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Background: Inguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics. This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs. Methods: This randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals. Discussion: This study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs. It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated. Trial registration: ClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023. [ABSTRACT FROM AUTHOR]

Purpose: The TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique's inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice. Methods: All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience. Results: In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40–80 procedures, > 80 procedures). Conclusion: Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic groin hernia repair has evolved and gained popularity and laparoscopic transabdominal preperitoneal (TAPP) procedure provides an opportunity to evaluate the peritoneal cavity and both inguinal areas without the need for additional dissection. There is still a paucity of evidence to support TAPP repair in the emergency setting. In this systematic review, we aim to evaluate the feasibility and safety of TAPP repair for incarcerated and strangulated groin hernias. Methods: PRISMA guidelines were followed for literature search and established inclusion and exclusion criteria were applied. Data were extracted and analyzed for the outcomes of interest. Results: Overall, 8 studies were included in the review, comprising 316 patients. Patients characteristics and outcomes were limitedly reported. Only 3 cases of conversion to open approach were reported and 2 recurrences were diagnosed. Postoperative complications are inconsistently reported but mostly refer to minor complications. There were no mortality cases. Visceral resections were performed in 25 cases due to ischemia, mostly extracorporeally. Conclusion: Laparoscopy is a game changer and TAPP approach is a feasible, safe, and effective technique for the emergent repair of groin hernias. Further studies and prospective randomized data are needed to establish its role in the emergent groin hernia management. [ABSTRACT FROM AUTHOR]

Background: The research for ideal technique for Hernia correction would have preferably less complication rates and low recurrences. In recent studies laparoscopic hernia repair has been preferred and has gained vast acceptance among surgeons. Both laparoscopic(TEP) repair and open hernia repair have shown to be better outcome in many studies. Material and Methods: This was a hospital based prospective comparative observational study in which 100 (50 each) subjects with a diagnosis of inguinal hernia those were willing to participate were taken for each of two groups i.e. laparoscopic totally extra peritoneal (TEP group) and Lichtenstein open tension-free mesh repair (Lichtenstein group). Results: TEP was associated with shorter operative time, shorter hospital stay and cosmetically better compared to Lichtenstein hernioplasty. The mean pain score in the TEP group was significantly less than the Lichtenstein group on all occasions up to 2nd week post-operatively. There was no conversion from TEP to open Lichtenstein repair. The hospital stay in Lichtenstein group was significantly longer compared to TEP group (p= 0.042). Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernias by an experienced surgeon for those desiring less pain, better cosmetic results, less postoperative complications, less hospital stay and early return to work. [ABSTRACT FROM AUTHOR]

Background Usually umbilical hernia contains bowel loops and omentum. The diagnosis becomes even more challenging when they imitate strangulated umbilical hernia. An acutely inflamed appendix has been seen in the femoral and inguinal hernia but is rarely found in the paraumbilical hernia. Objectives To observe the symptoms, findings, and treatment process of cases of umbilical/paraumbilical hernia in past literature and document a case report in the appendix within the paraumbilical hernia. Methods Literature has been searched with keywords and statements of umbilical hernia, appendix within the umbilical hernia, and paraumbilical hernia. Studies on appendix within paraumbilical hernia are scarce in the literature. Six studies from the past 12 years were included. Results There were six studies included. Pain, fever, vomiting, and swelling on the umbilicus were the common symptoms. No postoperative complication was seen. Conclusion Several factors can be responsible for umbilical hernia. A case report of a 50-years old male presented to Jinnah Hospital, Lahore with pain and umbilical swelling. Appendiceal inflammation was found in the hernia sac. Umbilical herniorrhaphy and appendectomy were done. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repairs are the one of most common type of surgeries performed worldwide. Surgical treatment of the defect is the only permanent solution. This study was done to evaluate the effectiveness of using pre-peritoneal mesh to repair the defects in patients with bilateral and recurrent inguinal hernias. Materials and methods: this prospective study was conducted including 100 patients presenting with bilateral inguinal hernias or recurrent inguinal hernia to the OPD of Department of surgery of KIMS, Narketpally over a period of 1 year. Results: 98% of the patients were males and majority of the patients were in their middle age group. Most of the patients had groin swelling as the most common presenting complaint. Most of the patients were in occupations involving heavy strength work. Smoking and lifting of heavy weights are the most commonly observed risk factors in present study. Majority of the patients had their procedures finished within 30-45 min. most of the patients had mild post-operative pain and were discharged within 2 days of the procedure. Conclusion: Open pre-peritoneal mesh repair is a cost-effective procedure with few post-operative complications, less requirement of anesthesia and short duration of surgery, early discharge from the hospital. [ABSTRACT FROM AUTHOR]

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

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]

Introduction: A giant inguinal hernia is described as an extension of the hernia below the midpoint of the patient’s inner thigh in the standing position. It is relatively rare but severely affects a patient’s quality of life and imposes specific challenges to the surgeons. Aim: The aim of this paper is to describe the management of giant inguinal hernia and its related challenges. Case study: A 51-year-old man, a chronic smoker, and a labourer at a construction site complained about a rapidly growing reducible right groin swelling with heaviness, and discomfort. He was counselled for surgical intervention a year earlier but defaulted on follow-up. There was a right giant inguinoscrotal swelling extending beyond the mid-thigh on standing position. He underwent inguinal hernioplasty successfully without any intra- or post-operative complication. Results and discussion: Challenges in managing giant inguinal hernias include loss of domain and a higher risk of cardiovascular compromises, intra- and post-operatively. Compared to other inguinal hernias, a giant inguinal hernia is also at a higher risk of surgical site infections, scrotal haematoma, and hernia recurrences. Conclusions: A giant inguinal hernia is a rare and challenging surgical problem for surgeons. Meticulous perioperative managements are important in ensuring such patients with a promising outcome. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are frequently encountered in surgical practice. Early analysis and elective repair is a safe and effective approach for patients of all ages that keep away from incarceration, strangulation, and complications and reduces morbidity and mortality. Aim and Objective: To study inguinal hernias and their management at a tertiary care hospital at NCMCH. Material and Methods: 60 cases of inguinal hernia admitted in NC Medical College and Hospitals were selected by purposive sampling method. All the cases were clinically suspected and diagnosed with inguinal hernia, above 12 years of age. All subjects underwent detailed clinical and radiologist examination and data was recorded. Post-operative follow-up was done to assess the complications. Result: Our study showed that indirect inguinal hernia (80%) was the more common than direct inguinal hernia (20%). 96.67% was reported unilateral hernia (Right 56.67% and Left 33.33%) and bilateral hernia in 6.67% of the cases. In 58.33% of cases, the bowel was the hernial content and in 41.67% of cases, omentum was the hernial content. It was observed that postoperative complications were very minimal i.e. wound infections (5%), groin pain (3.33%), hematoma (3.33%), scrotal swelling (1.67%), and recurrence (1.67%). Conclusion: The prevalence of inguinal hernia is increasing nowadays. The study concluded that hernioplasty (51.67%) is a better surgical choice for controlling hernia. For the better management of hernia, there is a need for awareness in the population that might also help detect it at an advanced stage and reduce the disorder's morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Over the course of the past several years, several improvements have been made to the traditional Lichtenstein's hernioplasty approach to reduce the likelihood of post-operative complications and eliminate the possibility of chronic pain. Earlier, mesh fixation was used to be done by suture application. However recently, different non-traumatic alternative methods of mesh fixation like tissue compatible glues are being considered. Methods: The present randomized control study included a total of 60 patients, randomized equally (n=30 each) into two groups. Patients in group A were operated on for hernia repair using polypropylene 2-0 sutures for mesh fixation while in group B N-Butyl-2 cyanoacrylate glue was used for mesh fixation. Results: Mesh fixation time was significantly more in patients with propylene sutures than in glue (p=0.001). Total surgery time was also more for patients of propylene suture group with unilateral (73.38±10.75vs 65.42±21.31, p=<0.001) or bilateral (149±51.19vs 136±30.93, p=0.606) hernia, however in patients with bilateral hernia the difference was not statistically significant. Post-operative pain, analgesia requirement, time taken to return to normal activity, and postoperative complications like seroma, hematoma, and local numbness were not statistically significant. Conclusions: the use of a synthetic tissue adhesive N-butyl-2-cyanoacrylate glue is a feasible option for mesh fixation in patients with simple inguinal hernias undergoing Lichtenstein's hernioplasty, without adversely affecting the clinical outcomes. [ABSTRACT FROM AUTHOR]

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

Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods: We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair-TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results: Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and ‘feeling’ of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic pain were seen in 1.20% of patients. No wound infections were observed. The average operative time was 97.77 minutes (SD=17.08); when associated surgery was present, it prolonged the operative time, and we found statistical significance (p=0.002). Similarly, the presence of recurrent hernia extended the operative time, which was found to be statistically significant (p=0.003). The conversion rate in our data was 2.41%. Drainage, which was performed in 13 patients (15.66%), decreased the incidence of complications, especially seroma (p=0.026). The mean length of hospital stay was 2.93 days (SD=1.81), with most of the patients having been discharged on the second postoperative day (37.35%). Only one recurrence was identified (1.20%). Conclusion: The laparoscopic approach for bilateral inguinal hernia treatment is feasible and has been proven to be advantageous. Our study emphasizes that the TEP procedure has low rates of complications, conversion and recurrence; hence, we recommend bilateral hernia repair. [ABSTRACT FROM AUTHOR]

Purpose: A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias. Methods: This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course. Results: Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful. Conclusion: Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful. [ABSTRACT FROM AUTHOR]

Introduction: Trans‐abdominal pre‐peritoneal (TAPP) repair is one of the standard techniques for laparoscopic repair of groin hernias. Literature has shown that both total extraperitoneal (TEP) and TAPP are equally effective with similar outcomes but TAPP has an advantage over TEP as there is more working space, and it provides access to the opposite side for repair of occult hernias. We reviewed our experience of TAPP repair in complicated groin hernias and compared the outcomes with uncomplicated groin hernia. Methods: Patients undergoing TAPP repair from January 2004 to December 2019 were analyzed, and divided into two groups—I uncomplicated and II complicated groin hernia. Results: TAPP repair was performed in 820 patients, of which 70.3% had uncomplicated and 29.7% patients had complicated hernias. Occult hernia was detected in 61 patients. The intra‐operative complications (16.8% vs 1.3%) and conversions (2.4%) were higher in complicated hernias. Laparoscopic assisted repair was used in 16.8% patients with complicated hernias. The incidence of post‐operative complications (62.1% vs 17.3%; P value <.01) were significantly higher in complicated groin hernia patients. The median follow‐up was 15 months; only three patients in the uncomplicated hernia group developed recurrence, and chronic groin pain was higher in the complicated hernia repair patients (P >.05) at 6 months. Conclusion: Although operative time, incidence of intra‐operative and post‐operative complications (albeit minor in nature), and conversions to open are higher after TAPP repair for complicated groin hernias, the short‐term outcomes (hematoma, mesh infection) as well as long‐term outcomes (chronic groin pain, port site hernia and recurrence) are not different when compared with uncomplicated hernias. TAPP repair can be used in both complicated and uncomplicated groin hernias with similar short‐term and long‐term outcomes, albeit with a slightly higher incidence of minor complications in complicated hernias. This can be taken into consideration while operating on patients with complicated hernias and taking informed consent. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ureteral obstruction is a common complication after kidney transplantation. Ureteral obstruction caused by inguinal hernia, however, is a rare complication of transplantation and requires urgent surgical repair to prevent allograft loss. CASE PRESENTATION: A 58-year-old man presented with allograft dysfunction 18-years after renal transplant. He was compliant with medications and given the long duration of allograft survival, a primary renal etiology was suspected. Thus, the initial work-up included allograft biopsy that was unremarkable. Three months later, worsening allograft function prompted further evaluation. At this time, allograft ultrasound and computed tomography led to the diagnosis of ureteral obstruction due to uretero-inguinal herniation of left kidney transplant secondary to bilateral sliding inguinal hernias. The patient was also found to have incidental renal cell carcinoma of the left native kidney. A percutaneous nephrostomy tube was placed and then followed by surgical repair with ureteral reimplantation, herniorrhaphy with mesh, and left native nephrectomy. CONCLUSIONS: Mechanical obstruction can occur years after kidney transplantation. Even though it is uncommon, ureteral obstruction due to inguinal herniation is critical. Early detection of this complication and surgery can salvage the allograft and prolong function. [ABSTRACT FROM AUTHOR]

Objective: Inguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia. Methods: The data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People's Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications. Results: A total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise. Conclusion: Laparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm. [ABSTRACT FROM AUTHOR]

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Background: The finding of a vermiform appendix within the peritoneal sac of an inguinal hernia is called Amyand's hernia. The reported incidence of Amyand's hernia and femoral hernia is 1% and 3.8%, respectively. To our knowledge, no cases have been reported in the literature that associate these two entities. We present the first case of incarcerated left-sided Amyand's hernia and synchronous ipsilateral femoral hernia found during emergency surgery. Case presentation: A 72-year-old woman was admitted to the Emergency Department for a complicated left inguinal hernia. An inguinotomy was performed that detected a large direct hernial sac and a synchronous femoral hernia. The opening of the inguinal hernia showed the presence of the cecum and the appendix, both without signs of inflammation. The femoral space was evaluated transinguinally, identifying the larger omentum that had slipped into the femoral canal. The primary closure of the posterior wall defect was performed with the McVay technique due to its large size, and then the hernioplasty was completed with a polypropylene mesh. No postoperative complications were reported. Conclusions: In the context of an incarcerated Amyand's hernia, the decision to perform an appendectomy in addition to hernia repair with or without mesh will depend on intraoperative findings. [ABSTRACT FROM AUTHOR]

Introduction: The increase in laparoscopic surgery in patients with obesity increases the incidence of trocar site hernia (TSH). Therefore, TSH represents a risk for the development of Richter's hernia (RH). Methods: We present the unusual case of a postoperative gastric bypass patient complicated with a high output enterocutaneous fistula through a trocar site wound. Results: The Laparoscopic surgery consists of an RH reduction, enterotomy, and repair of the preperitoneal space. Conclusion: RH complicated by high-output enterocutaneous fistula has not been previously reported. It is essential to close the preperitoneal space in bariatric surgery to avoid these complications. [ABSTRACT FROM AUTHOR]

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

Background: The inguinal hernia can be repaired using a variety of laparoscopic methods. The most popular procedures are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). TEP technique is regarded closet to ideal. However, it has limitations that inspired the evolution of e-TEP. This small e stands for enhanced or extended view. Although the division of Douglas' line is not inherent to e-TEP technique, it offers a wider working place for secondary ports. Objective: To compare extended view totally extraperitoneal repair with inherently divided Douglas' line to totally extraperitoneal repair of inguinal hernia concerning operative time, ease of the procedure and postoperative complications. Patients and Methods: This prospective cohort study enrolled 55 patients diagnosed with inguinal hernia underwent laparoscopic repair between January 2019 and November 2021. Thirty-one patients (56.4%) underwent e-TEP technique with inherently divided Douglas' line (group I) and twenty-four patients (43.6%) underwent TEP technique (group II). Results: No significant difference was found between the two groups regarding age, sex and body mass index. Overall complication rate was higher in TEP group than in e-TEP group. Mean operative time, hospital stay, and pain score were less in e-TEP technique with inherently divided Douglas' line. The number of used tacks, and early return to work were significantly different for favor of e-TEP group. Conclusion: Enhanced view TEP technique with inherently divided Douglas' line is superior to TEP technique for repairing inguinal hernia in providing a better visual angle and ergonomics with lower complication rates and shorter operative time. [ABSTRACT FROM AUTHOR]

Purpose: Incarcerated inguinal hernias can promote bowel ischemia. Emergent bowel resection is associated with increased postoperative morbidity. Risk factors for bowel resection might identify patients who benefit from elective inguinal hernia repair. Methods: Sixty-five consecutive patients undergoing emergency inguinal hernia repair between 2012 and 2018 at our institution were entered in a prospective database. Data analysis was approved by the local ethics committee. Patient characteristics, surgery data, and postoperative outcomes were compared between patients with and without bowel resection. Risk factors for bowel resection were assessed with univariate and multivariate analysis. Results: Patients requiring bowel resection were more often female (87%, P = 0.004) and presented in 67% with a femoral hernia. Postoperative complications occurred more often after hernia reduction and bowel resection compared to no resection (67% vs. 36%, P = 0.035). ASA score 3–4 and femoral herniation were independent predictors of bowel resection (P = 0,046 and P = 0,047, respectively). Conclusion: Highly comorbid patients can profit from early elective hernia repair to prevent bowel resection. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Recently, the number of minimally invasive surgeries (MIS) is increasing; however, a specific postoperative complication of MIS such as port‐site hernia needs to be recognized. A persistent postoperative ileus after MIS is rare and such symptoms need to be recognized as a probable sign of a port‐site hernia. Recently, minimally invasive surgery (MIS) approaches for early endometrial cancer have shown non‐inferior oncologic outcomes with better perioperative morbidity than open approaches. Nevertheless, port‐site hernias are a rare but specific surgical complication of MIS. Knowing the clinical presentation, surgery for port‐site hernias could help clinicians manage this condition. [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]

Background: One approach to evaluate decision-making is using the concept of decision regret, which measures patient remorse after a healthcare decision. This is particularly important for elective, preference-sensitive conditions with multiple treatment options, such as ventral and inguinal hernia repair. In this study, we assessed decision regret among patients who pursued surgical management of ventral and inguinal hernias.Methods: We retrospectively reviewed a statewide registry of adult patients who underwent elective ventral and inguinal hernia repair between January 2017 and March 2020 and completed a validated survey measuring decision regret. 30-day outcomes included complications, emergency department (ED) utilization, readmission, and reoperation. Multivariable logistic regression examined the association of regret with age, sex, race, insurance status, ASA, tobacco use, diabetes, admission status, surgical approach (open vs. laparoscopic vs. robotic), year, and outcomes.Results: 8315 patients underwent surgery during the study period with a mean age of 60.5 (14.7) years and 1812 (22%) female patients. Among 2159 patients who underwent ventral hernia repair, 248 (11%) reported regret to undergo surgery, 64 (3%) experienced a complication, 160 (7%) visited an ED, 86 (4%) were readmitted, and 29 (1%) underwent reoperation. Outcomes associated with regret after ventral hernia repair included complications (OR 2.33, 95% CI 1.26-4.29) and readmission (OR 2.67, 95% CI 1.51-4.71). Among 6,156 patients who underwent inguinal hernia repair, 533 (9%) reported regret to undergo surgery, 41 (1%) experienced a complication, 304 (5%) visited an ED, 72 (1%) were readmitted, and 63 (1%) underwent reoperation. Outcomes associated with regret after inguinal hernia repair included ED visits (OR 2.03, 95% CI 1.44-2.87) and readmission (OR 4.23, 95% CI 2.35-7.61).Conclusion: Roughly 1 in 10 patients undergoing hernia repair report regret with their decision to undergo surgery. Developing a better understanding of the factors associated with decision regret after hernia repair may better inform both patients and surgeon decision-making. [ABSTRACT FROM AUTHOR]

Understanding how resident participation in surgery affects outcomes is critical for academic surgeons. The purpose of this study was to evaluate if resident participation was associated with adverse outcomes for inguinal hernia repair. We used the Veterans Affairs Surgical Quality Improvement Program to look at 61,737 patients aged ≥18 y who had open inguinal hernia repairs from 1998 to 2018. Propensity weighting was used to compare postoperative complications and operative time for patients having surgery performed by an attending alone versus attending with a postgraduate year (PGY) 1, 3, or 5 residents. There were 29,806 hernias (48%) repaired by an attending, 12,024 (19%) by an intern, 9008 (15%) by a PGY-3 resident, and 10,898 (18%) by a PGY-5 resident. After propensity weighting, there was a 0.13% (95% CI −0.11% to 0.38%, P = 0.29) increase in complications with PGY-1 participation compared to cases performed by attendings alone, a 0.3% increase (95% CI 0.01% to 0.59%, P = 0.04) for PGY-3 residents, and a 0.4% increase (95% CI 0.11% to 0.69%, P = 0.007) for PGY-5 residents. There was also an increase in operative time of 26 min (95% CI 25 to 27, P < 0.001) with PGY-1 participation, 19 min (95% CI 18 to 20, P < 0.001) with PGY-3 participation, and 23 min (95% CI 22 to 24, P < 0.001) with PGY-5 participation. Resident involvement in inguinal hernia surgery was associated with a significant increase in operative time but had a minimal impact on postoperative complications. Although resident participation in hernia surgery is safe, surgical programs should focus on enhancing operative efficiency for residents. [ABSTRACT FROM AUTHOR]

Septic omphalophlebitis is a common disease process with a variety of morbidities and possible mortality. Affected umbilical remnant resection is highly successful but may not always be possible. Umbilical marsupialization can be implemented when total resection cannot be accomplished with minimally reported complications. Umbilical vein marsupialization was performed on three Percheron foals with extensive septic omphalophlebitis using the one‐stage paramedian translocation technique and prolonged postoperative antimicrobial therapy. Long‐term follow‐up revealed herniation at the marsupialization site in all foals. Two foals were subsequently treated with herniorrhaphy at the prior marsupialization site. One foal died due to septic peritonitis with hernia formation 3 months after marsupialization. This case series highlights hernia formation as a potential complication following one‐stage umbilical vein marsupialization in foals diagnosed with septic omphalophlebitis and should be considered as a possible postoperative complication. [ABSTRACT FROM AUTHOR]

In this study, we report a case of incarcerated direct inguinal hernia (DIH) after robot‐assisted radical prostatectomy (RARP) in a patient with concomitant DIH. The 71‐year‐old man underwent RARP. Six days later, he developed a right DIH incarceration. His laparoscopy findings revealed an incarcerated intestine that was adherent to the hernia orifice. After reducing the hernia, the peritoneum was found to be defective in the right DIH orifice. The DIH was then repaired via the Lichtenstein method. The patient was discharged without complications on postoperative day 13. No recurrence was observed at 3‐year follow‐up. When repair and peritoneum closure for concomitant DIH are not performed in RARP, it should be kept in mind that the nonrepaired concomitant DIH orifice may develop intestinal incarceration and adhesion to the hernia orifice without the peritoneum immediately after RARP. [ABSTRACT FROM AUTHOR]

Background: The Geriatric Assessment and Medical Preoperative Screening (GrAMPS) program was an initial attempt to understand and to define the prevalence of age-related risk factors in older patients undergoing elective ventral hernia repair (VHR) or inguinal hernia repair (IHR). Preliminary analysis found significant rates of previously unrecognized objective cognitive dysfunction, multimorbidity and polypharmacy. We now examine whether chronological age as a sole risk factor can predict a patient's perioperative outcomes, and if traditional risk calculators that rely heavily on chronological age can accurately capture a patient's true risk.Methods: This was a retrospective secondary analysis of the previously reported GrAMPS trial enrolling patients 60 years and older with a planned elective repair of a ventral or inguinal hernia. The rates of key postoperative outcomes were compared between various cohorts stratified by chronological age. Previously validated risk screening calculators [Charlson Comorbidity Index (CCI), National Surgical Quality Improvement Program (NSQIP)] were compared between cohorts.Results: In total, 55 (78.6%) of the 70 patients enrolled in GrAMPS underwent operative intervention by May 2021, including 26 VHR and 29 IHRs. Cohorts stratified by chronological age had similar rates of key perioperative wound and age-related outcomes including readmissions, postoperative complications, non-home discharges, and length of stay. Additionally, while the commonly used risk calculators, CCI and NSQIP, consistently predicted worse outcomes for older hernia patients (stratified by both median age and age-tertiles), screening positive on these risk assessments were not actually predictive of a greater incidence of postoperative complications.Conclusions: Chronological age does not accurately predict worse adverse postoperative complications in older hernia patients. Additionally, traditional risk screening calculators that rely heavily on age to risk stratify may not accurately capture a patient's true surgical risk. Surgeons should continue to explore nuanced patient risk assessments that more accurately capture age-related risk factors to better individualize perioperative risk. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcome prophylactic antibiotics and routine pre-surgical and post-surgical in terms of incidence of surgical site infection (SSI) and to explore the effect of various factors such as duration of surgery and patient characteristics (if any). Methods: A double-blinded prospective analysis of a total of 60 patients with the primary inguinal hernia was conducted from 24th August 2020 to 24th August 2021 at the Surgical Department of Nishtar Medical University & Hospital, Multan. The participants of the study were categorized into two groups such that 30 consecutive patients were placed in the study group who were administered with a single dose of prophylactic antibiotic 30 minutes before to mesh repair surgery and the remaining 30 patients were placed in the control group who were administered routine antibiotics pre and post-operatively. The effects in patients were observed till 30 days following surgery for any sign of infection. All the collected data were analyzed through SPSS (version 19). Results: The rate of infection in both groups was noted. The incidence of infection in the study group (13.3%) was higher as compared to the control group (10%). No patient underwent mesh removal and no significant difference in terms of post-operative complications was observed in the results of both groups. Conclusion: Both the treatments, prophylactic antibiotics and routine pre-surgical and post-surgical were equally effective. However, we recommend the administration of prophylactic since they are cost-effective and prevent bacterial drug resistance. [ABSTRACT FROM AUTHOR]

Background: The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intraabdominal pressure and weak abdominal wall. Objective: To assess laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative application time, early post-operative complications including seroma, early pain, sensory impairment, surgical site infection (SSI) and hospital stay time using meta-analysis approach. Patients and Methods: In our study ten trials included, three trials regarding 3d mesh versus conventional mesh in laparoscopic inguinal hernia repair including 9,118 participants were selected from electronic databases. Three trials regarding 3d mesh and four trials regarding polyprolene mesh. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Results: There is significant heterogeneity among trials (P = 0.002, I2 = 84%), mean difference 1.17, 95% CI -2.18, 4.52 and there is no statistically significance z = 0.49. Conclusion: There is no difference between conventional polyprolene and 3d mesh regarding intra-operative difficulties (operative time) and post-operative complications (chronic pain, recurrence, operative time and seroma). [ABSTRACT FROM AUTHOR]

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]

Groin hernia repair is one of the most common surgeries performed in the United States, with more than 700,000 performed every year. These repairs are commonly performed in an elective setting to alleviate symptoms and prevent obstruction and/or strangulation. Prior studies have demonstrated that watchful waiting is a reasonable option compared with surgery, because of the low risk of life-threatening complications from groin hernias. However, other studies have demonstrated that there is increased risk of mortality after surgery in older persons (age ≥65 years). Therefore, the question is if and when older patients should pursue groin hernia repair. In this article, we provide an evidence-based overview on the management and treatment of inguinal hernia repair in older persons. Focusing on which patients should be repaired, the optimal timing of surgery, what is the best anesthesia, how the repair should be performed, and the importance of understanding frailty should help surgeons and primary care physicians determine the best management of inguinal hernias in older adults. [ABSTRACT FROM AUTHOR]

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

Background: Although laparoscopic incisional hernia repair, especially laparoscopic intraperitoneal onlay mesh, is a widely used technique, it can cause serious complications, including mesh erosion, adhesive bowel obstruction, and chronic pain. The enhanced-view totally extraperitoneal (eTEP) technique has been reported to prevent such complications by placing the mesh in the retrorectus space. Here, we report the case of a patient with post-robot-assisted laparoscopic radical prostatectomy (RARP) incisional hernia repaired using the eTEP technique. Case presentation: A 67-year-old man, who underwent RARP for prostate cancer 4 years ago developed an incisional hernia. Abdominal computed tomography showed the presence of an epigastric incisional hernia measuring 4 cm long and 3.7 cm wide. We performed an eTEP repair. We closed the hernia defect using a 0 barbed suture and placed a self-gripping mesh measuring 20 cm long and 15 cm wide in the developed retrorectus space with no fixation. There were no postoperative complications, and the patient was discharged on postoperative day 2. Conclusions: eTEP repair is considered an extremely effective surgical treatment option for incisional hernias because of its few resulting postoperative mesh-and-tacker-related complications. [ABSTRACT FROM AUTHOR]

Background: In gynecology, the number of laparoscopic surgeries performed has increased annually because laparoscopic surgery presents a greater number of advantages from a cosmetic perspective and allows for a less invasive approach than laparotomy. Trocar site hernia (TSH) is a unique complication that causes severe small bowel obstruction and requires emergency surgery. Its use has mainly been reported with respect to gastrointestinal laparoscopy, such as for cholecystectomy. Contrastingly, there have been few reports on gynecologic laparoscopy because common laparoscopic surgeries, such as laparoscopic salpingo-oophorectomy, are considered low risk due to shorter operative times. In this study, we report on a case of a woman who developed a TSH 5 days postoperatively following a minimally invasive laparoscopic surgery that was completed in 34 min.Case Presentation: A 41-year-old woman who had undergone laparoscopic salpingo-oophorectomy 5 days previously presented with the following features of intestinal obstruction: persistent abdominal pain, vomiting, and inability to pass stool or flatus. A computed tomography scan of her abdomen demonstrated a collapsed small bowel loop that was protruding through the lateral 12-mm port. Emergency surgery confirmed the diagnosis of TSH. The herniated bowel loop was gently replaced onto the pelvic floor and the patient did not require bowel resection. After the surgical procedure, the fascial defect at the lateral port site was closed using 2-0 Vicryl sutures. On the tenth postoperative day, the patient was discharged with no symptom recurrence.Conclusions: The TSH initially presented following laparoscopic salpingo-oophorectomy; however, the patient did not have common risk factors such as obesity, older age, wound infection, diabetes, and prolonged operative time. There was a possibility that the TSH was caused by excessive manipulation during the tissue removal through the lateral 12-mm port. Thereafter, the peritoneum around the lateral 12-mm port was closed to prevent the hernia, although a consensus around the approach to closure of the port site fascia had not yet been reached. This case demonstrated that significant attention should be paid to the possibility of patients developing TSH. This will ensure the prevention of severe problems through early detection and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Of the various methods used, the laparoscopic surgical repair of inguinal hernias is widely performed. We aimed to estimate the incidence of bilateral and contralateral occult inguinal hernias in our surgical population and to compare the results of total extraperitoneal repair (TEP) for bilateral and unilateral inguinal hernias, occult and non‐occult hernias. Methods: We retrospectively reviewed data of patients who underwent TEP for the repair of adult inguinal hernias from January 2012 to November 2018 in our hospital. Results: Of the data of 259 patients included, 134 (51.7%) and 125 (48.3%) had unilateral and bilateral inguinal hernias, respectively, while 70 patients (27%) were found to have a contralateral occult inguinal hernia, intraoperatively. The mean operative time was 129 ± 48 minutes (range, 43–300 minutes) and 167 ± 55 minutes (range, 85–390 minutes) for the unilateral and bilateral groups, respectively, indicating a significantly longer duration of surgery for the bilateral group (P <.05). Recurrence occurred in 1.5% (5/134) and 0.4% (1/250) of the operated hernias in the unilateral and the bilateral groups, respectively, indicating a significantly lower rate of recurrence in the latter group (P <.05). The two groups showed no statistically significant differences with respect to the remaining perioperative data. The incidence of postoperative complications in occult hernias was not significantly different from that in non‐occult hernias. Conclusions: Our TEP method, involving a laparoscopic exploration from the intraperitoneal side, can be safely and effectively utilized for the repair of both bilateral and contralateral occult inguinal hernias. [ABSTRACT FROM AUTHOR]

Background and Objective: Bladder hernias occur in 1% to 4% of cases in the inguinal area. The hernial sac may contain any part of the bladder, such as the bladder diverticulum, all or part of the bladder and ureter. Most of these hernias are diagnosed during surgery. Delay in diagnosis can lead to serious complications and even death. The aim of this case report is to introduce a patient with a rare hernia of the bladder diverticulum in the inguinal region. Case Report: The patient is a 58-year-old man who referred to Namazi Hospital in Shiraz with a bulge in the right inguinal region with symptoms of incarcerated hernia. The patient complained of pain and swelling in the right inguinal region and did not show any signs or symptoms of urinary tract involvement. During laparotomy, the mass was found to be connected to the bladder and the patient underwent inguinal hernia repair. The patient was discharged from the hospital one day after the operation without any problems. No complications were reported in follow-up two months after surgery. Conclusion: According to our report, hernia of the urinary bladder diverticulum in the inguinal region may be asymptomatic. Therefore, accurate reporting of the patient's history and previous problems and diseases is required for careful surgical planning to prevent severe complications, including bladder injury in these people. [ABSTRACT FROM AUTHOR]

Background: Indirect inguinal hernia with a dilated internal ring but an intact posterior inguinal wall is classified as Nyhus type II. Females have a higher incidence of indirect hernia than direct hernia. The purpose of this study was to evaluate the efficacy of laparoscopic iliopubic tract repair (IPTR) compared with laparoscopic transabdominal preperitoneal (TAPP) hernioplasty in treating women with Nyhus type II hernia.Methods: This retrospective study included 318 women aged ≥ 20 years who were treated for Nyhus type II hernia from January 2013 to December 2018. The patients were categorized into two groups in accordance with the operative technique: the TAPP group (33 patients) and the IPTR group (285 patients). In the IPTR group, intraabdominal suturing of the iliopubic tract and transversalis fascia arch was performed without mesh implantation.Results: The mean operation time was shorter in the IPTR group (17.2 ± 3.9 min) than the TAPP group (20.5 ± 8.1 min, p = 0.028). The postoperative complication rate was higher in the TAPP group than the IPTR group [6.1% (2/33) vs. 0.4% (1/285), respectively; p = 0.001]. Inguinodynia occurred in one patient in the TAPP group and no patients in the IPTR group. The hospital stay did not significantly differ between the two groups. The numeral rating scale pain scores at 1 day and 1 week postoperatively did not significantly differ between the two groups. There was no recurrence in either group.Conclusions: Laparoscopic IPTR was safe and feasible for treating Nyhus type II hernia in women. [ABSTRACT FROM AUTHOR]

Background: Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP. Methods: The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed. Results: Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43rd operation, once the 90% proficiency on the logarithmic tendency line was achieved. The corrected operative time resulted 71.1 ± 22.0 vs. 60.8 ± 13.5 min during and after the learning curve (p = 0.011). Only one intraoperative complication occurred during the learning curve and required an orchiectomy. Postoperatively, three complications (one seroma, one hematoma, and one mesh infection) required invasive interventions during the learning curve, while no cases were recorded after it (p = 0.312). Conclusion: Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time. [ABSTRACT FROM AUTHOR]

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

Background: Laparoscopic inguinal hernia repair is widely adopted and well accepted in many centers. Objective: We aimed with this study to evaluate the technique regarding its advantages and disadvantages in Sohag University Hospital. Patients and Methods: This was a prospective observational study included 50 patients suffering from inguinal hernia admitted electively to Sohag University Hospital between September 2019 and April 2020. Patients were enrolled for laparoscopic Trans Abdominal Pre Peritoneal (TAPP) repair. Patients were evaluated regarding demographic criteria, clinical picture, operative, and postoperative course after an outpatient follow-up period of 6 months. Results: The mean operative time in minutes ±SD was (125±12.5) for the early 10 patients while it was (69.8± 24) for the last 25 patients. Intraoperative complications were encountered in two cases of visceral injury and one case of bleeding arising from the inferior epigastric artery that was managed laparoscopically without surgical sequelae. The duration of hospital stay ranged from 24-48 hours. Postoperative complications were encountered in 3 patients whom had surgical emphysema which resolved conservatively. Patients returned to full activities in 7.14 ± 0.96 days and returned to their work in 14 ±2.5 days. On follow-up, recurrence was not encountered allover the period of 6 months postoperatively. Conclusion: TAPP repair for inguinal hernias is justified as a feasible, reproducible, and safe technique with rapid recovery and early return to work as well as comparable morbidities to other techniques. It is recommended as the procedure of choice in elective groin hernia repair especially in bilateral cases, with short learning curve requiring little facilities in the center. [ABSTRACT FROM AUTHOR]

Introduction: As in the rest of the world, in Germany, inguinal hernia operations are among the most common operations. From an economic standpoint, very little is known about the influence of demographic, clinical or hernia-related parameters on the cost of inguinal hernia repair. We, therefore, evaluated individual patient parameters associated with higher costs with a special focus on multimorbidity. Methods: A total of 916 patients underwent hernia repair for primary or recurrent inguinal hernia between 2014 and 2017 at a single university center and were included in the analysis. The clinical and financial data of these patients were analyzed to identify cost-increasing parameters. Results: A majority of patients were male (90.7%), with a mean age of 55 years. The surgical methods utilized were mainly the TAPP (57.2%) and Lichtenstein (41.7%) procedures, with an average duration of surgery of 85 min and an average duration of anesthesia of 155 min. The mean cost of all procedures was 3338.3 € (± 1608.1 €). Older age, multimorbidity, emergency operations with signs of incarceration, longer hospital stays and postoperative complications were significant cost-driving factors. On the other hand, sex, the side of the hernia (left vs. right) and the presence of recurrent hernias had no influence on the overall direct costs. Conclusion: From a purely economic point of view, older age and multimorbidity are demographic cost-driving factors that cannot be influenced. The national hospital reimbursement system needs to consider and compensate for these factors. Emergency operations need to be prevented by early elective treatment. Long postoperative stays and postoperative complications need to be prevented by proper preoperative check-ups and accurate treatment. [ABSTRACT FROM AUTHOR]

Introduction: There are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry compared the outcome of scrotal vs. lateral vs. medial inguinal hernias and explored the relationship between hernia localization and outcomes. Methods: Included in the analysis were all primary elective unilateral inguinal hernias in men with scrotal, lateral or medial defect localization whose details had been entered into the Herniamed Registry by 712 participating institutions (status February 1, 2019). The relation of the hernia localization with the outcome parameters adjusted for pre-defined confounding patient- and procedure-related variables was analyzed via multivariable binary logistic models. Results: Details of 98,321 patients were thus available for multivariable analysis. These related to 65,932 (67.1%) lateral, 29,697 (30.2%) medial and 2,710 (2.7%) scrotal inguinal hernias. Scrotal hernias were associated with higher patient age, higher BMI, higher ASA score, larger defect, more risk factors and more frequent use of Lichtenstein repair. On the other hand, scrotal hernias were associated less commonly with preoperative pain. Multivariable analysis revealed that scrotal hernias had a highly significantly unfavorable association with postoperative complications, complication-related reoperations and general complications. But scrotal hernias had a highly significantly favorable relation with the pain rates at 1-year follow-up. Medial hernias were the hernia type most often related with recurrence and also had an unfavorable association with the pain rates at 1-year follow-up. Conclusion: Scrotal inguinal hernias demonstrated a very unfavorable relation with the postoperative complication rate, the rate of complication-related reoperations and the rate of general complications. But a very favorable association with chronic pain rates was identified at 1-year follow-up. Medial inguinal hernia had an unfavorable relation with the recurrence and pain rates. [ABSTRACT FROM AUTHOR]

Background: Typically, in-person follow-up in clinic is utilized after outpatient inguinal hernia repair. Studies have shown that phone follow-up may be successfully used for the detection of postoperative hernia recurrences. However, no studies have evaluated the detection rates of other postoperative complications, such as emergency department visits and readmissions, with the utilization of phone follow-up after inguinal hernia repair. The objective of our study was to investigate the safety of a phone follow-up care pathway following elective, outpatient inguinal hernia repair. Methods: In this retrospective cohort study, adult patients who underwent elective, outpatient inguinal hernia repair between 2013 and 2019 at a large academic health system in the Midwest United States were identified from the electronic health record. Patients were categorized by type of postoperative follow-up: in-person or phone follow-up. Baseline demographics, operative, and postoperative data were compared between follow-up groups. Multivariable logistic regression was performed to investigate predictors of having any related emergency department (ED) visit/readmission/reoperation within 90 days. Results: We included 2009 patients who underwent elective inguinal hernia repair during the study period. 321 patients had in-person follow-up only, while 1,688 patients had phone follow-up. There was a higher rate of laparoscopic repair in the phone follow-up group (85.4% vs. 53.0% for in-person follow-up). There were no differences in rates of related 90-day ED visits, readmissions, and reoperations between the phone and in-person follow-up groups. On multivariable logistic regression, receipt of phone follow-up was not a predictor of having 90-day ED visits, readmissions, or reoperations (OR 1.30, 95% CI [0.83, 2.05]). Conclusions: Patients who underwent phone follow-up had similarly low rates of adverse outcomes to those with in-person follow-up. Phone follow-up protocols may be implemented as an alternative for patients and provide a means to decrease healthcare utilization following inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background: The arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery. Case presentation: The patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month's duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively. Conclusions: Single-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair. [ABSTRACT FROM AUTHOR]

Purpose: To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPFMT) for umbilical, epigastric, spigelian, small incisional and "port-site" hernia performed as a day case procedure. Methods: We retrospectively analyzed records of patients who underwent OPFMT for umbilical, epigastric, Spigelian, small incisional and "port-site" hernia in ambulatory settings between 2004 and 2020 at Clinical Center of Serbia. Demographic and clinical characteristics, operative data and postoperative complications were compared between the groups. Univariate and multivariate analyses were performed to identify predictive factors for mesh infection and recurrence. Results: Overall, 476 patients were divided according to the type of hernia. Early postoperative complications were similar in all study groups. Mesh infection, chronic pain and recurrence were different between groups (p = 0.013, p = 0.019 and p = 0.011, respectively). Overall recurrence rate after OPFMT was 2.5%. Hernia defect, hematoma and length of postoperative stay at the Day Surgery Unit were identified as potential predictors of mesh infection (Odds ratio 6.449, 22.143 and 1.546, respectively; p = 0.027, p = 0.011 and p = 0.038, respectively) while mesh infection was the only potential predictor of recurrence in univariate analysis. Hematoma was an independent predictor of recurrence (Odds ratio 27.068; 95% Confidence interval 2.355–311.073; p = 0.008). Conclusion: The OPFMT performed under local anesthesia as a day case procedure is a safe technique associated with favorable long-term outcome. Hematoma is an independent predictor of mesh infection occurrence. [ABSTRACT FROM AUTHOR]

Purpose: Amyand's hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand's hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand's hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia.Methods: Six patients diagnosed with Amyand's hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes.Results: The diagnosis of six cases with Amyand's hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected.Conclusions: Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand's hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia. [ABSTRACT FROM AUTHOR]