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

Introduction: 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]

Inguinal hernia surgery is a constantly evolving field, with ongoing research efforts aimed at enhancing surgical techniques and outcomes for patients. This retrospective study conducted between 2015 and 2020 in the First Surgical Clinic of Craiova Emergency Clinical Hospital focused on the occurrence and characteristics of postoperative pain following inguinal hernia repair using the tension-free Lichtenstein procedure. A total of 178 patients were included in the study, with 16.85% reporting postoperative pain. The average pain intensity was 6.4 on a scale of 1 to 10. Patients described the pain as numbness, burning sensation, stinging, pressure, and tingling sensations. Notably, 50% of patients reported pain related to weather changes. While the study explored potential relationships between patient demographics, hernia type, and postoperative pain, no statistically significant associations were found. Approximately 20% of patients with postoperative pain reported adverse effects on their work, and 10% used analgesics for pain management. This study highlights the multifaceted nature of postoperative pain following inguinal hernia repair, emphasizing the need for further research to identify individual risk factors and adherence to international guidelines for hernia management. The findings also underscore the importance of effective pain management strategies to improve patient comfort and quality of life post-surgery. [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]

Bilateral ureteroinguinal hernia is a rare presentation with only five cases previously presented in the literature. We describe a 60-year-old male who was diagnosed with large bilateral hernias extending into the scrotum containing redundant ureters. Both hernias were repaired in staged fashion with retrograde temporary ureteral stent placement and modified Lichtenstein technique. Follow-up computerized tomography imaging with >5 years follow-up revealed intact repairs with no evidence of urinary obstruction. [ABSTRACT FROM AUTHOR]

Background: A hernia is an abnormal protrusion of a viscus or a part of it, through the wall that contains it but without a breach in the body surface. The present study was conducted to compare lichtenstein technique with Rutkow-Robbins and Gilbert double layer techniques in inguinal hernia repair. Materials & Methods: 45 cases of inguinal hernia of both genderswere divided into 3 groups of 15 each. Group I patients were managed with Rutkow-Robbins Repair, group II with Gilbert double repair and group III with Lichtenstein operation. Parameters such as side, anaesthesia used during operation, operation time, hospital time, return to work, recurrence and complications etc. were recorded. Results: Group I had 8 males and 7 females, group II had 9 males and 6 females and group III had 5 males and 10 females. Right side was involved in 6 in group I, 10 in group II and 7 in group III and left side in 9 in group I, 5 in group II and 8 in group III. Anaesthesia used was GA in 2, 4 and 3, LA in 3, 2 and 4 and SA in 10, 9 and 8 in group I, II and III respectively. The mean operative time was 53.2 minutes, 60.4 minutes and 52,9 minutes, hospitalization time was 2.7, 2.3 and 2.1 and return to work was 25.6 days, 24.1days and 23.8 days in group I, II and III respectively. The difference was significant (P< 0.05). Early complications were seen in 2, 3 and 5 and late in 3, 4 and 3 in group I, II and III respectively. The difference was non-significant (P> 0.05). Conclusion: Among Rutkow-Robbins, Gilbert double layer techniques and Lichtenstein technique of inguinal hernia repairs, Lichtenstein technique found to be the most useful method in terms of short operative time and hospitalization time. [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]

Background: This pilot trial investigates whether the trans rectus sheath extra-peritoneal (TREPP) mesh repair is a safe and effective procedure compared to the currently most performed inguinal hernia repair techniques TEP and Lichtenstein. Methods: Three hundred patients older than 18 years with unilateral inguinal hernia were included in this retrospective cohort study, of which 58 (19.3%) underwent TREPP, 190 (63.3%) TEP and 52 (17.3%) Lichtenstein. The primary outcome of this study was inguinal hernia recurrence rate within 1 year after surgery. Secondary objectives were chronic post-operative inguinal pain (CPIP) lasting more than 6 months, (major) complication rates and operating time. Results: Recurrence rate within 1-year post-operative was low overall in the study population and did not differ significantly between TREPP, TEP and Lichtenstein, respectively 1.7, 2.1, 0.0% (P = 0.591). The rate of CPIP for which the patient contacted the hospital was similar in the study groups: TREPP: 1.7%; TEP: 1.6%; Lichtenstein: 1.9%; (P = 0.591). The mean operating time in minutes (SD) was significantly shorter in the TREPP group compared with the two other patient groups (TREPP: 22.2 (± 5.7); TEP: 38.7 (± 14.8); Lichtenstein: 49.3 (± 17.1), P < 0.001). No major complications occurred in any patient of the study groups. Conclusion: TREPP seems to be an effective and safe technique for unilateral primary inguinal hernia repair. It is found to be comparable to TEP and Lichtenstein in terms of recurrence rates, chronic post-operative inguinal pain, and clinically significant adverse events. This pilot study proves the need for future research into the TREPP technique. [ABSTRACT FROM AUTHOR]

Purpose: For inguinal hernia recurrences, the European Hernia Society guidelines recommend laparo-endoscopic repair (LR) following a previous open surgery (OS) and, conversely, OS following previous laparo-endoscopic repair. Laparoscopic treatment of recurrences after previous LR is controversial. The purpose of this study was to determine the safety, feasibility, and reliability of a repeated transabdominal preperitoneal laparoscopic repair (reTAPP) for a recurrent hernia. Methods: We analyzed and compared a series of patients with recurrent inguinal hernia after LR who underwent repair by a conventional approach with similar patients who underwent reTAPP between January 2010 and December 2018. Results: Between January 2010 and December 2018, 2488 transabdominal preperitoneal laparoscopic inguinal hernia (TAPP) repairs were performed. Recurrence was observed in 46 (1.8%). Of these patients, 18 (39%; Group 1; G1) underwent conventional open repair (Lichtenstein technique) and 28 (61%; Group 2; G2) reTAPP. In G2, repair was successful in 24 patients (86%); however, four cases (14%) needed conversion to OS because of technical difficulties. Two patients re-recurred (4.3%), one in G1 which was resolved in a third approach with a reTAPP and the other in G2 which was resolved with OS. Conclusion: ReTAPP surgery for recurrences after previous TAPP repair proved to be safe and was associated with a shorter length of hospital stay and morbidity and recurrence rates comparable to OS at a highly specialized center. Randomized studies with a larger number of cases are necessary to confirm these findings and draw more robust and objective conclusions. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Ureteroinguinal hernias are exceptionally rare and are seldom diagnosed in the preoperative setting. There are 2 classifications of this type of hernia: paraperitoneal and extraperitoneal. Case Report: We report a case of a 67-year-old man who presented with urinary symptoms and a reducible right inguinal hernia. A computed tomography (CT) scan of the abdomen and pelvis suggested an ureteroinguinal hernia. Further diagnostics and treatment via cystoscopy, retrograde pyelogram, and right ureteral stent placement were performed, confirming the diagnosis and providing relief of the obstructive uropathy. The patient underwent an attempted elective transabdominal preperitoneal repair that was converted to an open Lichtenstein repair. Intraoperatively, an extraperitoneal ureteroinguinal hernia was identified. The patient did well postoperatively, and the stent was removed 1 month later. Conclusions: Only 20% of the ureteroinguinal hernias described in the literature are extraperitoneal. In our case presentation, we demonstrated successful identification and treatment of an extraperitoneal ureteroinguinal hernia. The diagnosis was made using a combination of the clinical presentation, CT of the abdomen and pelvis, and cystoscopy with retrograde pyelogram. The extraperitoneal classification was an intraoperative diagnosis. The treatment consisted of a temporizing ureter stent and definitive management with an open Lichtenstein repair. We recommend obtaining a CT scan when a patient presents with a combination of urinary symptoms and an inguinal hernia because this process was invaluable in our preoperative diagnosis. Stent placement at the time of diagnosis permitted an elective repair and aided in the identification of the ureter during the hernia repair. [ABSTRACT FROM AUTHOR]

Giant inguinal hernias are defined as inguinal hernias that extend below the midpoint of the inner thigh when the patient is in the standing position or an anteroposterior diameter of at least 30 cm or a laterolateral diameter of ~50 cm with non-reducibility for >10 years. This article presents a 39-year-old male with a five-year history of a giant left inguinal hernia that was treated with left inguinal hernia repair with mesh, orchiectomy, complicated scrotoplasty, intraoperative ultrasound and aspiration of 3.9 L of fluid from the hernia sac. Surgical repair of giant inguinal hernias can be challenging and is associated with a variety of complications. Various modalities have been described to assist in hernia reduction including debulking, or, as in this case, aspiration of the hernia sac and a preperitoneal incision. Although the Lichtenstein tension free repair is commonly used, no standard approach has been accepted. [ABSTRACT FROM AUTHOR]

Introduction: The International Guidelines for Groin Hernia Management recommends an anterior repair after a failed posterior repair, and laparoscopic repair after a failed anterior tissue repair or Lichtenstein repair. However, there are not enough studies to guide decision‐making for patients with recurrent hernia patients after combined anterior‐posterior repair. We investigate the safety and usefulness of transabdominal preperitoneal repair (TAPP) for recurrent hernia patients after failed anterior‐posterior repair. Methods: We conducted a retrospective analysis of 13 consecutive patients with recurrent groin hernia who underwent TAPP after prior anterior preperitoneal mesh repair (that created anterior and posterior scarring) between September 2013 and October 2018. The control group comprised 45 patients who underwent TAPP for recurrent hernia after anterior repair (43 nonmesh repairs and two Lichtenstein repairs). Results: There were no intraoperative complications, and chronic pain was not reported by the patients with prior anterior preperitoneal mesh repair. The mean operative time was 113 ± 31.3 minutes, and the mean postoperative stay was 1.62 ± 0.87 days. The Wong–Baker FACES rating scale score for pain on postoperative day 1 was 1.91 ± 1.5; on postoperative day 7, the score was 1.0 ± 0.89. None of these findings was significantly different from the findings in patients who had a prior anterior repair. A single patient experienced a further recurrence and underwent repeat TAPP. Conclusions: The use of TAPP after failed combined anterior‐posterior mesh repair may be feasible and safe for recurrent groin hernia. Further study is needed to determine long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernias are common problem in our setup and its surgery is amongst the most frequently performed procedures. Lichtenstein meshplasty hernioplasty has good results but recurrence after surgery can be distressing. The aim of this study is to assess short term post-operative complications of repair by Lichtenstein technique. Materials and Methods: In this crossectional study 120 patients were included. It was conducted in the department of surgery District Head Quarter, Abbott abad from June 2019 till June 2020. Patients were followed for complications. Temporary scrotal swelling and wound infection were amongst commonest problems. Results: In this study the mean age of presentation was 45.15±14.45 years. Right sided inguinal hernias were common findings. Indirect inguinal hernia was found in 59.2 percent population and hence was the commonest type followed by direct inguinal hernia and pantaloon hernia respectively. Post-operative complication included wound infection(5%), seroma formation(3.3%). Transient scrotal swelling was the most commonest problem encountered. Conclusion: This study indicated that lichtenstein meshplasty is safe, easy to learn, and can be performed in routine for inguinal hernia repair with low recurrence rate. [ABSTRACT FROM AUTHOR]

Giant inguinoscrotal hernia (GIH) is a high morbidity and mortality disease. Giant inguinoscrotal hernia containing omentum, intestinal segments or urinary bladder is a challenging surgical disease. The patient was diagnosed with bilateral giant inguinoscrotal hernia at the age of 81. The case had 22 years history of this uncommon disease. Ultrasound revealed a voluminous hernia sac containing bowel loops, greater omentum, and hydrocele. According the new classification of GIH, the patient was type II. He underwent complete surgical hernioplasty involving omentectomy and orchiectomy. After the surgery, any emerging complications were closely monitored. When giant inguinoscrotal hernia is diagnosed, operation should be recommended immediately. Treatment procedure of hernia should be according the classification of GIH. The Lichtenstein tension-free technique seems to be the best surgical procedure for the patient who have bilateral hernia. It should be used whenever possible in such cases. The patients should be carefully follow up postoperative in terms of abdominal compartment syndrome and respiratory insufficiency. [ABSTRACT FROM AUTHOR]

The number of renal transplants has been increasing in recent years. Recent literature data show that abdominal operations performed on patients who undergo renal transplant have higher morbidity and mortality. A 49-year-old man who had received a renal transplant from a living donor 19 years ago underwent Lichtenstein tension-free hernia repair. Anuria was observed after the operation. Renal ultrasound demonstrated massive hydronephrosis and an elevated serum creatinine level (4.6 mg/dL). It was thought that the ureter may have been obstructed because of the operation, and, with the patient under local anesthesia, all sutures and polypropylene mesh were removed. Urine output was still not present, so a percutaneous nephrostomy catheter was inserted to normalize renal function. The patient underwent reoperation under general anesthesia 45 hours after the first operation. It was observed that the ureter was ligated during high ligation. The ureter was released, and no additional intervention was performed. The patient was discharged 6 days later with a return to basal creatinine level and a percutaneous nephrostomy catheter. The patient was hospitalized twice for severe urinary tract infection and urosepsis within 3 months and received appropriate treatment. The patient has had an uneventful postoperative course for 18 months. Inguinal hernia repair is seen as a safe surgical procedure, but the risk of emerging urological complications is higher in patients with renal transplant. Imaging before surgery to identify the anatomy of the kidney and ureter may be useful. Delicate dissection of the extraperitoneal area during the operation will reduce surgical complications. [ABSTRACT FROM AUTHOR]

Background: Misdiagnosis or failure to intraoperatively detect occult hernia in the inguinal region can lead to the recurrence of postoperative hernia and the appearance of local pain symptoms, which affect the patient's quality of life and make it difficult to reperform hernia repair.Methods: This study included 1066 inguinal hernia patients who underwent surgical treatment at Shanghai Tongren Hospital between January 2016 and October 2018 to investigate ipsilateral occult hernia epidemiology, to analyze the characteristics of ipsilateral occult hernias with regards to patient age, gender, classification and anatomical site, and to explore the superiority and inferiority of the expert hernia surgeons/ non-expert hernia surgeons group and of operation methods in finding occult inguinal hernias.Results: The incidence of ipsilateral occult hernia in the surgical population was 8.26%. Ipsilateral occult hernia included indirect inguinal hernia, direct inguinal hernia, femoral hernia, obturator hernia, and spigelian hernia, among which the highest incidence was direct inguinal hernia (4.11%), followed by indirect inguinal hernia (2.45%). There was no difference in the incidence of ipsilateral occult hernia between males and females, but there were significant differences in the incidence of ipsilateral occult hernia, which decreased gradually with increasing age in patients younger than 70 years-old; there was no difference in incidence in patients over 70 years-old. There were significant differences in the incidence of ipsilateral occult hernia in the bilateral inguinal region between direct and femoral hernia, with the higher incidence found on the right side; in contrast, there was no difference in the incidence of indirect inguinal hernia in the bilateral inguinal region. There was no difference in the ability of experienced physicians to detect ipsilateral occult inguinal hernias, either professionally or by surgery.Conclusions: Ipsilateral occult inguinal hernia has a higher incidence in patients with inguinal hernia, especially older patients; therefore, it is necessary for experienced surgeons to carefully detect for possible occult hernia during the operation and in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied.Purpose: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations.Method: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019.Results: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially.Conclusions: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation. [ABSTRACT FROM AUTHOR]

Objective: To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Summary background data: Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. Methods: Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3–0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale ≥ 3, 0–10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. Results: A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7–8%), operated recurrences (2–4%), overall re-operations (4–5%), need for analgesics (1–2%), patient's satisfaction (93–97%) or in the feeling of a foreign object (11–18%) between the study groups. Conclusion: The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair. [ABSTRACT FROM AUTHOR]

Introduction: The use of drains continues to be a controversial topic in surgery. In a review of that topic for incisional hernia it was not possible to find sufficient evidence of the need for a drain. Likewise, for inguinal hernia surgery the data available are insufficient. Methods: In a multivariable analysis of data from the Herniamed Registry for 98,321 patients with primary elective unilateral inguinal hernia repair in men, the role of a drain was investigated. Results: A drain was used in 24.7% (n = 24,287/98,321) of patients. These patients were on average older, had higher BMI, longer operating time and received a smaller mesh. Drains were also used more often for patients with higher ASA score, risk factors, larger defects and scrotal hernia localization as well as for Lichtenstein, TEP and suture repair. The use of drains was highly significantly associated with intra- and postoperative complications as well as with complication-related reoperations. Hence, drains are used selectively in inguinal hernia repair for patients at higher risk of perioperative complications. Despite the use of drains, the outcome in this risk group is less favorable. It remains unclear if drains prevent further complications in high-risk patients. Conclusion: Drains are used selectively in high-risk men with primary elective unilateral inguinal hernia repair. Drains are associated with intra- and postoperative complications rates and complication-related reoperation rate. Drains can serve as an indicator for early detection of complications. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative progressive pneumoperitoneum (PPP) is mostly used for giant abdominal incisional hernias, and only a few isolated or paired cases that used PPP in the treatment of giant inguinal hernias (GIH) have been reported. The main objective of this study is to describe our technique in the use of PPP in the treatment of GIH in a series of patients who presented with this challenging condition. Methods: We retrospectively reviewed the medical records of a series of patients treated with PPP for GIH during a 6-year period (2012–2018) at a single institution. The demographics, preoperative, and surgical characteristics were analyzed. Results: In total, 7 patients were treated for GIH with PPP. The median age was 64 (range 30–89) years. The median history time with the inguinal hernia was 8 (range 2–20) years. The median time of PPP was 22 (range 15–30) days. All patients underwent the Lichtenstein technique. The median follow-up time was 12 (range 3–84) months. Three (42.8%) of the patients had preoperative complications. Two patients developed mild dyspnea during PPP, and another patient had subcutaneous emphysema during the insertion of the catheter. Two (28.5%) patients had postoperative complications. One of them developed a right scrotal abscess, and another patient developed bilateral grade III hydrocele. Conclusion: With our limited experience, it is too early to tell if this should be the gold standard for the treatment of GIH. To see if there is superiority among different procedures, more studies that compare the morbidity of PPP with that of other trans operative techniques are needed. Nevertheless, the procedure we propose has provided satisfactory results. [ABSTRACT FROM AUTHOR]

Background: Long-term clinical outcome after a recurrent inguinal hernia repair may be associated with the type of repair, that is, laparoscopic or open. The results from previous randomised controlled trials are inconclusive regarding the long-term risk of re-recurrence chronic pain. Accordingly, this trial compared laparoscopic transabdominal preperitoneal repair (TAPP) with Lichtenstein's repair. The primary outcome was repair for a re-recurrence. The secondary outcome was chronic pain. Methods: Multi-centre single-blinded, randomised trial on TAPP vs Lichtenstein's repair in male patients operated for a recurrent inguinal hernia after a primary open inguinal hernia repair. Follow-up for repair for a re-recurrence was registered in the Danish Hernia Database. Prospective follow-up data were achieved by a structured questionnaire on pain-related functional impairment using the Activities Assessment Scale (AAS-pain). Result: A total of 360 patients were randomised, 297 were mailed the follow-up questionnaire (63 excluded) after median 12 years (range 9–15). A total of 265 patients responded to the questionnaire (response rate 89%). The cumulative rate of repair for re-recurrence after 12 years was 10% (95% confidence interval (CI) 5.3–15.1%) vs 10% (5.6–14.7%) after TAPP or Lichtenstein, respectively (p = 0.764). Moderate/severe AAS-pain was reported by 4% (95% CI 1–8%) vs 7% (95% CI 3–11%) patients after TAPP or Lichtenstein, respectively (p = 0.698) Conclusion: Long-term re-recurrence rate and incidence of chronic pain was surprisingly high respectless of surgical approach and neither TAPP nor Lichtenstein's procedure was superior to improve surgical results. [ABSTRACT FROM AUTHOR]

Introduction: Synthetic non-resorbable mesh is almost standard in hernia surgery. However, several studies have showed negative effects of permanent implants such as chronic inflammation and complications involving different organs bordering the mesh. Such complications can raise the risk of chronic post-operative pain (CPP). Recently promising results regarding CPP have been published in patients with Lateral Inguinal Hernia (LIH) using a slowly resorbable mesh in Lichtenstein technique. For this reason the aim of the present study was to find the effect of a slowly resorbable implant on the long-term rate of hernia recurrence and chronic post-operative pain in patients with LIH repaired with TEP procedure.Methods: Prospective pilot study of TEP repair using TIGR® Matrix Surgical Mesh in 35 primary LIH. At 3-year follow-up the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire were employed to assess pain. Recurrence was determined by ultrasound and clinical examination.Results: All patients completed the pain questionnaires but one patient did not attend the planned clinical examination for the 3-year follow-up. No patients had CPP, as defined in the World Guidelines for Groin Hernia Management. Almost all patients had lower VAS score in any activity 3 years following surgery in comparison to the preoperative period. Three patients (8.8%) suffered symptomatic recurrence during the 3-year follow-up.Conclusion: TEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernia repair is one of the most performed procedure all over the world with more than 20 million procedures performed each year. Due to the lack of data in literature about the learning curve of the Lichtenstein procedure, we decided to reproduce a research on learning curves with the same methodology proposed in our previous study about laparoscopic hernia repair. The aim of this multicentre study was to analyse how many cases are required to achieve the learning curve for a Lichtenstein procedure.Methods: We performed a retrospective analysis of the first 100 Lichtenstein procedures performed by 4 trainees from three different institutions and compared them with the same number of procedures performed by 3 senior surgeons from the same institutions. The data about the achieving of learning curve were evaluated with CUSUM and KPSS test.Results: No differences about biometrical features were found between the seven groups of patients. CUSUM analysis showed that the trainees achieve the learning curve after 37-42 procedures, reaching an operative time similar to that one of the senior surgeons.Conclusions: In conclusion, we have shown that the number of procedures required to reach the learning curve from the beginning of surgical residency is around 40 hernia repairs. This number, produced in a controlled environment under strict supervision, could be the minimum requirement to start the procedure of accreditation and specialization in hernia surgery and is higher and steeper than previously reported. [ABSTRACT FROM AUTHOR]

Background: Sports hernia is a condition with longstanding groin pain without an obvious pathology. Even though no hernia is present, some of these patients have a groin hernia repair to relieve the pain. The aim of this study was to establish an overview of patient characteristics and surgical techniques in patients that have a groin hernia repair without a hernia present.Methods: This cohort study is based on nationwide data on hernia repairs from the Danish Hernia Database. Patients having a primary groin hernia repair without having a hernia between 1998 and 2011 were included and followed for minimum 4 years. We evaluated patient characteristics, type of surgery, and re-operation rates for laparoscopic and open surgeries.Results: Groin hernia repairs were performed in 1,028 groins where no hernia was present. The median follow-up after primary surgery was 11 years (range 4-17). Men represented 78% of the patients, and the mean age was 50 years (standard deviation 16.4). The most frequent type of surgery was the open Lichtenstein repair. The overall re-operation rate was 7% and this was evenly distributed across the different types of primary surgeries with no difference in neither the crude nor the cumulated re-operation rates. During re-operation, a groin hernia was found in 88% of the repairs.Conclusion: Groin hernia repairs in groins without a hernia are performed at all ages and with the typical patient being a middle-aged man receiving an open mesh repair. [ABSTRACT FROM AUTHOR]

Aim: To compare Lichtenstein and TEP methods regarding the endocrine and inflammatory response to surgery and the results of early postoperative period. Material and Method: 40 patients who had been operated for inguinal hernia at our clinic were included in the study. TEP was administered to the 20 patients while Lichtenstein was performed in another 20 patients. During the induction of anesthesia, postoperative 6th and 12th hours blood samples from the patients in both groups was obtained and serum ACTH, IL-6, WBC and CRP levels were measured. Results of early postoperative periods of operations were evaluated. Results: There was no difference between the two groups in terms of surgical endocrine responses. Inflammatory response parameters varied. In patients TEP applied on WBC values and average checked at 6th hours at statistically significant degree higher while average of CRP values checked in 6th hours is lower at statistically significant degree in the patients with TEP than patients who underwent Lichtenstein operation. There were no significant differences detected in any period between Lichtenstein and TEP group in terms of IL-6 value. Postoperative VAS values of Lichtenstein group were statistically significantly higher than those of patients who underwent the TEP. Conclusion: In study there wasn't difference between TEP and Lichtenstein repair in terms of inflammatory and endocrine responses. TEP repair, found to be superior than Lichtenstein repair operation; as it provides return to work early, the patients have less pain and less analgesic is needed, and less cost that promoted by the earlier return to work. [ABSTRACT FROM AUTHOR]

Background: The short‐term results of the TULIP trial comparing transinguinal preperitoneal (TIPP) inguinal hernia repair with the Lichtenstein method have been reported with follow‐up of 1 year. After TIPP repair, fewer patients had chronic postoperative inguinal pain (CPIP); they had better health status and lower costs. The present study reports the long‐term outcomes of this trial. Methods: All surviving patients initially randomized in the TULIP trial were contacted. Patients were interviewed by telephone and sent a questionnaire. Those reporting any complaints were invited for outpatient review. Chronic pain, hernia recurrence and reoperation were documented, along with any sensory change or disturbance of sexual activity. Results: Of 302 patients initially randomized, 251 (83·1 per cent) were included in the analysis (119 TIPP, 132 Lichtenstein), with a median follow‐up of 85 (range 74–117) months. Of 25 patients with chronic postoperative inguinal pain after 1 year, only one, who underwent Lichtenstein repair, still had groin pain at long‐term follow‐up. The overall hernia recurrence rate was 2·8 per cent (7 patients), with no difference between the groups. Conclusion: Both TIPP and Lichtenstein hernia repairs are durable. Patients with chronic postoperative inguinal pain after 1 year can be reassured that the groin pain tends to fade over time. [ABSTRACT FROM AUTHOR]

Background: Lichtenstein repair is standard practice for inguinal herniorrhaphy, but there is increasing public concern in the use of mesh and postoperative chronic pain. New mesh technology, such as the prolene hernia system, has a preperitoneal component to reinforce the myopectineal orifice aim to reduce the risk of recurrence and chronic pain. This meta-analysis compares outcomes using prolene hernia system versus lichenstein repair for inguinal hernias.Methods: Randomized-controlled trials comparing prolene hernia system and Lichtenstein repair were identified using Embase, Medline, and published conference abstracts. Primary outcomes were recurrence and chronic pain. Secondary outcomes were mean operating time, composite complications, surgical reintervention, and time to normal activities. Odds ration and standardized mean differences were calculated.Results: 1377 hernia repairs were identified from a total of 7 trials. Mean follow-up was 12-91 months. There was no difference between the techniques for recurrence [pooled analysis odds ratio: 0.86 (95% CI 0.32-2.28); p = 0.76] and chronic pain [pooled analysis odds ratio: 1.00 (95% CIs 0.65-1.55); p = 1]. Prolene hernia system demonstrated a shorter time to return to normal activities [pooled weighted mean difference - 0.54 (95% CI - 1.07 to - 0.01); p = 0.04]. Other outcomes were similar in mean operating time, composite complications, and surgical reintervention.Conclusion: Both prolene hernia system and Lichenstein repair appear comparable acceptable techniques for inguinal herniorrhaphy. Further longer-term studies of new mesh technologies will improve information available to surgeons and their patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to offer a prospective comparative assessment of long-term outcomes for inguinal hernia repair using Valenti and Lichtenstein techniques.Materials and Methods: 568 surgical procedures for unilateral inguinal hernia repair using the Valenti (group V) or the Lichtenstein technique (group L) were performed. After the mean follow-up time of 9 years (8-12), 185 patients (70.1%) treated using Valenti method and 186 patients (71.3%) treated using Lichtenstein method were clinically assessed. All clinical data were registered in National Hernia Registry. The rate of recurrence was assessed as primary outcome. The secondary outcome involved chronic pain (VAS).Results: 9-year recurrence rate was 2.2% in both groups. No significant difference in recurrence rate was demonstrated in analysis adjusted for surgeon's education, type of hernia, hernia size, hernia duration, or BMI between two groups (OR 1.0; 95% CI 0.69-1.67; p = 1.0). In follow-up the majority of patients reported no pain (71.9% in V; 73.7% in L). A constant pain was reported by four patients in each group. Severe pain was reported by 1.6% in V and 2.1% in L (p = 0.192).Conclusions: Inguinal hernia repairs using Valenti and Lichtenstein methods show high, long-term effectiveness and do not significantly differ in the recurrence rate. Both methods ensure a low rate of chronic pain. The use of a single mesh size with a precisely defined shape and of a uniform mesh fixation method ensures the standardization of surgical technique. The Valenti method is an uncomplicated, technically reproducible procedure with a low learning curve. [ABSTRACT FROM AUTHOR]

Introduction: he approaches for hernia repair have undergone a lot of advances and changes with various methods coming up. In this study we will be comparing the post operative outcomes in terms of success rate and complications in laparoscopic TEP and open Lichensteinhernioplasty. Methodology: The study was conducted by the surgery department of Sheth LG Hospital, Ahmedabad, between the period of August 2016 to July 2018. A total of 60 patients were studied and divided between the 2 equal groups. Patients were selected through Simple random sampling (computer generated) technique. the study was performed to compare the open Lichtenstein repair and laparoscopic mesh repair for direct inguinal hernias in terms of immediate post operative pain and length of hospital stay. Results: Post operative pain was higher in open group as compared to laparoscopic group while post operative hospital stay was lesser in laparoscopic group (1.5 days) as compared to open group (3 days). Conclusion: There is less post operative pain after laparoscopic repair and hospital stay is also comparatively less. Laparoscopic setup might be a cost affecting issue but early return to work can be considered an added benefit, particularly in govt. setups like ours where the patient might be the only earning member of the family. Keeping in view the limitations of Laparoscopic repair the choice between them should be made on a case to case basis depending on patient preference and other characteristics such as age, work, health status and cost etc. [ABSTRACT FROM AUTHOR]

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

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

The authors concluded that II nerve identification in Lichtenstein repair is a fundamental step while prophylactic II neurectomy seems to offer some advantages concerning postoperative pain at 6-month follow-up. Reference 1 Cirocchi R, Sutera M, Fedeli P. Ilioinguinal nerve neurectomy is better than preservation in Lichtenstein hernia repair: a systematic literature review and meta-analysis. [Extracted from the article]