parietal plane and visceral plane by pre-peritoneal fascia (PPF). Both bladder and spermatic cord components locate on the visceral plane. Dissection of the median area should be implemented on the parietal plane, namely "surgical space", to protect the bladder. The parietal plane is the "holy plane" of TEP. Dissection of the indirect hernia area should be implemented on the visceral plane, namely "anatomical space", to protect the spermatic cord components. The reduction of direct hernia could be understood as the easy separation of TF and PPF. The reduction of indirect hernia is relatively difficult separation of peritoneum and spermatic cord components. During the transition of parietal and visceral planes, PPF (especially the pre-peritoneal loop) should be dissected for complete parietalization, in order to flatten the mesh.

Background: Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation., Methods: A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis., Results: 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies., Conclusion: We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses., Competing Interests: Declaration of competing interest The authors have no potential competing interests that readers or editors might consider relevant to this publication., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Purpose: Altered composition of collagen and elastin in abdominal fascia has been linked with the pathogenesis of hernias. This has not been studied amongst Africans who have hernia presentations which vary significantly from Caucasian cohorts. The aim of this study was to determine, and compare, the collagen and elastin contents of the transversalis fascia and rectus sheath of inguinal hernia patients with non-hernia controls., Methods: Twenty-five patients with solitary, primary, uncomplicated inguinal hernia and twenty-five non-hernia controls were evaluated. Biopsies of the transversalis fascia and anterior rectus sheath were stained with Masson Trichrome and Verhöeff van-Gieson to isolate collagen and elastin respectively, which were quantified using the ImageJ/Fiji® image analysis software., Results: Inguinal hernia patients were aged 19-85 years with a mean age of 45.2 years, mean body mass index (BMI) of 23.3 kg/m 2 and mean duration of hernia of 42.5 months. Lateral hernias with no hernia defect or posterior wall defect [PL0] were the predominant clinical type. There were significantly lower collagen and higher elastin content in the transversalis fascia and rectus sheath of inguinal hernia patients [P < 0.001]. Regression analysis identified smoking and long duration of hernias as independent predictors of low collagen levels in this study CONCLUSION: Inguinal hernia patients in the study population demonstrated depleted collagen in the connective tissue of the inguinal canal. This might justify the routine use of prosthetic mesh for the reinforcement of the posterior wall during hernia repair.

Purpose: Double ipsilateral inguinal ("pantaloon") hernias and also the more advanced "combined" inguinal hernia involve disruption of the inguinal floor. In the case of pantaloon hernias, the medial boundary of the internal ring remains intact but in combined hernias this is fully disrupted, producing a single hernial protrusion. Deepening the pathophysiology of these hernias may be helpful in addressing hernia genesis, thus improving strategies for the treatment of this disease. Materials and Methods: A cohort of 22 patients who underwent inguinal hernia repair showed double ipsilateral (pantaloon) hernia, comprising distinct direct and indirect protrusions separated by a tissue septum. In 19 patients, the septal arrangement dividing the 2 hernias showed macroscopically evident structural damages, then excised and histologically studied. Different tissue markers were used for the identification of the structural damages. Results: Macroscopically, the divisor septum represents the boundary between internal ring and Hesselbach's triangle. Anteriorly it is composed by fibers of the internal oblique and transverse muscles, which form a complex with the inferior epigastric vessels on the corresponding posterior side of the inguinal floor. In the patient cohort studied, this anatomical structure showed a progressive sufferance characterized by chronic compressive damage. Conclusion: The anatomical structure which separates the indirect and direct components of a pantaloon hernia, herein referred to as the "septum inguinalis", has been shown progressively alter in both macro- and microscopically until it f undergoes disruption with development of a combined hernia. Understanding of this anatomical concept may help surgeons to perform sound repairs of these complex hernias.

Introduction: The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature., Methods: A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated., Results: All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures., Conclusion: A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.

Purpose: To present factual data on the medico-legal aspects of medicolegal claims after abdominal wall surgery in France., Method: Analysis of the complaints following parietal surgery that were addressed to a company that specializes in medical malpractice insurance between 2010 and 2016., Results: Of 209 files, 180 were analyzable; these included 75 women and 105 men with a mean age of 51 years and a mean BMI of 29.8. Cases were mainly heard by the Conciliation and Compensation Commission (CCI) (82 patients) and the High Court (79 patients). The surgical procedures concerned were groin hernias (85 patients) or anterior abdominal wall hernias (95 patients). Conventional open surgery was performed in 123 patients and laparoscopic surgery in 57 patients. The incidents motivating patient complaints after groin hernia surgery were chronic pain (27 patients), infection (24 patients), testicular damage (10 patients). Seven patients died as a result of this surgery (including one fetus). Claims after ventral hernia repair were motivated by infections (46 patients) and post-operative peritonitis or bowel obstruction (12 patients). Nine patients died following these ventral hernia repairs. Surgical error was identified in 59 of the 168 cases analyzed (35.1%); 44% of recognized faults were surgical site infections, 27% linked to delay in re-operation, and 20% were related to the operating room environment., Conclusion: Hernia surgery, although an everyday event for many practitioners, requires the same rigor as all other visceral surgery., (Copyright © 2019. Published by Elsevier Masson SAS.)

Purpose: The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases., Methods and Materials: From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes., Results: The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients., Conclusion: In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.

Purpose: The number of robot-assisted hernia repairs is increasing, but the potential benefits have not been well described. The aim of this study was to evaluate the available literature reporting on outcomes after robot-assisted hernia repairs., Methods: This is a qualitative review and meta-analysis of papers evaluating short-term outcomes after inguinal or ventral robot-assisted hernia repair compared with either open or laparoscopic approach. The primary outcome was postoperative complications and secondary outcomes were duration of surgery, postoperative length of stay and financial costs., Results: Fifteen studies were included. Postoperative complications were significantly decreased after robot-assisted inguinal hernia repair compared with open repair. There were no differences in complications between robot-assisted and laparoscopic inguinal hernia repair. For ventral hernia repair, sutured closure of the defect, retromuscular mesh placement and transversus abdominis release is feasible when using the robot. Length of stay was decreased by a mean of 3 days for robot-assisted repairs compared with open approach. There were no differences in postoperative complications and the operative time was significantly longer for robot-assisted ventral hernia repair compared with laparoscopic or open approach., Conclusions: For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option, as the use of a minimally invasive approach for these procedures decreases length of stay significantly. For inguinal hernias, the benefit of the robot is questionable. Randomized controlled trials and prospective studies are needed.

Purpose: Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction., Methods: The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here., Results: Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning., Conclusion: Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.

Background: We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20 years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach., Methods: From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed., Results: Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair., Conclusion: The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

Purpose: In some patients with recurrent inguinal hernias who have undergone previous laparoscopic herniorrhaphy, dissecting the entire posterior wall is difficult due to mesh adhesion. We applied a novel transabdominal preperitoneal (TAPP) hernioplasty technique that involves closing of the hernia defect and implantation of a newly added mesh while preserving the pre-existing mesh for inguinal hernia recurrence after laparoscopic herniorrhaphy. This study was performed to evaluate this novel technique for treatment of recurrent inguinal hernias. Methods: We evaluated 24 adult patients (23 male, 1 female; mean age, 55.8 ± 14.0 years; range, 26-77 years) with recurring inguinal hernias. A modified TAPP (mTAPP) procedure involving closing of the defect and implantation of an 8 × 6-cm 2 newly added mesh was performed. The new technique covered the whole posterior wall with pre-existing mesh. Results: Among the 24 patients, there were 12 direct hernias and 12 indirect hernias. The mean postoperative pain scores after 1 week were 2.5 and 2.0 in patients with direct and indirect hernias, respectively, and the mean duration until return to normal activities was 8.5 and 7.5 days in patients with direct and indirect hernias, respectively. The mean follow-up period was 21.0 ± 17.0 (range, 2-56) months. No chronic inguinodynia or rerecurrence was observed. Conclusions: In this novel mTAPP procedure for recurring inguinal hernias, closing sutures prevented mesh migration, and complete posterior wall overlap was possible using the pre-existing mesh and newly added mesh. The mTAPP procedure was an effective operation with few recurrences and complications.

Purpose: Clarify the composition of the Posterior wall of the Inguinal Canal(PWIC), the location and composition of the Transverse Fascia(TF), and the tissue origin of the Cremaster(C) by observing the anatomy of the inguinal region of the cadaver. Methods: 30 cadavers were dissected to observe the alignment of the muscles and fascia of the inguinal canal and the anterior peritoneal space. the anatomical levels of the posterior wall of the inguinal canal and the alignment of the Spermatic Cord(SC) were observed. Results: (1) The posterior wall of the inguinal canal was white, bright, and tough tendon membrane-like tissue; (2) the transverse fascia was a thin fascial tissue with only one layer of membranous structure located in the abdominal wall under the abdominal wall on the side of the blood vessels of the peritoneal cavity; (3) the internal oblique muscle and its tendon membrane, and the transversus abdominis muscle and its tendon membrane extended on the surface of the spermatic cord, and fused and continued to the cremaster on the surface of the spermatic cord. Conclusions: 1. PWIC is mainly composed of Internal oblique muscle of abdomen (IOMA), Aponeurosis of internal oblique muscle of abdomen (AIOMA), Transverse abdominal muscle (TAM), and Transverse abdominal aponeurosis(TAA) as the following four types: (1) TAM and AIOMA fused to form a tendinous layer; (2) IOMA and TAM form the posterior wall of the muscle in the PWIC; (3) IOMA and AIOMA continue in the PWIC; 4) TAM and TAA continue in the PWIC. 2.TF is a thin fascial tissue with only one layer of membrane structure, TF is not involved in the composition of PWIC, so this fascia has nothing to do with resisting the occurrence of inguinal hernia. 3. The spermatic cord that travels in the inguinal canal is fixed to the lower wall of the inguinal canal by the tendon membrane of the cremaster, which is organized from the internal oblique and transversus abdominis muscles and their tendon membranes, The inguinal canal is a musculotendinous canal. [ABSTRACT FROM AUTHOR]

Cord lipomas are frequent findings in laparoscopic inguinal hernia surgeries in male patients. The symptoms of lipoma and the potential benefits of removing them are often overlooked because the focus is on the primary pathology of the hernia itself. Current recommendations are to reduce this fatty content, when present. When inguinal cord lipomas are left untreated in inguinal hernia surgery they can potentially cause symptoms and be detected in follow-up imaging exams. The objective of this study was to study incidence of cord lipomas in a cohort operated on by a single group specializing in abdominal wall surgery, as well as to analyze the possible relationship of this finding with the patient's symptoms, the characteristics of the operated hernia and postoperative outcome. This is a prospective study of male patients operated on for inguinal hernia laparoscopically or robotically in a single reference center. Of the total of 141 hernias, the distribution according to European Hernia Society classification showed that 45.4% were lateral, 19.1% medial and 35.5% mixed, highlighting a variety in the presentation of hernias. Analysis of the size of the hernias revealed that the majority (35.5%) were ≤ 1.5 cm. Inguinal cord lipoma was present in 64.5% of the samples, with no statistically significant association between the presence of the lipoma and an indirect hernia sac or obesity. The incidence of surgical site occurrences (SSO) was 9,2%, with seroma and hematoma. No recurrences were observed during follow-up, indicating a successful approach. There were no statistically significant relationships between SSO, the presence of lipoma and indirect hernial sac. [ABSTRACT FROM AUTHOR]

We encountered a rare case of appendiceal carcinoma associated with Amyand's hernia, which was difficult to diagnose preoperatively. A 74-year-old man presented to our hospital with right lower abdominal pain. A hard mass was palpable in the right lower abdomen, and blood tests showed a slightly elevated inflammatory response. Computed tomography revealed a 7 × 5 cm mass with indistinct borders and heterogeneous internal density extending from the cecum to the right lower abdominal wall. We diagnosed appendiceal abscess, however, percutaneous biopsy which was performed for differential diagnosis with appendiceal carcinoma showed no malignancy. Thereafter, the patient was followed up. Two months later, a blood test showed insignificant changes in the inflammatory response and a high serum carcinoembryonic antigen level (48.6 ng/mL). An ultrasound showed a mass contiguous to the appendix, extending to the abdominal wall, with abundant blood flow signals. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the mass. Four months after the initial visit, the patient had an open ileocecal resection combined with an abdominal wall resection based on the preoperative diagnosis of appendiceal carcinoma invading the abdominal wall. During laparotomy, an enlarged appendix tip extended from the internal inguinal ring outside the inferior epigastric artery to the abdominal wall. Histopathological examination of the appendiceal tumor revealed well-differentiated adenocarcinoma, T4b (abdominal wall), N0, Ly0, and V0. When a right lower abdominal mass extends from the cecum to the abdominal wall, appendiceal tumors associated with Amyand's hernia should be considered. [ABSTRACT FROM AUTHOR]

Background: The current literature supports the closure of trocar sites ≥10‐mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5‐mm trocars. To date, evidence regarding the closure of 8‐mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8‐mm trocars. Methods: We prospectively collected data on all patients undergoing robotic‐assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8‐mm trocars was not closed. The enrolled patients underwent a follow‐up visit during which we conducted clinical and sonographic evaluations of all 8‐mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port‐site hernia. Results: We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1 ± 14.0 years, and mean BMI was 27.0 ± 3.9 kg/m2. The follow‐up visits were carried out after a median follow‐up of 14.5 (9.0–23.2) months. Only one case developed an asymptomatic 1 × 1 cm supra‐umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8‐mm trocars and skin sutures of 9.8 ± 0.5 out of 10 points. Conclusions: The occurrence of a trocar‐site hernia after 8‐mm robotic access is extremely low. Hence, the fascia closure may not be necessary. [ABSTRACT FROM AUTHOR]

The use of fibrin glue for inguinal hernia mesh fixation has been suggested to be effective in preventing hematomas and reducing postoperative pain compared to tacks and sutures.. The effect of fibrin glue can vary significantly based on the device used. This study assessed the efficacy of fibrin glue based on the type of devices used in an ex vivo system. The rabbit's abdominal wall was trimmed to a size of 3.0 × 6.0 cm and was secured at the edges with metal fixtures. To measure the maximum tensile strength at the point of adhesion failure, the hernia mesh was fixed to the rabbit's abdominal wall using fibrin glue in a 2 cm square area, left for 3 min, and then pulled at a speed of 50 cm/min. The test was conducted 10 times for each group. The median (minimum–maximum) tensile strength values using the spraying, two-liquid mixing, and sequential layering methods were 3.58 (1.99–4.95), 0.51 (0.27–1.89), and 1.32 (0.63–1.66) N, respectively. The spraying method had predominantly higher tensile strength values than the two-liquid mixing and sequential layering methods (P < 0.01). In conclusion, in hernia mesh fixation, the spraying method can be adopted to achieve appropriate adhesive effects. [ABSTRACT FROM AUTHOR]

Background Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast reconstruction has been poorly characterized. Methods A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction was conducted over 15 years. Patient operative characteristics were recorded and outcomes were analyzed. PROs were assessed using the BREAST-Q abdominal survey. Results In total, 75 women (108 flaps) with the mean body mass index (BMI) of 33.2 were included. Flaps included deep inferior epigastric artery perforator (24%), muscle-sparing (43%), and free transverse rectus abdominis myocutaneous flaps (f-TRAM; 33%). World Health Organization (WHO) obesity class, BMI, and flap type did not affect flap failure (1%) or complication rates. Hernia developed in 7%; all necessitated repair. Eight percent developed abdominal bulge; one was repaired. Hernia formation was associated with increased patient age (p < 0.05). Bulge formation occurred more often in f-TRAM donor sites (p = 0.005). BMI, WHO class, flap type, and mesh use were not related to hernia or bulge occurrence in either univariate or multivariate analysis. The survey response rate was 63%. Abdominal Physical Well-Being (proxy for abdominal wall function) and Satisfaction with Abdomen (patient-perceived cosmesis) were similar across flap types, age, and WHO classification groups. Patients with postoperative bulge reported higher abdominal physical well-being scores, regardless of flap type (p < 0.01). Bulge was correlated with lower satisfaction (p < 0.05). Conclusion The incidence of abdominal wall morbidity following abdominal free-tissue transfer for breast reconstruction was acceptably low in our population of obese patients. Hernia was a clinically significant complication, warranting surgical repair. Bulge was primarily a cosmetic concern and did not detract from patient-reported abdominal wall function. Age may represent an independent risk factor for hernia formation in this population. [ABSTRACT FROM AUTHOR]

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient’s giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness. [ABSTRACT FROM AUTHOR]

Background: Because of a weakening in the muscular structure of the wall of the abdomen, an abdominal wall hernia is a protrusion of the abdominal tissues or organs that occurs in the abdominal cavity. Aim: To report our current practice in Mansoura for strangulated inguinal hernia to identify incidence, types, methods of repair and risk factors related to postoperative complications. Patients and methods: This prospective observational research was conducted on 183 patients of irreducible inguinal hernia who presented with irreducible inguinal hernia and they were admitted to Mansoura University Emergency Hospital and Mansoura International Hospital. Results: The mean duration of the surgical procedure was 84.07 minutes. ICU admission was required in only two patients (2.8%), the duration of hospitalization ranged between 3 and 7 days. Regarding postoperative complications, scrotal edema was the most common complication (29.2%). Other early complications included seroma formation (8.3%), paralytic ileus (6.9%), superficial wound infection (5.6%), hematoma (1.4%), and leakage (1.4%). Only one patient had postoperative mortality (1.4%), one patient required hospital readmission (1.4%), and one patient required surgical intervention for peritonitis secondary to leakage from the anastomotic site (1.4%). Recurrence in 6 months postoperative was encountered in eight patients (11.1%) Conclusion: The incidence of strangulation is 39.3% among patients presented with irreducible inguinal hernia. The prevalence of heavy manual work, diabetes mellitus was statistically significantly higher in the irreducible strangulated cases. No significant differences were detected between the mesh and anatomical repairs groups regarding postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction and aim. Inguinal hernias are one of the major disorders in the field of general and visceral surgery and can be viewed as multifactorial diseases. Although the molecular mechanism that led to predistortion to inguinal herniation still remain unclear, is well known that defects leading to improper closure of the inguinal canal during fetal development and mechanisms contributing to weaker muscles of the abdominal wall can greatly increase the risk of developing the latter disease. Material and methods. A literature search was performed in all major electronic databases using keywords and Boolean operators to retrieve all available literature related to the topic. Due to the narrative nature of the review, there were no specific inclusion and exclusion criteria. Analysis of the literature. Genetic factors, undoubtedly, can interfere with these mechanisms and therefore play major role in developing hernias. To this end, the present narrative review provides an overview of genes with altered expression and genetic polymorphisms associated with inguinal herniation. Moreover, the results of genome-wide association studies (GWAS) exploring susceptible genetic loci associated with the disease have been reported. Conclusion. Nevertheless, more case-control studies and GWAS need to be conducted in different ethnic populations so as to provide better insights into the topic. [ABSTRACT FROM AUTHOR]

Background: Trans-abdominal pre-peritoneal (TAPP) hernia repair is a complex procedure that presents several challenges. Even though, due to the high prevalence of inguinal hernia, TAPP technique is increasing in frequency and robotic Abdominal Wall Surgery (rAWS) is emerging as a valuable tool in this regard. Although inguinal TAPP procedure principles have been published and simulation is needed, the availability of validated models remains scarce. Methods: A new low-cost model was developed to simulate inguinal rTAPP repair. For validity assessment, a new TAPP-specific fidelity questionnaire and assessment scale were developed to compare the performance of novices and experts in the simulated procedure. The models used were assessed at 60 min for execution and quality score. Results: Twenty-five residents and specialists from all over the country participated in this study. Execution, quality, and global performance was higher in the seniors group compared to juniors (8.91 vs 6.36, p = 0.02; 8.09 vs 5.14, p <.001; and 17 vs. 11,5, p <.001, respectively). Overall fidelity was assessed as being very high [4.41 (3.5–5.0), α =.918] as well as face [4.31 (3.0–5.0), α =.867] and content validity [4.44 (3.2–5.0), α =.803]. Participants strongly agreed that the model is adequate to be used with the DaVinci® Robot [4.52 (3.5–5.0), α =.758]. Conclusion: This study shows face, content, and construct validity of the model for inguinal TAPP simulation, including for robotic surgery. Therefore, the model can be a valuable tool for learning, understanding, practicing, and mastering the TAPP technique prior to participating in the operating room. [ABSTRACT FROM AUTHOR]

Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Assess the utility of a hands-on cadaver workshop for teaching abdominal wall reconstruction (AWR) using components separation technique. Methods: Over a year, from June 2022 to July 2023, 112 surgeons participated in seven training courses focused on the eTEP technique for inguinal and ventral hernias. The workshops covered theoretical learning sessions followed by hands-on training using frozen human cadavers. An online survey was used to know the influence of our workshop on the clinical practice of the attendees. Results: Out of 112 total participants, 70% (78) participants completed the survey. Among them, 58% (45) surgeons had over 10 years of experience. The workshop resulted in approximately 85% (66) of participants successfully adapting to eTEP. Confidence levels significantly increased for all steps of the technique after the workshop (p < 0.001, Rank-Biserial Correlation = −1.000). Participants expressed high satisfaction with the course. Conclusion: The cadaver model training program was found to be effective in reducing the learning curve and being replicable. This suggests its potential for widespread implementation as an introductory training model for learning the anatomy of abdominal wall and adapting this for treating hernias requiring AWR. [ABSTRACT FROM AUTHOR]

This article explores the impact of incisional hernias on abdominal wall strength. It highlights that incisional hernias, which commonly occur after abdominal surgeries, can lead to complications and a decrease in quality of life for patients. The study focuses on analyzing abdominal muscle strength in patients with incisional hernias compared to healthy individuals. The results indicate significant differences in abdominal muscle strength between the two groups, suggesting that incisional hernias can have a negative effect on abdominal wall strength. The study also identifies factors such as sex, hernia size, and BMI as influential factors in abdominal strength. It suggests that identifying reduced abdominal strength in individuals with hernias could improve their overall quality of life and inform perioperative management. The study proposes the use of a strain gauge as a cost-effective alternative for assessing abdominal muscle strength. However, it is important to note that the study has limitations, such as not considering baseline physical activity levels and back pain. This information can be valuable for individuals researching the effects of incisional hernias on overall health and quality of life. [Extracted from the article]

Abdominal wall hernia repair, a common surgical procedure, includes various techniques to minimize postoperative complications and enhance outcomes. This review focuses on the comparison between laparoscopic and robotic approaches in treating inguinal and ventral hernias, presenting the ongoing situation of this topic. A systematic search identified relevant studies comparing laparoscopic and robotic approaches for inguinal and ventral hernias. Randomized control trials, retrospective, and prospective studies published after 1 January 2000, were included. Search terms such as hernia, inguinal, ventral, laparoscopy, robotic, and surgery were used. A total of 23 articles were included for analysis. Results indicated similar short-term outcomes for robotic and laparoscopic techniques in inguinal hernia repair, with robotic groups experiencing less postoperative pain. However, longer operative times and higher costs were associated with robotic repair. Robotic ventral hernia repair demonstrated potential benefits, including shorter hospital stay, lower recurrence and lower reoperation rates. While robotic surgery offers advantages such as shorter hospital stays, faster recovery, and less postoperative pain, challenges including costs and training requirements need consideration. The choice between laparoscopic and robotic approaches for abdominal wall hernias should be tailored based on individual surgeon expertise and resource availability, emphasizing a balanced evaluation of benefits and challenges. [ABSTRACT FROM AUTHOR]

Summary: This report outlines the diagnosis, surgical treatment and successful outcome following the treatment of a foal presented with a congenital abdominal hernia. A focal ventral abdominal swelling, enlarging since birth, starting just caudal to the intact umbilicus and extending caudally over the prepuce was observed. Once in dorsal recumbency, the hernia was found to originate from a defect of the abdominal wall in the linea alba region. A simple closed herniorrhaphy with inversion of the large peritoneal sac into the abdomen was performed. Post‐operative complications included fever with the development of an abscess at the surgical site. This was diagnosed and drained with ultrasound guidance. Based on culture and sensitivity testing of the abscess exudate, antibiotic therapy was adapted and the foal made a full recovery. A clinical examination undertaken 1 year later revealed complete healing of the linea alba. Herniation due to a muscle wall default has not been previously reported in foals. This article reviews the commonly observed causes of herniation (umbilical and inguinal hernias). However, a third type of congenital ventral body wall hernia should be considered for the differential diagnosis of swelling of the preputial area in foals. [ABSTRACT FROM AUTHOR]

Lumbar incisional hernia is an uncommon complication that affects the abdominal wall integrity, accounting for approximately 3.5% of all cases. It typically occurs following open nephrectomy or aortic aneurysm repair surgeries. Although rare, lumbar hernias can lead to discomfort, aesthetic issues, or even intestinal obstruction. In extremely rare cases, lumbar herniation of the liver can occur. Here, the authors present a case of a 60-year-old female patient with liver herniation through a lumbar incisional hernia and a history of pyelolithotomy for renal calculi. The authors performed an open hernia repair with meshplasty. Lumbar incisional hernias are rare and still difficult to manage. Computed tomography is the diagnostic method of choice in the evaluation of the parietal wall defect to choose the appropriate therapeutic management. Surgical management modalities are still poorly codified, with no precise recommendations, and this is probably due to the relative rarity of the cases. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the impact of an abdominal wall surgery unit on postoperative complications (within 90 days postoperatively), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair. Methods: We conducted a retrospective cohort study of all adult patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. Short- and long-term outcomes were compared between the group of patients operated on in the abdominal wall surgery unit and the group of patients operated on by other units not specialized in abdominal wall surgery. A logistic regression model was performed for hernia recurrence. Results: A total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. The patients in the abdominal wall surgery group were younger (P ≤ 0.001) and had fewer comorbidities (P ≤ 0.001). There were no differences between the groups in terms of complications. The patients in the abdominal wall surgery group presented fewer recurrences (15% vs. 3%; P = 0.001). Surgery performed by the abdominal wall surgery unit was related to fewer recurrences in the multivariate analysis (HR = 0.123; 95% CI = 0.21–0.725; P = 0.021). Conclusions: Specialization in abdominal wall surgery seems to have a positive impact in terms of recurrence in recurrent inguinal hernia repair. The influence of comorbidities or type of surgery (i.e., outpatient surgery) require further study. [ABSTRACT FROM AUTHOR]

Introduction: The illustrated anatomical atlases of the 19th century created a new visual language, preparing students for dissection and surgeons for operating. Objective: The objective of this study is to analyze the dissection atlases of the 19th century from a specialty perspective of the abdominal wall. Method: Literature review of PubMed, LILACS, Cochrane Library databases; supplementary search using Google and university libraries. As keywords have been used: abdominal wall, inguinal nerves, ilioinguinal nerve, iliohipogastric nerve, genitocrural nerve, hernia, anatomy and surgery. A critical analysis of texts from any country or language is carried out, with no time limit. Results: 42 illustrated texts are analyzed to select 5 German, 3 English and 4 French atlases. The inguinal blades, the surgical contribution and the neural and vascular variants of corona mortis are discussed. Conclusions: The descriptive anatomy of the 18th century gave way to the topographical during the 19th century, favoring the development of surgical anatomy and surgery as a specialty. Illustrated atlases were the best training medium. Each atlas meant for its author a high vital impact. Most of the knowledge is copied from a small group of surgeons. Cartoonists were essential in turning atlases into works of art. Each country evolves to a surgery with different aspects. Hernia pathology is basic in the development of surgery. A great anatomical variability in the groin and abdominal wall is demonstrated. [ABSTRACT FROM AUTHOR]

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

Inguinal hernia repair is one of the most commonly performed surgical activities worldwide. Given the circumstances, understanding and identifying the risk and the protective factors is an essential step in order to prevent, diagnose and treat such a common condition. For a long time, obesity was generally considered to be a risk factor in the occurrence of an inguinal hernia. Studies have provided some unexpected data, suggesting that it might actually be a protective factor. This review aims to provide an overview on this topic, taking into account systemic aspects such as collagen distribution and metabolism. In inguinal hernia patients, the ratio between type I collagen and type III collagen is decreased, with type III collagen being responsible for the weakness of the abdominal wall. In obese patients, the extracellular matrix becomes richer in collagen, especially type I collagen, which will generate strength and stiffness. Obesity seems to be a protective factor indeed, but in order to understand the underlying mechanism and to choose the optimal surgical approach, further research is needed. [ABSTRACT FROM AUTHOR]

Purpose: There is a growing trend to expand Ambulatory Surgery (AS) criteria in abdominal wall surgery. No Admission (NOADS) circuit. The present study aimed to assess the impact of classification criteria on postoperative results and hospital stays in a NOADS versus a conventional admission circuit to throw some light on surgical circuit inclusion. Methods: A retrospective analysis of a prospective;y maintained database was performed comparing groin hernia's interventions in a NOADS vs Admission circuit in our center in 2018–2021. A multiple regression predictive model followed by a retrospective retest were dessigned to assess the impact of each criterion on hospital stay. In total, 743 patients were included, 399 in the Admission circuit (ADC) and 344 in NOADS circuit (NOADS). Results: There were no statistical differences in complication or readmission rates (p = 0.343 and p = 0.563), nevertheless, a shorter hospital stay was observed in NOADS (p = 0.000). A hierarchical multiple regression predictive model proposed two opposite scenarios. The best scenario, not likely to need admission, was a female patient operated via the laparoscopic approach of a unilateral primary hernia (Estimated Postoperative Stay: 0.049 days). The worst scenario, likely to need admission, was a male patient operated via the open approach of a bilateral and recurrent hernia (Estimated Postoperative Stay: 1.505 Days). Conclusion: Groin hernia patients could safely benefit from a No Admission (NOADS) circuit. Our model could be useful for surgical circuit decision-making, especially for best/worst scenarios. [ABSTRACT FROM AUTHOR]

Background: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. Method: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. Results: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. Conclusion: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology. [ABSTRACT FROM AUTHOR]

Introduction: Mesh fixation in inguinal hernia repair, has been a controversial subject for many years. Therefore, in this study, we evaluated and compared fixation and non-fixation of mesh in Transabdominal Preperitoneal (TAPP) Inguinal hernia repair. Methods: In this randomized control trial, 100 patients diagnosed with unilateral inguinal hernia were included. We divided the study population into two groups of fifty. For both groups, a 15 × 13 cm Prolene(polypropylene) mesh was used for repair. In the fixation group, mesh was fixed to the abdominal wall by endoscopic tacks, while in the non-fixation group, mesh was secured at the proper place without any fixation. Postoperative outcomes were complications, recurrence, and pain intensity after 1-, 3- and 6-months. Results: Postoperative pain intensity in the 1st month [Median of 2 and 0, (P < 0.001)], and 3rd month [Median of 0.5 and 0, (P < 0.001)], in the fixation group were significantly higher than the non-fixation group. However, 6 months after surgery, pain intensity was almost similar for both groups. In the 6th postoperative month, only one patient experienced recurrence who was in the fixation group. The rate of recurrence and urinary retention between the groups was not significant. Conclusion: It was observed that until 6 months after surgery patients who received the non-fixating method of TAPP repair experienced lower levels of pain in comparison to the fixation group while other complications did not differ between the two groups. This trail was registered at www.irct.ir with Trial Registration Number of IRCT20210224050491N1. [ABSTRACT FROM AUTHOR]

Rate of complex hernia (inguinal hernias previously repaired with posterior approach, history of open prostatectomy, incarcerated hernias, scrotal hernias) was higher in RIHR (p < 0.001; 29% vs. Despite increased utilization of component separation over time and the uptake of MIS approaches, it remains unclear how hernia size and operative approach influence a surgeon's choice to perform component separation at the time of hernia repair. Notably, 168 (40%) of all component separations were performed for hernias < 6 cm in size, while 29 (7%) of component separations were for hernias measuring less than 2 cm. The rate of MIS repair was no different for smaller (< 6 cm) versus larger (6 + cm) hernias (35.0% vs. 34.4%, p = 0.91). Sixteen (3%) patients experienced a hernia recurrence in LIHR versus 4 (0.7%) in RIHR (p = 0.003). [Extracted from the article]

The most prevalent type of abdominal wall hernias are inguinal. Although the prevalence of inguinal hernias is unknown, roughly 500,000 cases are treated in hospitals annually. There is a dearth of information on inguinal hernia primary and recurrence rates in our nation. to compare the age- and gender-specific prevalence rates of inguinal hernia. to estimate the prevalence of inguinal hernia among various age groups. According to the study, those between the ages of 41 and 50 (29.29%) are the most susceptible to developing an inguinal hernia. Eighty eight percent of the patients were men. The most frequent hernia among patients was on the right side. In the study population, heavy object lifting and chronic coughing were frequently identified as risk factors. Our findings may serve as a useful guide for future research on the frequency of inguinal hernias in general populations. [ABSTRACT FROM AUTHOR]

Context: Inguinal herniotomy is the most frequently performed operation in the pediatric age group. The clinical outcome of inguinal hernias and hydroceles in pediatric patients should be assessed periodically. Aims: This study aims to analyze the clinical presentation and outcome of a large series of pediatric inguinal hernias and hydroceles from a tertiary care institute. Settings and Design: A retrospective study performed on cohort of pediatric patients with inguinal hernias and hydroceles from January 1983 to December 2014. Subjects and Methods: Pediatric patients, aged <16 years with inguinal hernias and hydroceles were studied. Results: There were 8000 pediatric patients with 7350 (91.875%) males and 650 (8.125%) females (M:F = 11.3:1). Only 60 (0.75%) were in neonatal age group and 1770 (22.125%) were infants. Out of 8000, 170 (2.125%) patients presented with incarcerated inguinal hernia. A total of 8260 herniotomies were performed which included 260 cases with bilateral disease. Inguinal hernia constituted 6195 (75%) patients and hydrocele in 2065 (25%) cases. Associated genital anomalies and abdominal wall defects were present in 252 (3.15%) cases. In 80 (1%) patients, additionally ipsilateral orchiopexy were performed for unilateral undescended testis in 76 (0.95%) patients and unilateral ectopic testis 4 (0.05%) patients. Postoperative complications were present in 48 (0.6%) cases. Conclusions: Complications associated with inguinal hernias including those presenting with incarceration and strangulation are rare if they are managed in time and under the supervision of an experienced pediatric surgeon. We recommend a yearly clinical audit (assessment of morbidity and mortality statistics) of pediatric inguinal hernias and hydroceles managed with inguinal herniotomy. [ABSTRACT FROM AUTHOR]

Background and Aim: Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium‐ or long‐term studies that have compared outcomes between these two techniques. Methods: This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques. Results: A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died. Conclusions: Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively. Key points: It was found that in the Colombian population with inguinal hernia, using the Nyhus technique generates significantly less recurrence at 1 year, compared to the Lichtenstein technique.Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications.In the Colombian population, there was a high incidence of inguinal hernia in women, compared to the literature. [ABSTRACT FROM AUTHOR]

Interparietal inguinal hernia, an exceedingly rare type of inguinal hernia in which the hernia sac anatomically lies between the tissue layers of the abdominal wall, is difficult to diagnose from physical findings. Given the few reports on interparietal inguinal hernias, this condition has remained fairly unrecognized. Herein, we report the successful imaging and laparoscopic diagnoses as well as repair of an interparietal inguinal hernia. Atypical physical findings and computed tomography data help in the diagnosis of an interparietal inguinal hernia. The laparoscopic approach is useful and feasible for both the diagnosis and treatment of interparietal inguinal hernia. [ABSTRACT FROM AUTHOR]

Background: Some children with chronic abdominal wall pain or groin pain do not have an inguinal hernia but suffer from anterior cutaneous nerve entrapment syndrome (ACNES). Diagnosing ACNES is challenging, especially in children as a diagnostic gold standard is lacking. A paediatric questionnaire containing 17 simple items was earlier found to discriminate between abdominal pain due or ACNES or IBS. Scores range from 0 points (ACNES very unlikely) to 17 points (ACNES very likely). The present study investigates whether this 17-item questionnaire predicted treatment success in children receiving therapy for ACNES. Methods: Children < 18 years who presented in a single institute between February 2016 and October 2021 with symptoms and signs suggestive of ACNES completed the questionnaire before intake and treatment. Treatment success after 6–8 weeks was defined as self-reported 'pain-free' (group 1), ' > 50% less pain' (group 2) and ' < 50% less pain' (group 3). Group differences regarding sex, age, BMI, symptoms duration and questionnaire scores were analysed. Results: Data of 145 children (female 78%, mean age 14.7 ± 2.3 years, mean BMI 21.1 ± 3.9) were analysed. All children received a diagnostic trigger point injection using an anaesthetic agent, and 75.5% underwent subsequent surgery for untractable pain. The three groups were comparable regarding sex distribution, age, BMI and symptoms duration. In addition, questionnaire scores were not different (group 1: n = 89, mean score 13.4 ± 2.7, group 2: n = 24, 13.4 ± 2.3 and group 3: n = 32, 13.0 ± 2.7, p > 0.05). Conclusions: Treatment success was attained in 78% of children undergoing surgery for ACNES. A simple questionnaire scoring items associated with abdominal pain did not predict treatment success. [ABSTRACT FROM AUTHOR]

Background: Upper lumber hernia is a rare entity which can cause obstruction and strangulation. Laparoscopic technique has been considered effective for such hernia repairs; however, there is no report of use of the self-expanding mesh. Case presentation: A 77-year-old woman visited to our hospital complaining of a bulge of about 5 cm in the left lumbar dorsal region while standing. Abdominal CT and MRI scans showed a fascial defect in the left lumbar abdominal wall and confirmed the presence of a hernia, in which retroperitoneal fatty tissue and the descending colon protruded. Transabdominal preperitoneal repair (TAPP) was performed and the operative findings revealed the hernia orifice, 3 × 2.5 cm in diameter, between two intercostal nerves. To avoid nerve injury or entrapment, the number of mesh fixation was desirable minimum; therefore, a self-expanding mesh with a memory-recoil ring was used. The mesh, 9.5 × 13 cm in diameter, was placed and tacked to the abdominal wall at two points, 1 cm ventral and dorsal to the hernia orifice. The postoperative course was uneventful and no pain or recurrence was observed with follow-up of 6 months. Conclusion: We herein present a case of upper lumber hernia successfully repaired by TAPP with a self-expanding mesh. [ABSTRACT FROM AUTHOR]

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