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Background: It is important to determine how well-informed sports fans are about inguinal hernias and what variables put them at risk for getting one. Methodology: Study conducted from August 2023 to December 2023. The approved online survey was distributed on social media platforms throughout Saudi Arabia. Results: Of the 459 people who took part in our study, 52.1% were men and 44.9% were between the ages of 20 and 30. The distribution of participants with high, average, and poor knowledge and awareness yielded 11%, 56%, and 33%, respectively. Unmarried women under the age of 40 exhibit a higher and average understanding of hernia compared to married men over the age of 40, with a comparison rate of 73. % vs. 56%, p=.001, 77% vs. 57%, p=.001, 69.6% vs. 60.3%, p=.001, respectively. Conclusion: There is sufficient understanding, familiarity, and knowledge regarding hernias and the factors that put individuals at risk among those involved in sports and fitness. It is advisable for married men aged 40 and above to acquire knowledge regarding hernias and the various factors that contribute to their susceptibility. Healthcare providers should give priority to this specific population when providing education on inguinal hernias to patients [ABSTRACT FROM AUTHOR]

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

Background: Postoperative internal hernias after Roux-en-Y gastric bypass (RYGB) have an incidence of 2%-9% and are a surgical emergency. Evidence on factors associated with length of stay (LOS) after emergent internal hernia reduction in RYGB patients is limited. Methods: This is a retrospective review of patients who underwent internal hernia reduction after RYGB at our tertiary care center over a 5 year period from 2015 to 2020. Demographics, comorbidities, and intra- and postoperative hospital course were collected. Univariate and multivariate linear regressions were used to investigate factors associated with LOS. Results: We identified 38 patients with internal hernia after RYGB. These patients with mean age 44.1 years were majority female (71.1%) and white race (60.5%). Of the 24 patients where the RYGB was done at our institution, the mean RYGB to IH interval was 43 months. Petersen's defect (57.8%) followed by jejuno-jejunal mesenteric defect (31.6%) were the most common locations for IH. Both Petersen's and jejuno-jejunal mesenteric hernias were found in 4 cases (10.5%). Revision of bypass and small bowel resection were required in 13.2% and 5.3% of cases, respectively. The median (interquartile range) length of stay (LOS) was 2 days. On the multivariate analysis, male sex (P =.019), conversion to exploratory laparotomy (P =.005), and resection of small bowel (P <.001) were independent risk factors for increased LOS. Conclusion: The most common location of IH after RYGB is Petersen's defect, followed by jejuno-jejunal mesenteric defect. LOS was significantly associated with male sex, exploratory laparotomy, and resection of small bowel. [ABSTRACT FROM AUTHOR]

Sternal luxation/dislocation is a rare condition and is most often the result of trauma. Medical and surgical management have been described, with scarce information regarding the best treatment option for these cases. A 1-year-old domestic shorthair cat was presented for severe sternal dislocation and a left humeral fracture. Given the displacement observed at the level of the sternum and pain associated, surgical stabilization was elected. A partial lung lobe hernia was identified during the open stabilization of the sternum. Management of the hernia and sternal luxation stabilization were performed with the aid of video-assisted thoracoscopy. The cat recovered uneventfully, and no postoperative complications were reported. [ABSTRACT FROM AUTHOR]

This document consists of several abstracts on various topics related to hernia repair and abdominal wall reconstruction. The abstracts cover different surgical techniques, materials used, complications, long-term outcomes, the impact of the COVID-19 pandemic, and environmental sustainability. The studies provide valuable information for library patrons conducting research on hernia repair and abdominal wall reconstruction, offering insights into different aspects of the procedures and their outcomes. [Extracted from the article]

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]

Objectives: This study aimed to evaluate the outcomes of laparoscopic inguinal hernia repair (LIHR) regarding postoperative pain, recurrence rates, duration of hospital stay and other postoperative outcomes within the context of a tertiary care teaching hospital in South India, and the initial experience of laparoscopic repairs. The current consensus in the literature often suggests LIHR as superior to open inguinal hernia repair (OIHR). Methods: This single-centre, retrospective, observational study was conducted at the Jawaharlal Institute of Postgraduate Education and Research, Puducherry, India, from January 2011 to September 2020. All patients who underwent elective OIHR and LIHR were included. Data on the patients demographics, comorbidities, hernia type, mesh characteristics, surgery duration, hospital stay and immediate postoperative complications were collected and analysed. Results: A total of 2,690 OIHR and 158 LIHR cases were identified. The demographic profiles, hospital stay and complication rates were similar in both groups. However, surgical site infection was present exclusively in the OIHR group (3.55% versus 0.0%; P <0.05). The timeline for returning to normal activities was statistically shorter for the LIHR group (6 versus 8 days; P <0.05). The most frequent immediate complication in the LIHR group was subcutaneous emphysema (6.54% versus 0.0%; P <0.05). Recurrence (9.23% versus 3.61%; P = 0.09) and chronic pain (41.53% versus 13.55%; P <0.05) were higher in the LIHR group. Conclusion: Lower recurrence and chronic pain rates were observed with OIHR in the initial experience with LIHR in the hospital. However, LIHR had significant advantages concerning faster patient recovery and lower rates of surgical site infections. While the results contribute an interesting deviation from the standard narrative, they should be interpreted within the context of a learning curve associated with the early experience of the research team with LIHR. [ABSTRACT FROM AUTHOR]

Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information. [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]

Key Clinical Message: Incidence of bilateral inguinal hernia encompassing bilateral ovaries in adult female is very thin and concomitant association with Mayer–Rokitansky–Küster–Hauser syndrome is out of ordinary. Along with surgical management of hernia, these females need multidisciplinary slant to manage gynecological, social, and emotional issues. In mature females, bilateral ovarian inguinal hernias are a rarity. In this situation, ultrasonography is the basic adjunct to confirm the diagnosis. Mayer–Rokitansky–Küster–Hauser syndrome is typically linked to ovarian hernias in grown‐up females. The most important ways to avoid problems are early diagnosis and surgical repair. A 25‐year‐old lady presented to our outpatient clinic with a history of swelling in bilateral inguinal region for 1 month. On the ultrasound examination, the right ovary was visualized in the right high inguinal canal, and the left ovary was seen at the level of deep inguinal ring with no visualization of the uterus in its normal anatomical position. The patient underwent bilateral inguinal exploration under spinal anesthesia, and herniated contents were successfully reduced back to anatomical locations. Clinical care for such a clinical condition must be multifaceted, involving intensive counseling, relocating the uterus, fallopian tube, and ovary to preserve fertility, and preventing consequences like incarceration and strangulation. [ABSTRACT FROM AUTHOR]

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Female sex has been associated with worse outcomes after groin hernia repair (GHR), including a higher rate of chronic pain and recurrence. Most of the studies in GHR are performed in males, and the recommendations for females extrapolate from these studies, even though females have anatomy intricacies. The round ligament of the uterus (RLU) is associated with pelvic stabilization and plays a role in sensory function. Transection of the RLU during GHR is controversial as it can allow easier mesh placement but can favor genitourinary complications and chronic pain. As no previous meta-analysis compared preserving versus transecting the RLU during minimally invasive (MIS) GHR, we aim to perform a systematic review and meta-analysis evaluating surgical outcomes comparing the approaches. Methods: Cochrane Central, Embase, and PubMed databases were systematically searched for studies comparing transection versus preservation of the RLU in MIS groin hernia surgeries. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, chronic pain, paresthesia, recurrence rates, and genital prolapse rates. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics. A review protocol for this meta-analysis was registered at PROSPERO (CRD 42023467146). Results: 1738 studies were screened. A total of six studies, comprising 1131 women, were included, of whom 652 (57.6%) had preservation of the RLU during MIS groin hernia repair. We found no statistical difference regarding chronic pain, paresthesia, recurrence rates, and postoperative complications. We found a longer operative time for the preservation group (MD 6.84 min; 95% CI 3.0–10.68; P = 0.0005; I2 = 74%). Conclusion: Transecting the RLU reduces the operative time during MIS GHR with no difference regarding postoperative complication rates. Although transection appears safe, further prospective randomized studies with long-term follow-up and patient-reported outcomes are necessary to define the optimal management of RLU during MIS GHR. [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]

Background: Amyand's hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand's hernia. Case presentation: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand's hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months. Conclusions: Unlike the traditional definition of Amyand's hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand's hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy. [ABSTRACT FROM AUTHOR]

This case series highlights the importance of a thorough differential diagnosis in patients with groin swelling, often mistaken for inguinal hernias. It presents three patients with groin swelling initially suspected of having inguinal hernias but diagnosed differently upon further investigation. Patient 1 had a recurrence of endometrial adenocarcinoma in the right groin, Patient 2 had penile carcinoma with left inguinal metastasis, and Patient 3 had a metastasis of prostate carcinoma in the left groin. These cases underline the need to consider various pathologies beyond the common diagnosis of inguinal hernia. Accurate diagnosis requires a careful clinical examination and appropriate diagnostic tools, ensuring correct treatment. [ABSTRACT FROM AUTHOR]

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

Introduction: The dissection of the preperitoneal space is performed using a monopolar instrument to prevent bleeding in laparoscopic transabdominal preperitoneal hernia repair (TAPP). It may also cause energy injuries and nerve damage. Aim: To assess the effectiveness and safety of dissection of the preperitoneal space without electrocoagulation (DPSWE) in TAPP throughout the process. Material and methods: A retrospective analysis of data of 134 patients was made. The electrocoagulation group (EG) relied on monopolar instruments. In the non-electrocoagulation group (NEG) mainly scissors were used without electrocoagulation. The patients were followed for up for 3 months. Intraoperative and postoperative conditions and other complications were observed. Results: The VAS scores in the NEG were lower than those in the EG (p < 0.05). The operation time in the NEG was shorter than that in the EG (p < 0.05). Hospitalization expenses, scrotal seroma formation, and rupture of hernia sac in the NEG were lower than those in the EG (p < 0.05). The intraoperative bleeding volume above 20 ml in the NEG was higher than that in the EG. There was no significant difference in the incidence of postoperative bleeding, vas deferens injury, intestinal injury, surgical site infection, length of hospital stay, urinary retention and hernia recurrence in the NEG and the EG (p > 0.05). There was no significant difference in the incidence of surgical site infections (SSIs) in the NEG and the EG. Conclusions: DPSWE is effective and safe. DPSWE may reduce postoperative pain and have no significant increase in postoperative bleeding. [ABSTRACT FROM AUTHOR]

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

Purpose: This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC). Method: From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2–5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence. Result: Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0–38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament. Conclusion: The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed. [ABSTRACT FROM AUTHOR]

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

Amyand's hernia is a rare condition, in which the appendix is found in the inguinal hernia sac. Many patients remain asymptomatic and this pathological condition is most commonly diagnosed intraoperatively. We report a case of a 66-year-old male who was admitted to the hospital for an inguinal hernia repair and the presence of the appendix in the inguinal hernia sac was discovered intraoperatively. We performed a reduction of the appendix in the abdominal cavity and a hernia repair with a mesh and a plug. There are few studies in literature about the appropriate method of treatment and, because of that, the therapeutic approach remains controversial. Therefore, we also conducted a review of the literature in order to obtain some conclusions regarding the management of Amyand's hernia. [ABSTRACT FROM AUTHOR]

Purpose: The use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited. The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique. Methods: A retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022. Perioperative variables and short- and long-term outcomes were examined. Statistical analysis was performed using chi-square test for nominal variables and Student's t test for continuous ones. A p value < 0.05 was considered statistically significant. Results: Sixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group. Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023). Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate. Conclusions: Emergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the value of ultrasonography in predicting metachronous contralateral inguinal hernia (MCIH) and diagnosing contralateral persistent processus vaginalis (CPPV) in children with unilateral inguinal hernia, a prospective study was conducted. Methods: All participants underwent a preoperative ultrasound on the contralateral groin. Patients in group A1 received operating procedure according to ultrasound results (patients with negative contralateral US results received hernia repair on the affected side), and patients in group A2 received operation according to laparoscopic results (patients received hernia repair and CPPV ligation). All patients were followed up 2 years and compared to a historical control (group B) who underwent open hernia repair only on the affected side regardless of contralateral US results. Results: In groups A1 and A2, laparoscopic exploration revealed the presence of a CPPV in 490 cases. Ultrasound was found to be accurate in 104 out of the 490 cases with four false-positive and 386 false-negative results. This yielded an accuracy of 59.3%, a sensitivity of 21.2%, and a specificity of 99.2%. 10 patients in group A1, and 74 patients in group B developed MCIH. The accuracy, sensitivity, and specificity of the value of ultrasonography in predicting MCIH were 89.3%, 52.4%, and 92.5%, respectively. Conclusions: Preoperative ultrasonography of the contralateral groin is currently unable to accurately detect CPPV, but it appears to be a promising method in predicting MCIH by using rigorous diagnosing criteria. [ABSTRACT FROM AUTHOR]

Most abdominopelvic structures can find their way to a groin hernia. However, location, and relative fixation are important for migration. Gastric outlet obstruction (GOO) from a stomach-containing groin hernia (SCOGH) is exceedingly rare. In the current report, we present a 77-year-old man who presented with GOO from SCOGH to our facility. We performed a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) of patients presenting with SCOGH since it was first reported in 1802. Ninety-one cases of SCOGH were identified (85 inguinal and six femoral) over the last two centuries (1802–2023). GOO from SCOGH occurred in 48% of patients in one review and 18% in our systematic analysis. Initial presentation ranged from a completely asymptomatic patient to peritonitis. Management varied from entirely conservative treatment to elective hernia repair to emergent laparotomy. Only one case of laparoscopic management was documented. Twenty-one deaths from SCOGH were reported, with most occurring in early manuscripts (1802–1896 [n = 9] and 1910–1997 [n = 10]). In the recent medical era, outcomes for patients with this rare clinical presentation are satisfactory and treatment ranging from conservative, non-operative management to surgical repair should be tailored towards patients' clinical presentation. [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]

Aim: To evaluate the role of intraoperative local anesthetic use in the reduction of postoperative pain after totally extraperitoneal (TEP) hernia repair. Settings and design: Teaching hospital in Delhi, RCT. Materials and methods: 18-60-year-old men with unilateral inguinal hernia were randomized to either ropivacaine group (30) or placebo group (30) using a randomization sequence generated online. Port sites and preperitoneal space received either 0.75% ropivacaine or 0.9% saline (placebo). The primary outcome was numerical response scale (NRS) pain score at 6 hours after surgery. The secondary outcomes include NRS at 2 hours, 24 hours, and total analgesic requirement during the first postoperative week. The same surgeon using the same type of mesh performed all procedures using three midline ports and without mesh fixation. The patient, surgery team, and observer were blinded. Statistical analysis used: Shapiro--Wilk test of normality, median test for independent samples. Results: All patients underwent allocated procedure. There were no conversions. The baseline parameters were comparable in the two groups. The Shapiro--Wilk test of normality revealed that the data were not distributed normally. The median NRS at 6 hours was 3 (IQR 1, 3) in the ropivacaine group compared with 3 (IQR 1, 4) in the placebo group (p = 0.981, Independent samples median test). Similar comparable pain scores were obtained at 2 and 24 hours. No significant difference was noted in analgesic requirement in the first 24 hours, till postoperative day 7, time to ambulation or micturition between groups. Conclusions: Infiltration of port sites and preperitoneal space with ropivacaine does not reduce postoperative pain or analgesic requirement in TEP. Clinical significance: The use of local anesthetic agents intraoperatively has no added benefit in reducing postoperative pain in TEP hernia repair. [ABSTRACT FROM AUTHOR]

Inguinal hernias are more common in preterm and neonates and incidence of incarceration are reported to be more in the first 6 months of life. Strangulation follows incarceration and various incarcerated and strangulated contents having been reported in the sac. The fistulation of the herniated content through the scrotal skin is quite rare with only a few reported cases. We present the case of entero‑scrotal fistula in a neonate managed with staged repair along with a brief review of the literature. A 27-days-old, full-term male presented with faecal discharge from the right scrotum. He had no tell‑tale signs of obstructed hernia. A faecal fistulous opening was located in the right hemi‑scrotum. The terminal ileum was seen as the content with an antimesenteric perforation, divided ileostomy and scrotal debridement was done and later ileo-ascending anastomosis was performed electively. Neonatal hernias should be considered an urgency and we advocate early surgery. The resource‑limited setting and poor post‑natal surveillance may have added to the worries. In our case, swelling and fistulation occurred in a very brief period of 36 h. We managed the child with a diversion stoma followed by ileo-ascending anastomosis later. [ABSTRACT FROM AUTHOR]

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

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

Case 1 was a 67-year-old man and case 2 was an 85-year-old woman. Both patients experienced recurrent internal inguinal hernia after undergoing treatment for inguinal hernia using the Prolene Hernia System, and the transabdominal preperitoneal approach was successful. In recurrent cases, the extent of underlay patch expansion and adhesion is variable. Therefore, it is crucial to select an appropriate technique, such as the extent of dissection and the choice of mesh, based on intraoperative findings. [ABSTRACT FROM AUTHOR]

Inguinal hernia containing the vermiform appendix is a rare entity. It is more common in children than in adults. It can be discovered incidentally during the surgical intervention performed for the cure of the inguinal hernia or when the appendix shows inflammatory changes, a situation that can lead to diagnostic confusion with a number of other diseases. Imaging can guide the diagnosis, which often comes as an intraoperative surprise. The therapeutic approach is controversial both in terms of whether or not to perform an appendectomy in the case of an appendix without inflammatory changes and especially in terms of using a mesh during the hernia repair process. Since the pathology is not very frequent, there are no standardized stages in terms of surgical ethics that can guarantee good surgical practice. The study aimed to carry out a review of the specialized literature to obtain some conclusions or trends regarding the management of this pathology. The low frequency of this type of hernia did not allow the consultation of large-scale studies or extensive reviews focusing on case reports or case series communications. The obtained results were statistically analyzed and integrated in relation to the surgical attitude depending on the particularities of the condition. [ABSTRACT FROM AUTHOR]

Purpose: Open repair of groin hernia is an essential skill for the general surgeon. This study aimed to develop a low-cost hernia model based on a validated high-fidelity model and assess its effectiveness in teaching inguinal hernia repair to surgical trainees from many institutions throughout Africa. Methods: Using inexpensive, locally available materials, a low-cost hernia model was created. Six models were constructed, and a workshop was conducted for surgical residents. Pre- and post-workshop surveys were administered to assess knowledge, confidence, and understanding. Statistical analyses were performed using paired t tests and the Wilcoxon signed-rank test. Results: The low-cost hernia model consisted of various readily available materials and cost an average of $5.07. Sixty-eight trainees participated in the workshop, and 59 completed the post-workshop survey. Participants reported a significant increase in confidence for both mesh and non-mesh repairs and an improved understanding of hernia anatomy after the workshop. Trainees scored an average of 5.6 (SD 1.9) out of 10 questions on the pre-workshop quiz and 7.9 (SD 1.4) out of 10 on the post-workshop quiz (p < 0.001), indicating improved knowledge. All trainees supported the use of the model for education. Conclusion: The low-cost hernia model demonstrated its effectiveness in enhancing trainees' understanding of hernia anatomy and increasing their confidence in hernia repair. Integrating low-cost hernia models into training programs can help improve trainees' knowledge and confidence in a safe and affordable environment. [ABSTRACT FROM AUTHOR]

Background: Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. Methods: We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. Results: 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR − 1.02; 95% CI − 1.87, − 0.17; P = 0.02; I2 = 94%) and operative time (OR − 9.21; 95% CI − 16.82, − 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). Conclusions: Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to understand our center's experience with the rare entity of muscular groin hernias. Specifically, to determine this hernia's incidence and characteristics and provide valuable information to surgeons that can be utilized at the time of a hernia repair regardless of modality used. Methods: This was a retrospective chart review between 2005 and 2019. Patients who had a primary or recurrent groin hernia operation for an atypically located hernia (other than direct, indirect, or femoral) were included. Descriptive statistics were utilized to present the hernia and patient data as median (interquartile range, range). Results: There were 152 patients with 155 muscular hernias identified in primary operations and 41 patients with 41 muscular hernias identified in recurrent operations. In both primary and recurrent groups there were more males, and the males were on average younger with a higher body mass index (BMI) than females. Most muscular hernias were located lateral (76) or lateral/superior (33) to the internal ring with a median distance between 2 and 3 cm (1, 0.3–5; 2.8,2–5) from the internal ring. A concurrent ipsilateral inguinal hernia was found and repaired in 42.3% of left and 46.8% of right sided primary muscular hernia operations. A concurrent ipsilateral inguinal hernia was noted in 5% of left and 14.3% of right sided recurrent muscular operations. In left sided recurrent operations for a muscular hernia, 68.9% had a previous ipsilateral inguinal hernia repair and in right sided recurrent operations, 67.7% had a previous ipsilateral inguinal hernia repair. Conclusion: This study describes a previously unidentified groin muscular hernia in both primary and recurrent hernia operations as a potential cause of hernia recurrence and identifies muscular hernia locations. This information can be utilized at the time of surgery to identify and subsequently repair these defects, leading to improved patient and hernia outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Intestinal necrosis is a frequent complication in patients with incarcerated femoral hernias (IFH). Knowing the low incidence of IFH, few series with large samples studied predictive factors of intestinal necrosis. The main objectives of our study were to determine the predictive preoperative factors of intestinal necrosis in patients with IFH and to compare its morbidity with that related to incarcerate inguinal hernias (IIH). Methods: We conducted a retrospective observational cohort study in which we included patients with incarcerated groin hernias (IGH). This is a single-center study between January 2004 and December 2021. Patients were divided into two groups: group A (admitted for IFH) and group B (admitted for IIH). Intestinal necrosis was confirmed intraoperatively. Results: 383 patients with IGH were included in the study: 91 patients had IFH (23.76%) and 282 patients had IIH (76.24%). In patients with IFH, the median age was 67 years. We had 60 females (66%) and 31 males (34%). Bowel ischemia was present in 29 patients (32%). Bowel necrosis was present in 14 patients (16%). We identified three independent variables predicting bowel necrosis in patients with IFH: Duration from symptoms to surgery, NLR (Neutrophil to Lymphocyte ratio), and urea. Bowel ischemia and bowel necrosis were significantly higher in patients with IFH compared to those with IIH. Conclusions: In summary, we found that duration from symptoms to surgery, NLR, and urea were significantly predictive of intestinal necrosis in patients with IFH. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic review was to assess the inheritance of groin hernias. Methods: The primary outcome was to assess the inheritance based on the family history of groin hernias. We included studies that reported family history in patients with groin hernias, assessed the development of groin hernias in patients with a positive family history, or assessed the development of groin hernias in twins. Searches were conducted in PubMed, EMBASE, and Cochrane CENTRAL in November 2021. Results were synthesized narratively and with meta-analyses. Results: Twenty-two studies with unique participants were included. While two twin studies did not show convincing results of a genetic origin in children, database studies with low risk of bias showed that a positive history in parents or siblings increased the risk of inguinal hernia in children, and the risk was highest between mothers and daughters and between sisters. In adults, patients with inguinal hernia had higher odds of having a positive family history compared with patients without groin hernia (odds ratio 5.3, 95% confidence interval 3.3–8.7), and a nationwide study found the highest risk of inguinal hernia repair when a sister had been repaired compared with a brother. This study also found that having a sibling repaired for a groin hernia increased the risk of femoral hernia repair. Conclusion: Despite studies being heterogeneous, there is overwhelming evidence that a positive family history is a risk factor for developing inguinal hernia in both children and adults, seemingly with a pronounced female–female inheritance pattern. [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]

Objective: Rare disease. Background: Amyand hernia is a rare condition described as the presence of the appendix within an inguinal hernia. The clinical presentation of can be atypical, depending on the length of the defect's history and the size of the hernia. As inguinal hernia repair is considered a routine surgical procedure, giant hernias are mostly encountered in countries with limited medical care or with patient rejection of surgical management. Case Report: We report a case of a 56-year-old patient with a history of a chronic giant inguinal-scrotal hernia for more than 10 years who presented himself to the Emergency Department with acute pain in the scrotum and fever. Computed tomography revealed a perforated appendicitis located in the inferior part of the scrotum. The patient underwent a surgical procedure with an inguinal and middle laparotomy approach, revealing a full incarceration of the right and traverse colon, terminal ileal loop, and omentum, along with evidence of a perforated appendicitis. Standard appendectomy and direct hernia repair were successfully performed. Conclusions: To the best of our knowledge, this is the first case of a perforated appendicitis within a right giant inguinal hernia described in the modern English-language literature. Rare in our daily practice, giant hernias are a real challenge regarding their surgical management during and after surgery, making this case with a perforated appendicitis even more arduous. [ABSTRACT FROM AUTHOR]

Background: International guidelines of groin hernia treatment strongly recommend to fixate the mesh in large M3 medial defects during TAPP/TEP procedures. The main purpose of fixation is to decrease the recurrence rate which is alarmingly high in case of those defects. In 2022, a team consisting of hernia surgeons and scientists from universities of technology conducted an experimental study with the use of 3D groin model to verify the hypothesis that fixation is not necessary in above cases. Experiment showed that rigid and anatomically shaped meshes are able to maintain its position in the groin without fixation. Similar conclusions were recently published in Swedish database registry analysis. To confirm above results, we decided to conduct a multicenter randomized controlled trial. Methods: Main objective of MEFI Trial is to verify the hypothesis that non-fixation of spatial, standard polypropylene meshes is non-inferior to fixation of flat, polypropylene lightweight meshes in M3 hernias by laparoendoscopic approach. Eleven large surgery centers in Poland having proficiency in laparoendoscopic groin hernia repairs were recruited for this study. Recurrence in 12-month follow-up was set as a primary endpoint. Pain sensation (Visual Analog Scale) and incidence of other complications (hematoma, seroma, SSI) were also noted. Based on the statistical analysis, minimal sample size in both arms was established at 83–102. The first arm (control) consists of patients undergoing a repair with the use of a flat, macroporous mesh with fixation using histoacryl glue. In the second arm, patients will be operated with the use of anatomically shaped, standard-weight mesh without fixation. Study will be double-blinded (patient/surgeon). After the dissection of preperitoneal space, surgeon will open a sealed envelope and find out which technique he will have to perform. Follow-up will be performed by Study Secretary (also blinded to the method used) via phone call 3 and 12 months after surgery. Discussion: Based on experimental study and recent registry analysis, we believe that the recurrence rate in both groups would be on the same level, giving hernia societies a strong argument for amending the guidelines. Trial registration: ClinicalTrials.gov NCT05678465. Registered on 10 January 2023. [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]

Background: There is a paucity of data comparing open, robotic, and laparoscopic approaches on unilateral, non-recurrent inguinal hernias. Our study presents a large, retrospective triple-arm outcome analysis between robotic, laparoscopic, and open unilateral, non-recurrent inguinal hernia repairs at a single institution. Methods: 706 patients who underwent elective, non-recurrent inguinal hernia repair performed by 8 general surgeons at a single institution from 2016 to 2019 were reviewed retrospectively. Patient baseline characteristics, operative times, resident involvement, and postoperative outcomes were analyzed for all repair types. A cost analysis of the different procedures was performed. Results: There were 305 laparoscopic repairs, 207 robotic repairs, and 194 open repairs. Open and laparoscopic repairs were performed on patients who were older (p =<.001) and with a higher Charlson Comorbidity Index (p =<.001). Patient BMI was higher in minimally invasive repair than open repair (P =.021). There were no significant differences in complication rates on pairwise analysis. Robotic and open repairs had significantly longer operative times than laparoscopic repairs (P <.001). There was less resident involvement in robotic repair than with the other approaches (P <.001). Resident involvement was associated with shorter OR times (P =.001) and no significant difference in postoperative complications. There was a trend over the study period toward faster operative times and more robotic repair. Robotic repair is the most expensive repair, followed by laparoscopic and open repairs. Conclusion: All 3 repair techniques can be performed without significant differences in outcomes. The technique utilized should be based on surgeon preference and patient characteristics. [ABSTRACT FROM AUTHOR]

Background: Driving physician behavior change has been an elusive goal for quality improvement efforts aimed at reducing low-value care. We proposed the use of "nudge" interventions at the surgeon level in order to reduce post-surgical opioid overprescribing in accordance with consensus guidelines. Methods: We used 2017 Medicare data to identify outlier surgeons. A peer data benchmarking report that showed each surgeon the average number of opioid tablets they prescribed for an open inguinal hernia repair procedure from January 1, 2017 to December 31, 2017. We conducted a 1:1 randomized controlled trial providing outlier surgeons a report of their opioid prescribing patterns for a standard operation compared to the national average and prescribing guidelines. Results: There were 489 surgeons randomized to the intervention, of which 180 (36.8%) had data in the post-intervention period. Data was available for 87 surgeons in the intervention group and 93 surgeons in the control group. 97.7% of surgeons in the intervention group reduced their opioid prescribing pattern compared to 95.7% in the control group. Surgeons who received the data benchmarking report intervention prescribed 14.3% less opioids than surgeons in the control group (10.54 (SD 5.34) vs. 12.30 (SD 6.02), P =.04). The intervention was associated with a 1.83 lower mean number of opioid tablets prescribed per patient in the multivariable linear regression model after controlling for other factors (Intervention group vs. control group 95% CI [−3.61, −.04], P =.04). Discussion: The implementation of a peer data benchmarking intervention can drive physician behavior change towards high-value care. [ABSTRACT FROM AUTHOR]

Purpose: Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. Methods: Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. Results: A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). Conclusion: Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity. [ABSTRACT FROM AUTHOR]

Inguinal hernias are a widespread condition, responsible for a large number of acute abdomen cases. Typically, indirect, rather than direct, hernias lead to complications, as a consequence of their narrower hernial defect. We report a 71-year-old male patient with a rather rare incidence of a direct incarcerated hernia who presented with acute pain in the left inguinal area at a university general hospital in Thessaloniki, Greece, in 2017. Upon clinical examination, an irreducible inguinal mass was palpated. Therefore, the existence of a complicated hernia was suspected. The patient underwent an emergency repair, during which it was established that the hernia was direct and incarcerated and that its sac contained an ischaemic epiploic appendage. The hernia was successfully repaired with mesh, the patient recovered uneventfully and was discharged five days later. Despite the rarity of complicated direct inguinal hernias, they should always be included in the differential diagnosis of irreducible groin masses as they can increase severe complications. [ABSTRACT FROM AUTHOR]

A 5 mm port site hernia during laparoscopic surgery is rarer than a 12 mm port site hernia. Here, we report the case of a 5 mm port site hernia in an 85-year-old woman who underwent long-term steroid therapy and laparoscopic right nephrectomy. There was also a hernia at the port site where the drain was placed. Due to the 5 mm port at the drain removal site, fascial suturing was impossible after removal of the drain, and countermeasures were difficult. However, we believe that patients at a higher risk of port need suturing wound patients like this and should be carefully observed. [ABSTRACT FROM AUTHOR]

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

Epidermoid cysts of the canal of Nuck are an uncommon surgical cause of female inguinal enlargement when the processus vaginalis fails to close during embryologic development. The canal of Nuck, formed by the processus vaginalis in the inguinal canal, is a homolog of the processus vaginalis in men. The canal of Nuck should be considered in the differential diagnosis when a non reducible groin mass is observed in women and girls. Ultrasonography (USG) is the primary imaging modality that accurately and reliably diagnoses these groin masses. The incidence of pathologies is mainly encountered in young girls and is lower in adults. Various pathologic disorders related to the failure of processus vaginalis obliteration can occur, including the herniation of intraabdominal structures such as the uterus, fallopian tube, ovary and hydrocoele of the canal of Nuck. Hernias are often suspected in paediatric patients with lumps in the inguinal region. Here the authors, present a case of an epidermoid cyst of the canal of Nuck in a two-year-old female identified by USG and Magnetic Resonance Imaging (MRI). The two-year-old female underwent surgical treatment, and subsequent histopathologic evaluation of the cystic lesion revealed an epidermoid cyst. Due to its rarity, the epidermoid cyst of the canal of Nuck is commonly misdiagnosed as a typical groin mass. [ABSTRACT FROM AUTHOR]

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