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Objective:The aim of this study was to investigate the relationship between left sided inguinal hernia and varicocele.Method:Between July and October 2022, 60 patients with left inguinal hernia (group 1) and 60 patients without hernia (group 2, control group) were included in our prospective study. Those with a history of right inguinal hernia, left epididymoorchitis, scrotal surgery or inguinal hernia surgery were not included in the study. The patients were evaluated for the presence of left varicocele. Grade of the varicocele, the diameters of the pampiniform plexus veins, and the neck diameter of the hernia were measured.Results:There were 120 male patients in our study (group 1 n=60, group 2 n=60). While the age range of the patients with hernia was 23-60 years (mean age: 36±8.4 years), the age range of the patients without hernia was 20-58 years (mean age: 33±9.5 years). There was no statistically significant difference between the groups in terms of age distribution (p=0.89). While the incidence of varicocele was 58.3% (35/60) in group 1, it was 23.3% (14/60) in group 2 [relative risk 2.5 (95% confidence interval (CI) (1.507, 4.147)] and odds ratio of 4.6 [95% CI (2.091, 10.118)]. While the median grade of varicocele was 1 in group 1, it was 0 in group 2, and a statistically significant difference was found (p

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

Lumbar hernias are rare, and the diagnosis can be easily missed. Acquired lumbar hernias can occur spontaneously; however, they are increasingly being reported due to trauma or flank surgery. A good history and examination can aid in diagnosis with imaging confirming the condition. Hernia repair can be laparoscopic or through open surgical approaches. We report a case of primary spontaneous lumbar hernia which was managed by an open approach to close the defect with retromuscular mesh placement. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify and summarize the evidence and risk factors of canine inguinal hernia containing the uterus (Inguinal Hysterocele; IH) etiology by presenting our clinical experience with a literature review. A total of 18 canine IH cases were evaluated in the study. Of these, four have not yet been published anywhere, two have been published before, and 12 were obtained through a literature review. According to the findings, 81.3% of the cases were small/medium races, 83.3% were =5 years old, and 72.7% were multiparous. Totally 83.3% of the cases were chronic and 72.2% of the cases had a hernia on the left side of the body. In inguinal gravid hysterocele (IGH) cases, clinical symptoms started after >30 days of pregnancy. In addition to estrogen, repeated exposure to sex hormones and conception/birth status are also effective in etiology. Finally, the uterus herniates into the inguinal canal and conception/uterine pathologies occur in the already herniated uterus. Inguinal hysteroceles are causes life-threatening problems. In the clinic, inguinal swellings/masses can be confused with adipose tissue, so careful control and surgical intervention of swellings/masses can eliminate serious problems that may develop. [ABSTRACT FROM AUTHOR]

The recurrence rate in patients who undergo surgery for abdominal wall hernias (AWHs) is high. AWHs have been hypothesized to be a disease of the extracellular matrix, which is supported by evidence showing a high incidence of AWHs in patients with connective tissue disorders. This study aimed to investigate the most recent literature studies describing the levels of several matrix metalloproteinases (MMPs) in the blood and fascia, with the objective of better clarifying the pathogenetic role of matrix metalloproteinases (MMPs) and their inhibitors in inguinal hernias (IHs). A systematic literature search was conducted using the PubMed, Scopus, and Web of Science electronic databases to identify eligible studies. The identified studies were included in the analysis, and a qualitative synthesis of the results is provided to describe the most recent findings. Seventeen studies were included. An association between MMP-2 and direct IHs has also been demonstrated. MMP-1, MMP-2, MMP-9, MMP-12, and MMP-13 levels were increased in both the serum and fascia of patients with IHs. The analysis of inhibitors showed an increase in tissue inhibitors of metalloproteinases (TIMPs), specifically TIMP-1 in IHs, particularly in direct hernias, and a reduction in TIMP-2 in the biopsy samples of the transversalis fascia. In contrast, a reduction in TIMP-1 and an increase in TIMP-2 levels have been reported only in the serum of patients with IHs. Metalloproteinases play a crucial role in the pathogenesis of IHs. The analysis of other molecules, such as TIMPs or their correlation with specific genes, is enhancing our understanding of the pathophysiology of IHs. However, more prospective studies, including comprehensive clinical and laboratory data collection, are required to confirm the relationship between the studied biomarkers and the risk of IHs. [ABSTRACT FROM AUTHOR]

Several studies have recently reported the rare occurrence of internal herniation of the small bowel after laparoscopic colorectal surgery. Most cases of internal herniation after laparoscopic colorectal surgery occur due to a mesenteric defect. However, there have been no reports on the indications for closing mesenteric defects to prevent the development of an internal hernia. This study reports a case of an internal hernia of the proximal jejunum near the ligament of Treitz in a patient who underwent laparoscopic sigmoidectomy with splenic flexural mobilization and high ligation of the inferior mesenteric vein. Assessing the risk for internal herniation before completing the initial surgery is crucial. Additionally, mesenteric defect closure should be performed to prevent the development of internal hernias among patients with a potential risk. [ABSTRACT FROM AUTHOR]

Internal hernias secondary to exposed structures after lateral lymph node dissection (LLND) for rectal cancer are rare. A 53‐year‐old man who underwent laparoscopic ultra‐low anterior resection and bilateral LND presented to our emergency department with sudden‐onset severe abdominal pain and vomiting. Computed tomography demonstrated a closed loop obstruction of the intestine in the right lateral pelvic cavity and a significantly dilated small bowel in the abdominal cavity. Laparoscopic surgery revealed small bowel migration into the space between the right ureter and umbilical artery. The herniated bowel was laparoscopically reduced, and the small bowel exhibited no ischemic changes. Meanwhile, the hernial orifice was left unrepaired. The patient was discharged on the seventh postoperative day without complications. An internal hernia caused by exposed structures after lymphadenectomy should be a differential diagnosis in patients who have undergone LLND for rectal cancer and then present with severe abdominal pain and vomiting. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations are a vascular anomaly most often found in the central nervous system; however, they can present ubiquitously in any organs or tissues. We present the case of a 55‐year‐old man who developed a tender, reducible inguinal bulge and underwent laparoscopic transabdominal preperitoneal inguinal hernia repair under the clinical diagnosis of an inguinal hernia. Intraoperative observation revealed no hernia sac, but a poorly defined spermatic cord mass, appearing to be responsible for the patient's symptoms, was found and removed. The pathology of the mass was consistent with the diagnosis of an arteriovenous malformation of the spermatic cord. Surgeons should keep in mind the small possibility of arteriovenous malformations in patients with clinical presentation of an inguinal hernia, as they may cause massive bleeding during and after the operation unless handled appropriately. [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: Laparoscopic inguinal hernia repair has an established role in the management of this condition in children in trained hands. Indeed, it is fast becoming the gold standard for the treatment of inguinal hernia in children. The laparoscopic technique has the advantage that it is simple, feasible, and safe. Also, the contralateral internal inguinal ring and other hernia sites such as femoral, obturator, or internal hernia can be diagnosed and treated at same sitting and other occult pathologies may be diagnosed. The risk of injury to the vas deferens and cord structures in this procedure is lesser when compared to the conventional open technique. [ABSTRACT FROM AUTHOR]

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

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]

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

Inguinal hernia is one of the most common surgical diagnoses in childhood and is often diagnosed during the first year of life. Clinically, the inguinal hernia usually manifests as a bulge in the groin area and represents the protrusion of the organs of the peritoneal cavity through a preformed or secondary made aperture. An inguinal hernia can also manifest as a stiff, significantly painful resistance in the groin or scrotum area, which cannot be freely reponed, it is a so-called „incarcerated" or strangulated inguinal hernia. An incarcerated hernia in a child is one of the acute abdominal events. Treatment of inguinal hernia is only surgical. Non-incarcerated inguinal hernia surgery is a planned procedure. The aim of the article is to offer an overview of current surgical methods in the treatment of inguinal hernia in children. The operations of inguinal hernia in children can be performed in several ways. In addition to open inguinal surgery, a minimal invasive approach can also be chosen, using the PIRS (Percutaneous Internal Ring Suturing) method, or the laparoscopic purse-string method, or other laparoscopic approaches. Inguinal hernia is operated under general anaesthesia. Inguinal hernia operations in children can also be performed in the form of one-day surgery. [ABSTRACT FROM AUTHOR]

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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]

Uretero-inguinal hernia (UIH) is a rare condition in children. We present our experience with an unexpected UIH in a male infant with associated anomalies and a literature review of pediatric cases. A full-term male newborn was referred to our hospital for microcolon and right hydroureteronephrosis. Voiding cystourethrography showed grade-IV right vesicoureteral reflux and a dilated, convoluted, ureter protruding in the right inguinal canal, suggesting a right UIH, which was uneventfully repaired at 2 months of life. UIH is a rare type of inguinal hernia in children that pediatric urologists and surgeons should be aware of. In experienced hands, and when preoperatively suspected, surgical management is safe and effective. [ABSTRACT FROM AUTHOR]

Introduction: Despite being one of the most commonly performed operations in the US, there is a paucity of data on practice patterns and resultant long-term outcomes of groin hernia repair. In this context, we performed a contemporary assessment of operative approach with 5 year follow-up to inform care for the 800000 persons undergoing groin hernia repair annually. Methods: This was a retrospective cohort study of adult patients undergoing elective groin hernia repair in a 20% representative Medicare sample from 2010–17. Surgical approach [minimally invasive (MIS) vs open] was defined using appropriate CPT codes. The primary outcome was operative recurrence at up to 5 years following surgery. We estimated the overall risk of operative recurrence using a multivariable Cox proportional hazards model. Results: Among 118119 patients, the majority (76.4%) underwent an open repair. Compared to patients who underwent MIS repair, patients in the open surgery cohort were older (mean age 72.7 vs 71.0, p < 0.001), more often female (14.4 vs 10.9%, p < 0.001), less often white (86.9 vs 87.7%, p < 0.001), and had a higher prevalence of nearly all measured comorbidities Patients in the open cohort had a lower incidence of operative recurrence at 1-year (1.0 vs 1.5%, p < 0.001), 3-years, (2.5 vs 3.5%, p < 0.001), and 5-years (3.7 vs 4.7%, p < 0.001). In the Cox proportional hazards model, we found that patients who underwent an open groin hernia repair were significantly less likely to experience operative recurrence (HR 0.86, 95% CI 0.79–0.93). Conclusions: In this study, we found that open groin hernia repair was associated with a lower risk of operative recurrence over time. While this may be related to patient comorbidity and age at the index operation, future work should focus on the impact of surgeon volume on outcomes in the modern era. [ABSTRACT FROM AUTHOR]

Littre hernia is a rare type of hernia in which a Meckel diverticulum is found in the hernia sac. Given the rare nature of this disease, little data on demographics and surgical management exists. In this article, we provide a case report of a strangulated inguinal Littre hernia and perform a systematic review of the literature. The PubMed database was searched on 5 March 2022, and all cases of Littre hernia in adults that had English abstracts or full-text were analyzed. Our primary objective was to evaluate the surgical management and outcomes of this particular type of hernia, and our secondary objectives were to assess demographic characteristics, presentation particularities, and recurrence rates. We identified 89 articles with 98 cases, including our own. Results show a high prevalence of complications described intraoperatively, with strangulation being present in up to 38.46% of patients. The laparoscopic approach was utilized in patients with femoral, inguinal, and umbilical hernias. The most commonly performed type of resection was MD resection, followed by bowel resection, while a minority of cases (5.48%) remained unresected. Mesh repair was more frequently performed in patients with MD resection. A mortality rate of 8.7% in patients who underwent bowel resection was found. A relatively high number of reports of ectopic tissue (21.21%), ulceration (12.12%), and tumors (9.09%) were found. The average follow-up was 19.5 ± 10.29 months, with no hernia recurrence. In conclusion, most cases are admitted in an emergency setting, and intestinal obstruction is frequently associated. A minimally invasive approach can be an option even for complicated hernias. MD resection or bowel resection is usually employed, depending on the extent of ischemic lesions. Patients undergoing bowel resection may be prone to worse outcomes. [ABSTRACT FROM AUTHOR]

Nerve damage has been implicated in chronic groin pain, particularly iliohypogastric, ilioinguinal, and genital branches of genitofemoral nerves. We investigated whether three nerve identification (3N) and preservation is associated with decreased pain 6 mo after hernia repair compared to two common strategies of nerve management: ilioinguinal nerve identification (1N) and two nerve identification (2N). We identified adult inguinal hernia patients within the Abdominal Core Health Quality Collaborative national database. Six-month postoperative pain was defined using the EuraHS Quality of Life tool. A proportional odds model was used to estimate odds ratios (ORs) and expected mean differences in 6-month pain for nerve management while adjusting for confounders identified a priori. Four thousand four hundred fifty one participants were analyzed; 358 (3N), 1731 (1N), and 2362 (2N) consisting mostly of White males (84%) over the age of 60 y old. Academic centers identified all three nerves more often than ilioinguinal or two nerve identification methods. Median 6-month postoperative pain scores were 0 [interquartile range 0-2] for all nerve management groups (P = 0.51 3N versus 1N and 3N versus 2N). There was no evidence of a difference in the odds of higher 6-month pain score in nerve management methods after adjustment (3N versus 1N OR: 0.95; 95% confidence interval 0.36-1.95, 3N versus 2N OR: 1.00; 95% confidence interval 0.50-1.85). Although guidelines emphasize three nerve preservation, the management strategies evaluated were not associated with statistically significant differences in pain 6 mo after operation. These findings suggest that nerve manipulation may not contribute as a significant role in chronic groin pain after open inguinal hernia repair. [ABSTRACT FROM AUTHOR]

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

In equine practice, inguinal hernia is a common disease and can be either acquired (direct) or congenital (indirect). This retrospective study aimed to describe the presentation and surgical management of acquired inguinal/scrotal herniation in 11 working donkeys (nine intact males, one gelding, and one female). All donkeys had a unilateral acquired inguinal/scrotal hernia, which was noticed by the owner for a period of two to 24 weeks. All the swellings were reducible, painless, not accompanied by an acute abdomen. Ultrasonography, rectal, and clinical examination are useful tools for the diagnosis of inguinal/scrotal hernias in donkeys. Eight animals underwent successful inguinal herniorrhaphy with the removal of the testicle at the affected side, and the superficial inguinal ring was closed by application double-layer polypropylene mesh. The recovery period ranged from 14 to 25 days (average, 16.8 ± 2.8 days). All donkeys released from the clinic returned to their previous levels of exercise. Our study showed that acquired inguinal or scrotal herniation in donkeys is not a clinical emergency requiring prompt intervention. To the best of our knowledge, this is the first report describing this condition in donkeys. [ABSTRACT FROM AUTHOR]

Introduction: Amyand's hernia is defined as an inguinal hernia, containing the appendix in the hernia sac. It is a rare form of hernia. Its management is increasingly codified. Clinical history: A 5-year-old patient with a non-remarkable past history was brought for consultation with an intermittent inguino-scrotal swelling and discomfort. Clinical examination revealed a non-tender inguino-scrotal swelling with positive transillumination. A conclusion of a communicating hydrocele was made; hence, an indication for surgery. Per operatively, we had as findings the appendix present within, and linked to the hernia sac. We performed an appendectomy and a high ligation of the hernia sac. The post-operative evolution was favourable. Anatomopathological analysis revealed a catarrhal appendix. Conclusion: Amyand's hernia remains a rare pathology that can be seen in children with a persistent peritoneo-vaginal canal. Dissection of the hernia sac must be carried out carefully since it is most often discovered intraoperatively and accidental injury to the appendix, which is attached to the wall of the hernia sac can lead to serious complications. [ABSTRACT FROM AUTHOR]

Sciatic hernia is a rare type of pelvic floor hernia. The herniated tissue can include the ureter, small and large bowel, and ovary, among other tissues. Only a few cases of laparoscopic treatment for a sciatic hernia with small-bowel incarceration have been reported. We report our experience using a laparoscopic approach for treatment of sciatic hernia in an 83-year-old woman and review the literature on sciatic hernias. The patient was referred to our hospital complaining of constipation and abdominal bloating. Computed tomography (CT) scanning showed a right sciatic hernia containing the small bowel. Laparoscopic repair of the sciatic hernia was performed using a self-fixating mesh. The patient was discharged after an uneventful postoperative course and has not developed abdominal bloating or constipation postoperatively. In conclusion, a sciatic hernia was successfully repaired using a laparoscopic trans-preperitoneal approach and ProGrip Self-Fixating Mesh. [ABSTRACT FROM AUTHOR]

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

Background: The Fellowship Council (FC) is a robust accreditation body with numerous fellowships; however, no specific criteria exist for hernia fellowships. This study analyzed the case log database to evaluate trends in fellowship exposure to hernia repairs. Methods: FC hernia case log records (2007–2019) were coded as inguinal or ventral hernias and with or without mesh repair. Retrospective analysis examined total hernia repairs logged, type of repair, program designation, and robotic adoption. Robotic adoption was categorized by quartiles of program performance according to the final year of analysis (2018–2019); yearly performance was then graphed by quartiles. Results: Over this twelve-year period, 93,334 hernia repairs, 5 program designations, 152 unique programs and 1,558 unique fellows were analyzed. The number of fellows grew from 106 (2007–2008) to > 130 (2018–2019). Total hernias repairs per fellow increased from an average of 41.2 in 2007–2008 to 75.7 in 2018–2019 (183.7%). Open and robotic hernia repairs increased by 241.9% and 266.3%, respectively; laparoscopic hernia repairs decreased by 14.8%. Inguinal and ventral hernia repairs comprised 48.1% and 51.9% of total cases, respectively. Advanced GI/MIS and Advanced GI/MIS/Bariatrics programs logged the majority of hernia repairs (86.0–90.2%). 2014 began an exponential rise in robotic adoption, with fellows averaging < 1 robotic repairs before and > 25 repairs in 2019. A significant difference was found between all groups when comparing quartiles of robotic adopters (median robotic repairs per fellow; IQR): first quartile (72.0; 47.9–108.8), second quartile (25.5; 21.0–30.6), third quartile (13.0; 12.0–14.3) and fourth quartile (3.5; 0.5–5.0) (p-value < 0.05). Conclusions: This twelve-year analysis shows a near doubling in the growth of total hernia repairs, with a decrease in laparoscopic repairs as robotic repairs increased. These data show the importance of hernia repairs in FC fellows' training and warrant further granular analysis to determine specific accreditation criteria for hernia fellowship designations. [ABSTRACT FROM AUTHOR]

Background: Emergency presentations of hernias can pose significant morbidity. In addition, providing optimal surgical intervention can be challenging due to patient and disease factors with multiple treatment modalities available. Recently there have been several guidelines written to help standardize practices in hernia management. The aim of our study was to review emergency hernia operations at our tertiary level teaching hospital, the method of repair and how this matched to international guidelines. Methods: We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3‐year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage. Results: A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%). Conclusion: Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias. [ABSTRACT FROM AUTHOR]

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

Introduction: Among the hospital acquired infections, Surgical Site Infection (SSI) still remains as the major problem for surgeons. Inguinal hernia surgeries are considered as clean surgeries, incidence of SSI in posthernioplasty is found to be 3.1%-4.5%. But in tertiary care centres in developing countries like India incidence is found to be high 11-14%. Aim: The aim of the present study was to compare the efficacy of preoperative single dose ceftriaxone infiltration at the incision site and preoperative Intravenous ceftriaxone only in preventing SSI in hernioplasty. Materials and Methods: A prospective interventional study was conducted at SRM Medical College and Research Institute, Chengalpattu, Tamil Nadu, from May 2021 to October 2022 for a duration of 18 months in 100 Patients, who attended the surgical outpatient block or other known cases of inguinal hernia who were referred to the surgery department from other departments. They were divided into group A or group B randomly. Hernioplasty was done on these groups, preoperative, intraoperative and postoperative wound swab was sent for these patients. Postoperatively patients were followed up on 3rd, 7th and 14th day and assessed for development of SSI. The continuous variables were presented as mean and SD. The categorical variables were expressed in percentages. The significance of continuous scale data between two groups were determined using student t-test. The Chi-square/Fischer's-exact test was used to evaluate the significance of the categorical data analysed. Data analysis was computed using Statistical Package for Social Sciences (SPSS) version 27 and Microsoft excel office 2019. Results: Male preponderance was seen 91% in inguinal hernias. Most of the patients belonged to the age group of 41-60 (54%) years of age. Ten patients (20%) developed SSI who got i.v. antibiotic injection but only three patients (6%) developed SSI who got intraincisional antibiotic injection with a p-value of 0.037 (<0.05) showing significance. One patient developed haematoma for with re-exploration was done on Postoperative Day (POD) #3. Two patients developed wound gapping for which secondary suturing was done on POD #7 and suture removal was done on POD #21. For rest of the all the patient's suture removal was done on POD #14. Intraopertive and postoperative and organism growth was seen only in the 13 patients who developed SSI. Most common organism isolated was staph, Aureus (38.5%, 5 cases). All 13 patients who developed SSI had some co-morbidity. Out of the 13 patients who developed SSI 11 patients (84%) had surgery for more than 30 minutes. Mean hospital stay was 3-5 days (87%). Conclusion: In the present study, there was significant reduction in incidence of SSI in the group, which received preoperative single dose Intraincisional ceftriaxone than the other group which received only preoperative intravenous ceftriaxone. Preoperative intraincisional antibiotics significantly reduces the rate of SSI because of the higher concentration achieved at the incision site. [ABSTRACT FROM AUTHOR]