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Introduction Inguinal hernia most frequent problem in human being adult as well as children suffer with it. Inguinal hernia repair done under “anesthesia” {such as local anesthesia, spinal anesthesia, nerve block, epidural anesthesia, & general anesthesia}, depending upon number of variables i.e. patient’s acceptance, surgeon’s preference, safety, practicality and cost effectiveness. Objectives To compare nerve block versus spinal Anesthesia in Lichtenstein tension-free mesh inguinal hernia repair Methods The Present study, conducted as a hospital-based comparative prospective study at the Department of General Surgery, Muzaffarnagar Medical College & Hospital, Muzaffarnagar, U.P., aimed to investigate the efficacy of two different anesthesia techniques in inguinal hernia repair. Over an 18-month period, 100 patients meeting the inclusion criteria. The study utilized a combination of ilioinguinal and iliohypogastric nerve blocks alongside field blocks for anesthesia administration, ensuring proper analgesia and relaxation. Cases were grouped based upon fitness for spinal anesthesia, comorbidities, and patient preference. Group A underwent mesh repair under spinal anesthesia, while Group B received nerve block via inguinal field block technique. Results In the <40 year group, Nerve Block accounts for 2.0% of cases while Spinal Anaesthesia accounts for 10.0%. In the 41-50year group, Nerve Block represents 64.0% of cases, whereas Spinal Anaesthesia represents 60.0%. In the >50 age group, Nerve Block represents 34.0% of cases, and Spinal Anesthesia represents 30.0%. On comparison of seroma occurrence between Group A and Group B revealed interesting insights. In Group A, comprising 50 cases, 45 cases (90.0%) exhibited seroma, while 5 cases (10.0%) did not. Similarly, in Group B, consisting of another 50 cases, 47 cases (94.0%) showed seroma, with 3 cases (6.0%) without it. When considering both groups collectively, out of 100 cases, 92 cases (92.0%) had seroma, while 8 cases (8.0%) did not. Conclusion We came to the conclusion that all patients with primary inguinal hernias benefit from Lichtenstein mesh repair performed under local anesthesia for a number of reasons. Simpleness, dependability, efficacy, safety, a smooth recovery period marked by easily managed pain, a prompt return to full range of activities, and high patient satisfaction are a few of these. [ABSTRACT FROM AUTHOR]

Introduction: It is estimated that up to 28% of global disease burden is surgical with hernias representing a unique challenge as the only definitive treatment is surgery. Surgical Outreach for the Americas (SOfA) is a nongovernmental organization focused primarily on alleviating the disease burden of inguinal and umbilical hernias in Central America. We present the experience of SOfA, a model focused on partnership and education. Methods: SOfA was established in 2009 to help individuals recover from ailments that are obstacles to working and independent living. Over the past 15 years, SOfA has partnered with local healthcare providers in the Dominican Republic, El Salvador, Honduras, and Belize. The SOfA team consists of surgeons, surgery residents, triage physicians, an anesthesiologist, anesthetists, operating room nurses, recovery nurses, a pediatric critical care physician, sterile processing technicians, interpreters, and a team coordinator. Critical partnerships required include the CMO, internal medicine, general surgery, nursing, rural health coordinators and surgical training programs at public hospitals. Results: SOfA has completed 24 trips, performing 2074 procedures on 1792 patients. 71.4% of procedures were hernia repairs. To enhance sustainability of healthcare delivery, SOfA has partnered with the local facilities through capital improvements to include OR tables, OR lights, anesthesia machines, monitors, hospital beds, stretchers, sterilizers, air conditioning units, and electrosurgical generators. A lecture series and curriculum on perioperative care, anesthesia, anatomy, and operative technique is delivered. Local surgery residents and medical students participated in patient care, learning alongside SOfA teammates. Recently, SOfA has partnered with SAGES Global Affairs Committee to implement a virtual Global Laparoscopic Advancement Program, a simulation-based laparoscopic training curriculum for surgeons in El Salvador. Conclusion: A sustainable partnership to facilitate surgical care in low resource settings requires longitudinal, collaborative relationships, and investments in capital improvements, education, and partnership with local healthcare providers, institutions, and training programs. [ABSTRACT FROM AUTHOR]

Summary: A 6‐week‐old male Shetland pony was presented with pollakiuria and a scrotal mass. The diagnostic procedures conducted included a thorough clinical examination, external palpation, a scrotal ultrasonographic examination and urinary catheterisation. These revealed an indirect herniation of the urinary bladder into the tunica vaginalis. Subsequently, the case was managed surgically with a partial cystectomy through an inguinal approach. Bilateral castration was performed with an additional closure of the superficial inguinal ring. Five months post‐surgery, a routine telephone questionnaire highlighted no postoperative concerns. Gross examination of the inguinal region revealed no abnormalities and the foal was maturing as expected. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 million individuals worldwide undergo inguinal hernia surgery annually. The Lichtenstein technique is the most commonly used surgical procedure in this setting. The objective of this study was to revisit this technique and present ten recommendations based on the best practices. Methods: PubMed and Scientific Electronic Library Online were used to systematically search for articles about the Lichtenstein technique and its modifications. Literature regarding this technique and surgical strategies to prevent chronic pain were the basis for formulating ten recommendations for best practices during Lichtenstein surgery. Results: Ten recommendations were proposed based on best practices in the Lichtenstein technique: neuroanatomical assessment, chronic pain prevention, pragmatic neurectomy, spermatic cord structure management, femoral canal assessment, hernia sac management, mesh characteristics, fixation, recurrence prevention, and surgical convalescence. Conclusion: The ten recommendations are practical ways to achieve a safe and successful procedure. We fell that following these recommendations can improve surgical outcomes using the Lichtenstein technique. [ABSTRACT FROM AUTHOR]

Pediatric health checkups have been mandatory for all citizens since 1966 based on the Maternal and Child Health Law in Japan, and cryptorchidism or undescended testis in adult males are rare. We report a case of an adult right inguinal hernia and cryptorchidism treated simultaneously with laparoscopic transabdominal preperitoneal repair and laparoscopic orchiectomy. A 35-year-old man came to our department with a chief complaint of bulging in the right inguinal region for several months. He was diagnosed with a right inguinal hernia and was scheduled for transabdominal preperitoneal repair. During intraoperative intraperitoneal observation, a white 30-mm mass was found in the hernia orifice. A diagnosis of right cryptorchidism was made, and transabdominal preperitoneal repair and laparoscopic orchiectomy were performed. Laparoscopic simultaneous surgery could be safely performed in an adult patient with a hernia complicated by a cryptorchidism. It can be recommended as a surgical option in such cases. [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]

Background: Considering that right paraduodenal hernia is a rare internal hernia with abnormal anatomy and is often encountered during an emergency, surgeons may lack knowledge about it and choose incorrect treatment. Thus, this case report is a helpful complement to the few previously reported cases of right paraduodenal hernia. Additionally, we reviewed all the reported right paraduodenal hernia cases and proposed appropriate surgical strategies according to different anatomical features. Case presentation: The case involved a 33-year-old Chinese male patient who was admitted to the hospital due to abdominal pain. The patient was initially diagnosed with small bowel obstruction, and conservative treatment failed. An emergency operation was arranged, during which a diagnosis of right paraduodenal hernia was made instead. After surgery, the patient recovered well without abdominal pain for 2 years. Conclusion: Although right paraduodenal hernia accounts only for a small proportion of paraduodenal hernia, its anatomical characteristics can vary considerably. We divided right paraduodenal hernia into three types, with each type requiring a different surgical strategy. [ABSTRACT FROM AUTHOR]

BackgroundThis analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF.MethodsPubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords “Glue mesh repair,” “Tack mesh repair,” “Inguinal Hernia,” “Herniorrhaphy,” “Laparoscopic,” “Mesh Fixation,” and “Randomized controlled trials.”ResultsIn this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: −1.07, (−1.90, −0.25)]. We also used funnel plots and Egger's regression to test for publication bias.ConclusionIn summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.

Introduction: Hernia is one of the most common surgical conditions causing disability and requiring hospital admission and surgery. The aim of this study was to find out the prevalence of hernia among patients admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery between 14 April 2021 and 13 April 2023 and were collected from 1 July 2023 to 31 July 2023 from the hospital records. Ethical approval was obtained from the Institutional Review Committee. The patient admitted to the Department of Surgery was included and those with incomplete data were excluded. Convenience sampling was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 2057 patients, the prevalence of hernia was 247 (12.01%) (10.61-13.41, 95% Confidence Interval). A total of 31 (12.55%) hernias were irreducible and 15 (6.07%) were operated in the emergency setting. The most common type of hernia was inguinal hernia found in 169 (68.42%) and hypertension was the most common comorbidities found in 48 (19.43%). Conclusions: The prevalence of hernia was similar to other studies done in similar settings. Hernia accounts for a major surgical burden in our setting. So, early diagnosis and treatment could reduce the morbidity and mortality related to it.

Purpose: Inguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies. Methods: This review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane's RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses. Results: A total of 23 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76–87%) for the ilioinguinal nerve, 62% (95% CI: 54–71%) for the iliohypogastric nerve, and 41% (95% CI: 27–55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs. Conclusion: The ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy. [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]

Background: Groin hernias commonly present acutely in high-risk populations and can be challenging to manage. This retrospective, observational study aimed to report on patient demographics and outcomes, following acute admissions with a groin hernia, in relation to contemporary investigative and management practices. Methods: Adult (≥18 years old) patients who presented acutely with a groin hernia to nine National Health Service trusts in the north of England between 2002 and 2016 were included. Data were collected regarding patient demographics, radiological investigations, and operative intervention. The primary outcome of interest was 30-day inpatient mortality rate. Results: Overall, 6165 patients with acute groin hernia were included (4698 inguinal and 1467 femoral hernias). There was a male preponderance (72.5 per cent) with median age of 73 years (interquartile range (i.q.r.) 58–82). The burden of patient co-morbidity increased over the study period (P < 0.001). Operative repair was performed in 2258 (55.1 per cent) of patients with an inguinal and 1321 (90.1 per cent) of patients with a femoral hernia. Bowel resection was more commonly required for femoral hernias (14.7 per cent) than inguinal hernias (3.5 per cent, P < 0.001) and in obstructed (14.6 versus 0.2 per cent, P < 0.001) or strangulated (58.4 versus 4.5 per cent, P < 0.001) hernias. The 30-day mortality rate was 3.1 per cent for the overall cohort and 3.9 per cent for those who underwent surgery. Bowel resection was associated with increased duration of hospital stay (P < 0.001) and 30-day inpatient mortality rate (P < 0.001). Following adjustment for confounding variables, advanced age, co-morbidity, obstruction, and strangulation were all associated with an increased 30-day mortality rate (all P < 0.001). Conclusion: Emergency hernia repair has high mortality rates. Advanced age and co-morbidity increase both duration of hospital stay and 30-day mortality rate. Acute groin hernia presentations are a common feature of the emergency general surgery workload. This high-volume, retrospective, observational study shows that patients presenting with groin hernias are often elderly and are becoming increasingly co-morbid. Changing patient demographics are influencing investigation and management techniques as demonstrated in this study. [ABSTRACT FROM AUTHOR]

Purpose: This research examined opioid use, pain intensity, and pain management after primary unilateral inguinal hernia repair (PUIHR) at a single-center specialty hospital. Methods: After research, ethics board approval, and informed consent, pain scores (0–10 numerical rating scale [NRS]) were obtained from survey-based questionnaires administered at the pre- and 3-day postoperative timepoints. Descriptive results are presented as frequency, mean, standard deviation, range, median, and interquartile ranges, as appropriate. Significance tests were conducted to compare participants who did and did not receive opioids after surgery. p-value <0.05 is considered statistically significant. As the standard of care, participants received nonopioid multimodal analgesia (acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)) and opioids, when necessary. Results: A total of 414 and 331 participants completed the pre- and 3-day postoperative questionnaires, respectively. Out of the 414 participants, 38 (9.2%) received opioids during the postoperative stay. There was no significant difference between pain frequency or mean preoperative NRS pain intensity scores of those who did and did not receive opioids. Mean NRS pain intensity scores on day 3 after surgery were significantly higher for participants who received opioids (3.15±2.08) than those who did not (2.19±1.95), p=0.005. Conclusion: Most participants did not receive opioids after PUIHR and had lower mean postoperative NRS pain intensity scores compared to those who did, most likely reflecting the need for opioids among the latter. Opioids were discontinued by day 3 for all participants who received them. Therefore, for most patients undergoing PUIHR, effective pain control can be achieved with nonopioid multimodal analgesia in the early postoperative period. [ABSTRACT FROM AUTHOR]

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

Introduction: Amyand's hernia (AH) is a rare type of inguinal hernia that occurs when the appendix is trapped within the hernia sac. AH accounts for approximately 1% of all inguinal hernias. However, there is currently no comprehensive review on the manifestation of AH in preterm infants. Case presentation: A male preterm infant, born at 31+5 weeks’ gestational age with a birthweight of 1040 g, presented with a right inguinal mass at 39 days of life. The inguinal mass was firm, irreducible and erythematous. The infant also exhibited symptoms of fever and poor feeding. An abdominal X-ray showed an obstructive ileus consistent with clusters of cyst-like gas bubbles suggesting pneumatosis intestinalis. Recognizing the urgent need for intervention, emergent surgery was performed. A transverse incision along the right inguinal crease. An intraoperative exploration revealed a gangrenous appendix within the hernia which indicating AH. Herniorrhaphy and appendectomy were successfully performed without any postoperative complications. Feeding was resumed 8 days after the surgery, and the infant was discharged soon with full recovery. Conclusion: AH is characterized by an irreducible inguinal mass that is predominantly found on the right side in preterm infants, especially males. In less mature infants, the manifestation of AH may be more severe. Therefore, AH should be considered in the differential diagnosis of infants with abdominal emergencies, and careful intra-operative assessment is essential. AH typically requires less complex treatment and has a favorable prognosis compared to other abdominal conditions in preterm infants.

Background. The management of a recurrent inguinal hernia varies depending on multiple factors. In the case of recurrent inguinal hernias after open anterior repair, the laparoscopic approach is recommended. TEP and TAPP procedures are considered to have similar results. The purpose of the study is to evaluate on our sample if there are differences between primary inguinal hernia cases and recurrent hernia after laparoscopic TAPP and TEP procedures. Materials and Methods. We retrospectively reviewed the medical records of 300 patients who underwent laparoscopic inguinal hernia repairs at our hospital from March 2013 to March 2023. Results. Of the 300 patients, 39 of them (13%) had recurrent hernias after open anterior procedures. The mean age of patients with recurrent hernias was 56.82 years, compared to 50.47 years in those with primary hernias. In 27 cases we used the TAPP approach (69%), while in the remaining 12 cases the TEP approach (31%). Operative time for recurrent hernias was 72.69 minutes as opposed to 58.49 minutes for primary hernias. The percentage of peritoneal tears was higher for recurrent hernias (38%) than for primary hernias (18%). Conclusions. Surgery for inguinal hernia recurrence, is often more complex and time-consuming than for a primary hernia. However, postoperative results are favorable, with a low complication rate. Out of the two minimally invasive approach options, TAPP is our choice, especially due to the increased incidence of peritoneal tears. [ABSTRACT FROM AUTHOR]

Purpose: Incisional hernia is the most common complication of midline laparotomy. Although obesity is a known risk factor, the incidence of hernia formation in obese patients is not well defined. We sought to define the rate of incisional hernia formation in obese patients undergoing primary midline laparotomy in a large academic medical center. Methods: Obese patients (BMI ≥ 30 kg/m2) who underwent an elective or urgent primary midline laparotomy from 2017 to 2021 at our institution were retrospectively identified. A blinded hernia surgeon reviewed imaging to assess for incisional hernia formation, defined as a midline fascial defect with intra-abdominal contents herniated outside of the peritoneal cavity. Results: A total of 2241 patients met inclusion criteria. Cross-sectional imaging was available for 914 (41%) of these patients. The median BMI for all patients was 34.3 kg/m2 (range 30.0–59.1). Median time to follow-up imaging was 316 days (181–957, IQR = 185) for all patients and 316 days (201–903, IQR = 184) for patients with incisional hernia. In total, 474 (51.9%) had radiographic evidence of an incisional hernia. Colorectal and General Surgery demonstrated the highest rate of incisional hernia (p < 0.001). During the study period, 138 patients (15.1%) underwent surgical repair of their hernia at our institution, with the highest percentage being Colorectal Surgery patients. Conclusion: There is a high rate of hernia formation and subsequent hernia repair in obese patients undergoing midline laparotomy. Most importantly, these findings demonstrate an immediate and pressing need to identify the patient risk factors and technical issues related to this rate of hernia formation. [ABSTRACT FROM AUTHOR]

Hernia is an exceedingly common pathology, to which inguinal hernias are frequently diagnosed. Though this entity is regularly seen, in pregnancy a different diagnosis must be excluded: round ligament varicocele (RLV). Round ligament varicocele has a similar presentation to inguinal hernia, and therefore is often misdiagnosed. Though misdiagnosis potentially occurs from a lack of knowledge of the disease, RLV has shown that it's at least as common as inguinal hernia in pregnancy. The issue with misdiagnosis occurs as there is significant difference in management; hernia may require operative intervention, while RLV follows a conservative course. Therefore, an accurate diagnosis is essential, and an incorrect diagnosis can be associated with an unnecessary operation and consequence. We present the case of a patient in her second trimester who was referred for surgery due to suspicion of an inguinal hernia, and review the literature for evaluation recommendations, appropriate diagnostic strategies, and management tactics for RLV. [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]

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

PurposeTotal extraperitoneal prosthesis (TEP) is one of the most commonly used laparoscopic inguinal hernia repair procedures. This work aims to report the application of membrane anatomy to TEP and its value in intraoperative space expansion.MethodsThe clinical data of 105 patients, from January 2018 to May 2020, with inguinal hernia who were treated with TEP (58 patients in the General Department of the Second Hospital of Sanming City, Fujian Province, and 47 patients in the General Department of the Zhongshan Hospital Affiliated to Xiamen University) were retrospectively analyzed.ResultsAll surgeries were successfully completed under the guidance of the concept of preperitoneal membrane anatomy. The operation time was 27.5 ± 9.0 min, blood loss was 5.2 ± 0.8 ml, and the peritoneum was damaged in six cases. The postoperative hospital stay was 1.5 ± 0.6 days, and five cases of postoperative seroma occurred, all self-absorbed. During the follow-up period of 7–59 months, there was no case of chronic pain and recurrence.ConclusionThe membrane anatomy at the correct level is the premise of a bloodless operation to expand the space while protecting adjacent tissues and organs to avoid complications.

This article, published in Equine Veterinary Education, discusses the use of standing flank laparotomy as a surgical approach for the treatment of inguinal herniation in horses. Acquired inguinal herniation is a common cause of small intestine incarceration, particularly in stallions. The article presents a retrospective case series of two Percheron horses that underwent reduction of strangulated hernias through a flank laparotomy procedure. The authors conclude that standing flank laparotomy can be a viable alternative to ventral laparotomy in draft horses for correcting inguinal herniation, but caution that there are limitations and potential pitfalls associated with this approach. [Extracted from the article]

This article presents a case study of a 74-year-old male who experienced obstructed urosepsis due to a ureteroinguinal hernia. The patient initially responded to antibiotics and fluid resuscitation, but continued to have fevers. Due to challenges with accessing the ureter, the patient underwent urgent open inguinal hernia reduction and repair. Post-operatively, the patient made a good recovery and a repeat CT scan showed a reduction of the hernia and improved drainage of the ureter. Ureteroinguinal hernias are rare and surgical intervention is indicated in cases of symptomatic hernias or obstructive urosepsis. This case demonstrates the effective use of hernia repair for managing ureteroinguinal obstructed upper tract sepsis. [Extracted from the article]

Introduction: Hernia is one of the most common surgery-requiring conditions. Despite this, hernia still needs to be studied in more detail. The main objective of the study was to find out the prevalence of hernia among patients admitted to the Department of Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients admitted to the Department of Surgery of a tertiary care centre from 1 July 2021 to 31 December 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 202/2079/80). The patient admitted to the Department of Surgery during the study period was included and those with incomplete data were excluded. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 3236 patients, the prevalence of hernia was 749 (23.14%) (21.69-24.59, 95% Confidence Interval). The inguinal hernia was the most common type found in 574 (77.25%), followed by an umbilical hernia in 64 (8.61%). A total of 79 (10.55%) had comorbidity among patients with hernia. Conclusions: The prevalence of hernia in our study was found to be higher than in other studies done in similar setting. Easily accessible health facilities, competent primary surgical care and health education should be taken into account by the policymakers to reduce the morbidity and mortality of this condition.

Peritoneal dialysis (PD) is a risk factor for inguinal hernia, and herniorrhaphy on PD might be complicated by PD fluid.Although sac resection should contribute to preventing indirect hernia recurrence, the safety on PD has not beendescribed. This case series describes the detailed surgical procedures and long-term outcomes of 16 cases ofinguinal herniorrhaphy on PD. Results are shown as median (range). The age was 67.5 (53–83) years. Beginning atthe 6th case, we omitted interim hemodialysis and performed the Lichtenstein procedure. We performed sac excisionin the 14 patients. No complication related to PD was found. The follow-up period was 41.5 (4–124) months. Norecurrence occurred. They could continue PD for 21.5 (4–103) months after surgery. The total PD duration was 38.5(18–152) months. In conclusion, inguinal herniorrhaphy with sac resection may not compromise safety even forpatients on PD and achieve the expected PD duration without recurrence. [ABSTRACT FROM AUTHOR]

Inguinal and incisional hernias are the two most common types of hernias caused by abdominal wall weakness and defects in connective tissue. The structure of the extracellular matrix, mainly collagen and metalloproteinases (MMPs), and their regulators have been studied extensively and found to play a significant role in the pathophysiology of hernias. One of the regulators of MMPs, tissue inhibitor metalloproteinases (TIMPs), bind to MMPs and inhibit its activity significantly shifting the balance towards collagen synthesis rather than degradation. Due to their importance in collagen metabolism, their metabolism might be significant in the aetiology of hernias. Our study used immunohistochemical techniques to investigate the possible effects of TIMP 1 and 2 on the samples taken from the abdominal walls of patients with inguinal and incisional hernias, compared them with control patients, and reviewed the literature. In this study, samples of 90 patients (30 patients from control, inguinal hernia, and incisional hernia groups) were taken and analysed. These samples were stained with TIMP‐1 Ab‐2 and TIMP2 Ab‐5 (Clone 3A4) antibodies and evaluated under ×100 magnification. The degree of staining was classified as (a): No staining (0), (b): Staining less than 10% (I), (c): Staining between 10% and 50% (II), (d): Staining more than 50% (III). Statistical analyses were done. No significant difference was found between groups in terms of patient demographics. Smoking and family history of hernia was not found to be associated with TIMP expression. TIMP1 expression was significantly higher in the incisional and inguinal hernia group than in the control group (P <.05), while the level of TIMP2 was higher in the control group. (P <.05). TIMP1 and TIMP2 levels did not significantly differ between incisional and inguinal hernia groups. We found significantly increased TIMP‐1 levels in tissue samples from patients with hernia supporting its suggested role in hernia pathophysiology. Local alterations in MMP and TIMP levels might play a role in the pathogenesis of hernias. Thus detection of TIMP in tissues can be important for clinical use after further validation studies. In the era of molecular medicine, detecting TIMP levels in hernia patients can impact clinical practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site, type of repair, and clinical circumstances. Many risk factors are known and they must be considered before the procedure. In developing countries, follow up and maintenance of databases are critical to understand the real numbers. Methods: a retrospective cohort study analyzed adult patients who have undergone inguinal hernia repair at Hospital de Clínicas de Porto Alegre, a tertiary care government public hospital, between 2013 and 2015. Medical records, telephone, and letter contact have been reviewed in order to complete the minimum period of 5 years of follow-up. The analyzed data focused on the surgeon’s experience and the recurrence rate in 5 years of follow-up. Results: a total of 1094 medical records were selected and a complete five years follow-up were possible in 454 patients - 538 inguinal hernia repairs due to bilateral approach in 84 patients. These 454 patients answered, in a validated questionnaire about symptoms of recurrence. The total recurrence rate was 9.29%. For the patients who had Nyhus IV, recurrence rate was 24.1% against 9.9% after primary hernia repair, with a 2.4 higher risk. There was no difference in recurrence between surgeons and training surgeons. Conclusion: our data reveal an acceptable recurrence rate in a tertiary care hospital with residents, and to our knowledge is the first Brazilian report with long term follow up. An increased re-recurrent hernia was found when compared with primary hernia repair.

The article describes the case of a 55-year-old male patient who complained of left-sided inguinoscrotal swelling for one year and was diagnosed of a sliding hernia.

Purpose: The purpose of this study was to report and evaluate a laparoscopic surgical technique for the treatment of parastomal hernia (PSH) after ileal conduit urinary diversion aiming to minimize PSH recurrence and perioperative complications. Methods: We retrospectively evaluated all patients who underwent a PSH (after ileal conduit urinary diversion) repair at Addenbrookes Hospital, Cambridge. As a surgical approach, a laparoscopic repair with mesh was utilized in all cases. Subsequently, we performed a voluntary follow-up of the patients to evaluate long-term recurrence and complication rates. In addition, we conducted a reassessment of the cross-sectional imaging available. Results: Between November 2008 and December 2019, 27 patients underwent hernia repair due to a clinically significant hernia. Out of those patients, one suffered from a post-operative wound infection. In total 23 patients participated in the follow-up with a median follow-up period of 91 months. Follow-up examination revealed two cases of recurrent PSH (8.7% of patients followed up), four patients suffered from minor complications (14.8%). Conclusion: Repair of PSH associated with ileal conduit is particularly scarce. Our surgical approach presents the only laparoscopic case series of an effective method for treating a PSH from an ileal conduit with a low complication and recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Awakening following general anesthesia (GA) is one of the most important concerns of anesthesiologists in their daily work. Previous studies on adult humans found that caffeine could accelerate awakening after anesthesia. This study aimed to determine whether or not caffeine can accelerate awakening after anesthesia in children undergoing inguinal herniorrhaphy under GA. Methods: In this randomized clinical trial, we enrolled 18 children undergoing inguinal herniorrhaphy under GA with inhaled anesthetics from June 2019 to September 2019 in the tertiary hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). These children were randomly allocated to two groups. In group A, the children received intravenous caffeine (10 mg/Kg) at the end of the surgery, and in group B, the children received intravenous normal saline at the end of the surgery. The primary outcome was laryngeal mask airway (LMA) removal time at the end of anesthesia. Intra-operative hemodynamic data and side effects such as nausea, vomiting, dysrhythmia, cyanosis, and seizures in the recovery room were recorded and compared between the two groups. We used the independent-samples t test, Fisher's exact test, and repeated measures ANOVA for analyzing the data. P values<0.05 were considered statistically significant. Results: There were no significant differences in terms of demographic characteristics and hemodynamic data between the two groups. Furthermore, the time from the induction of anesthesia to laryngeal mask removal was 44.77±7.87 min in the placebo group and 44.55±10.68 min in the caffeine group. Therefore, there was no significant difference between the two groups (P=0.961). Conclusion: In children undergoing inguinal herniorrhaphy under GA, 10 mg/Kg of caffeine could not accelerate awakening from GA. However, caffeine did not increase the blood pressure and heart rate in the children, and no significant side effects were observed. Trial Registration Number: IRCT20190511043550N1. [ABSTRACT FROM AUTHOR]

In the current study, we aimed to compare sexual function and pain during the sexual activity of men who underwent surgery with the open or laparoscopic total extraperitoneal hernia repair techniques. Patients were randomised into two groups according to the technique used during the operation: the Lichtenstein hernia repair open technique (n = 63) and the laparoscopic total extraperitoneal repair technique (n = 57). In both groups, postoperative sexual function score was significantly improved compared with the preoperative period (p <.001 for both), but the change was higher in the laparoscopy group (6.8 ± 3.7) compared with the open group (4.3 ± 4.4) (p <.001). In both groups, postoperative pain during sexual activity score was significantly decreased compared with the preoperative period (p =.001 for the open group and p <.001 for the laparoscopy group), with the amount of decrease being higher in the laparoscopy group (1.8 ± 0.9) compared with the other (1.1 ± 1.4) (p =.002). This study showed that both hernia repair techniques had a positive impact on sexual function and pain during sexual activity. The improvement in sexual parameters and pain during sexual intercourse was better in the laparoscopy group. [ABSTRACT FROM AUTHOR]

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.

Background: Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches. Methods: We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted. Results: A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences. Conclusion: Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair. [ABSTRACT FROM AUTHOR]

Background/aim: Lumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital.Methods: Patients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded.Results: A consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1-113 months), only 1 (3%) lumbar hernias recurred for the entire cohort.Conclusions: Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia. [ABSTRACT FROM AUTHOR]