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Background Methods Results Conclusion Groin hernia repair (GHR) is a performed procedure worldwide, with approximately 20 million surgeries carried out each year. Despite being less common in females, there is a lack of research on how sex influences the outcomes of GHR. This systematic review and meta‐analysis aim to assess how patient sex impacts results in GHR.We performed a systematic review and meta‐analysis according to Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines. We searched for studies up to October 2023 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The studies included focused on sex outcomes for both robotic and open GHR procedures. Data extraction and quality assessment were conducted using the Risk of Bias in Non‐Randomized Studies ‐ Of Interventions tool. Our statistical analysis was performed using the metafor package in RStudio.After screening a total of 3917 articles, we identified 29 studies that met our criteria, comprising a total of 1,236,694 patients. Among them, 98,641 (7.98%) patients were females. Our findings showed that females had higher rates of hernia recurrence (RR 1.28), chronic pain (RR 1.52), and surgical site infections (SSIs) (RR 1.46) compared to males. Females showed a lower tendency to undergo minimally invasive surgery (MIS) with a relative risk of 0.82 (95% CI 0.69–0.97; p = 0.02).Females tend to face higher rates of complications after GHR such as an elevated risk of chronic pain, recurrence, and surgical site infections (SSI). Moreover, they undergo fewer MIS options compared to males. These results underscore the importance of research to enhance outcomes for women undergoing GHR. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The surgical technique in large hiatal hernia (HH) repair is controversially discussed and the outcome measures and follow‐up schemes are highly heterogeneous. The aim of this study is to assess the true recurrence rate using computed tomography (CT) in patients with standardized large HH repair.Prospective single‐center study investigating the outcome after dorsal, mesh‐enforced large HH repair with anterior fundoplication. Endoscopy was performed after 3 months and clinical follow‐up and CT after 12 months.Between 2012 and 2021, 100 consecutive patients with large HH were operated in the same technique. There were two reoperations within the first 90 days for cephalad migration of the fundoplication. Endoscopic follow‐up showed a correct position of the fundoplication and no relevant other pathologies in 99% of patients. Follow‐up CT was performed in 100% of patients and revealed 6% of patients with a cephalad slippage, defined as migration of less than 3 cm of the wrap, and 7% of patients with a recurrent hernia. One patient of each group underwent subsequent reoperation due to symptoms. There was no statistical correlation between abnormal radiological findings and clinical outcomes with 69.2% of patients being asymptomatic. Multivariate logistic regression did not show any prognostic factor for an unfavorable radiologic outcome. Ninety‐four percent of patients rated their outcomes as excellent or good.Radiological follow‐up after large HH repair using CT allows to detect slippage of the fundoplication wrap and small recurrences. Patients with unfavorable radiological outcomes rarely require operative revision but should be considered for further follow‐up. [ABSTRACT FROM AUTHOR]

Background: Finding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass. Clinical presentation: We describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh. Discussion: Inguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents. Conclusion: This report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The Lichtenstein technique is the standard treatment for adult open inguinal hernia repair. Among the non‐mesh repair techniques, Shouldice has shown the best results and is comparable to mesh repairs in selected cases. Due to the risk of chronic groin pain associated with the Lichtenstein technique, Shouldice has increased in popularity, and some surgeons have adopted it as a viable first‐line option.MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for randomized controlled trials (RCT) published until February 2024. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random‐effects model. Heterogeneity was assessed using the Cochran Q test and I2 statistics with p‐values <0.10 and I2 > 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2.Fourteen RCTs comprising 2784 patients were included, of whom 1379 (47.5%) were submitted to the Shouldice hernia repair and 1513 (52.5%) to the Lichtenstein technique. Shouldice was associated with a significant increase in the recurrence rate (4.2% vs. 0.9%; RR 3.68; 95% CI 2.05–6.60; p < 0.001; I2 = 0%) compared with Lichtenstein. The number needed to treat (NNT) to prevent one Shouldice recurrence was 30.3. There were no significant differences between groups in chronic pain, urinary retention, bladder injury, testicular atrophy, wound infection, hematoma–seroma, or hypesthesia.The Lichtenstein technique was associated with reduced recurrence rates compared with Shouldice in patients undergoing inguinal hernia repair. However, the overall recurrence rate with the Shouldice technique was still low (4.2%), suggesting that it may be a viable option in selected patients. [ABSTRACT FROM AUTHOR]

This narrative review investigates the use of direct oral anticoagulants to treat patients undergoing surgical and nonsurgical procedures and the most effective management strategies for these medications based on the type of procedure, including elective, emergent, urgent, or semiurgent. Importance: Direct oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism. Observations: For elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures). For patients undergoing minimal bleeding risk procedures, DOACs may be continued, or if there is concern about excessive bleeding, DOACs may be discontinued on the day of the procedure. Patients undergoing a low to moderate bleeding risk procedure should typically discontinue DOACs 1 day before the operation and restart DOACs 1 day after. Patients undergoing a high bleeding risk procedure should stop DOACs 2 days prior to the operation and restart DOACs 2 days after. With this perioperative DOAC management strategy, rates of thromboembolism (0.2%-0.4%) and major bleeding (1%-2%) are low and delays or cancellations of surgical and nonsurgical procedures are infrequent. Patients taking DOACs who need emergent (<6 hours after presentation) or urgent surgical procedures (6-24 hours after presentation) experience bleeding rates up to 23% and thromboembolism as high as 11%. Laboratory testing to measure preoperative DOAC levels may be useful to determine whether patients should receive a DOAC reversal agent (eg, prothrombin complex concentrates, idarucizumab, or andexanet-α) prior to an emergent or urgent procedure. Conclusions and Relevance: When patients who are taking a DOAC require an elective surgical or nonsurgical procedure, standardized management protocols can be applied that do not require testing DOAC levels or heparin bridging. When patients taking a DOAC require an emergent, urgent, or semiurgent surgical procedure, anticoagulant reversal agents may be appropriate when DOAC levels are elevated or not available. [ABSTRACT FROM AUTHOR]

Background: The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. Case presentation: A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. Conclusions: This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key. [ABSTRACT FROM AUTHOR]

Purpose: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. Methods: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. Results: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25–38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. Conclusion: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion Parastomal hernia repair is a poorly evidenced area, with uncertainty around the optimum management. There is considerable heterogeneity within the patient cohort, and currently there is no standardization of patient descriptors in the reporting of parastomal hernia repair. The aim of this study was to develop a core descriptor set of key patient characteristics for patients undergoing surgical repair of a parastomal hernia for reporting in all parastomal hernia research.A longlist of descriptors was generated from a review of the existing literature. The longlist was discussed with patients with lived experience of parastomal hernia repair. Colorectal, general and hernia surgeons took part in a three‐round international modified Delphi process using a nine‐point Likert scale to rank the importance of descriptors. Items meeting predetermined thresholds were included in the final set and discussed and ratified at the consensus meeting.Seventy seven respondents completed round one, with 23 (29.8%) completing round three. Eighty six descriptors were rated across the three rounds, with 52 descriptors shortlisted. The consensus meeting ratified a final core descriptor set with 19 descriptors across eight domains: anatomy, contamination, disease, previous treatment, risk factors, symptoms, pathway and other hernia.The core descriptor set reflects characteristics that are important to surgeons when reporting on parastomal hernia repair. The use of this agreed core descriptor set may aid the reporting of future studies. [ABSTRACT FROM AUTHOR]

Background: Actinomycosis is a suppurative and granulomatous inflammation commonly caused by Actinomyces israelii. Due to its rarity and the paucity of characteristic clinical features, diagnosis of intra-abdominal actinomycosis is challenging, especially when the patient has a treatment history of abdominal cancer. Case presentation: The patient is a 72-year-old man who has a history of multiple abdominal surgeries for rectal cancer, including low anterior resection for primary rectal cancer, partial hepatic resection for metachronous liver metastasis, and Hartmann surgery for local recurrence. The patient has also undergone parastomal hernia repair using the Sugarbaker method. One year after hernia repair, computed tomography (CT) identified a mass lesion between the abdominal wall and the mesh, suggesting the possibility of peritoneal recurrence of rectal cancer. The accumulation of fluorodeoxyglucose (FDG) was evident via positron emission tomography-CT (PET-CT), while tumor marker levels were within the normal range. On laparotomy, the small intestine, abdominal wall, mesh, colon, and stoma were observed to be associated with the mass lesion, and en bloc resection was carried out. However, postoperative histopathological examination revealed an actinomyces infection without any cancerous cells. Conclusions: This case highlights the challenges faced by surgeons regarding preoperative diagnosis of actinomycosis, especially when it occurs after the resection of abdominal cancer. Also, this case reminds us of the importance of a histopathological examination for abdominal masses or nodules before starting chemotherapy. [ABSTRACT FROM AUTHOR]

This document contains summaries of several videos on colorectal surgery techniques. The videos cover a range of topics including rectal cancer surgery, pelvic exenteration, diagnostic tests, and surgical procedures for various conditions. The summaries provide information on the safety, feasibility, and efficacy of these techniques, as well as the importance of understanding anatomical variations. These videos offer valuable insights for researchers and library patrons interested in colorectal surgery. [Extracted from the article]

Introduction Inguinal hernia is the most frequently diagnosed hernia. It accounts for 75% of all abdominal wall hernias and has a lifetime incidence of 27% in males and 3% in women. Open inguinal hernia repair has long been the method of choice for most surgeons and is often recommended in contemporary literature as the optimal approach for primary unilateral inguinal hernia. Lichtenstein tension free mesh repair remains the standard criterion. It is known to be relatively simple and effective with minimal pain. Objective The aim of this study is to compare the efficacy of N-butyl cyanoacrylate glue with that of classical method of mesh fixation by suture in Lichtenstein tension free Inguinal Hernia repair in terms of chronic groin pain without increasing other complications. Methods A Prospective, Hospital based observational comparative study was planned, which includes 40 patients per group. All patients included were above 18 years of age. All the participants were divided into 2 groups mesh fixation with sutures and N-butyl cyanoacrylate glue. Total duration of the study was 3 months from the day of the surgery with 4 intervals of follow up at POD1, POD 7, Month 1 and Month 3. Results When comparing postoperative pain between the groups, it was observed that patients in the glue fixation group experienced significantly less pain than those in the suture group at various intervals: postoperative day 1 (POD1), postoperative day 2 (POD2), 1 month, and 3 months. Additionally, immediate pain was notably reduced in the glue fixation group. Furthermore, no reports of pain were recorded at 1 month and 3 months postoperatively. Moreover, the incidence of local complications was lower in the glue fixation group compared to the suture fixation group. Conclusion The use of N-butyl cyanoacrylate glue resulted in reduced immediate postoperative pain and quicker recovery times due to its less invasive nature and avoidance of tissue trauma associated with sutures. Additionally, the application of glue was found to be faster and technically easier, potentially reducing operation time with no recurrence. Conversely, traditional suture fixation, while reliable, was associated with higher postoperative discomfort and a slightly increased risk of complications such as chronic pain. [ABSTRACT FROM AUTHOR]

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

Background: To predict the quality of life following laparoscopic inguinal hernia repair, using Carolina Comfort Scale is used. Method:This study was a prospective observational study conducted at Government Medical College,Srinagar (tertiary care hospital). This study included 30 patients with inguinal hernias. Carolina Comfort Scale was used pre-operatively (modified for pre-operative use by omitting questions related to mesh). After proper consent 93.3% patients underwent TAPP and 6.7% patients underwent TEP by single surgeon. Dextile 3-D mesh was used in all patients which was fixed using tackers. Post operatively patients were followed up at 2 and 6 weeks CCS score was again assessed. Data was collected and statistical analysis was done. Result:All of the patients completed all three questionnaires. All of the patients were male. The mean age was 54.7 ±10.30 yrs. Half of the patients were having direct and the other half having indirect hernia.80% patients were having unilateral and 20% were having bilateral hernias.93.3% patients underwent TAPP and 6.7% TEP. It was found that there was significant improvement in quality of life following repair with p-value <0.001. Also it was found that patients having score of more than 20 pre-operatively were more likely to have persistent discomfort in post -operative period. Also patients having less score (< 10) pre-operatively were found to have high score at 2 weeks which reduced at 6 week. Conclusion:There was significant improvement in quality of life following laparoscopic inguinal hernia repair. Also, pre-operative score can predict the outcome after surgery. Hence this scale should be used preoperatively as well for counseling the patients. [ABSTRACT FROM AUTHOR]

Background: A ventral hernia is a protrusion of abdominal viscus through the anterior abdominal wall occurring at any site other than the inguinal and femoral areas and is a common problem encountered by surgeons. Objective: to know the clinical presentations of the ventral hernias, predisposing factors (risk factors) for the development of ventral hernias, different methods of surgical repair of the ventral hernias, complications following surgery and their follow-up. Methods: This was a prospective study was at Department of General Surgery, S S institute of Medical Sciences Davangere Karnataka between August 2020 and August 2021..Results: The youngest patient was 12 years old and the oldest was 76 years old. The mean age at presentation was 47 years. paraumbilical hernia (49%) was the most common variety followed by epigastric hernia (22%) and umbilical hernia (18%). Highest incidence is found in the 41-50 age group. Majority of the patients presented with swelling & Pain over& around the umbilicus or in the line of the scar of previous surgery. Paraumbilical hernia was the most common amongst the ventral hernias with an incidence of 46%. Of which, most occurred in infra-umbilical region. There is significant association between constipation smoking, obesity and occurrence of ventral hernia (p<0.001). 6% recurrence rate was observed after 1 year of follow up. Wound infection rate was 4%.3% with only repair and 1% with sublay repair. Conclusions: Apart from recurrence, other postoperative complications like seroma formation and wound infection attributed largely to extensive dissection and tissue handling during hernia repair.8 In present study, there was slightly more chance of seroma formation in onlay group, which may be due to extensive tissue dissection and increased blood loss. [ABSTRACT FROM AUTHOR]

Sir William Macewen, a Scottish surgeon, made significant contributions to neurosurgery, beginning with his successful brain tumor resection in 1879. Born in 1848, Macewen's upbringing in a maritime family fostered a practical approach to learning. Macewen's pivotal brain tumor surgery demonstrated his adherence to antiseptic practices and precise localization techniques. Controversy arose regarding his precedence in neurosurgery, which he addressed through meticulous documentation and public presentations. His diagnostic prowess extended to cases of cerebral abscesses and intracranial conditions, relying on clinical observations rather than imaging technology. His 1893 monograph on brain infections remains influential in neurosurgery. Beyond neurosurgery, Macewen was innovative in asepsis, hernia repair, and bone surgery. His legacy as a clinical educator and advocate for surgical advancements earned him widespread recognition. This historical review aimed to explore and evaluate the published literature regarding Macewen's early brain tumor surgeries, seeking to establish his precedence over later surgeons including Godlee and Bennett. [ABSTRACT FROM AUTHOR]

Purpose: As Japanese society ages, the number of surgeries performed in elderly patients with hiatal hernia (HH) is increasing. In this study, we examined the feasibility, safety, and potential effectiveness of the addition of anterior gastropexy to hiatoplasty with or without mesh repair and/or fundoplication in elderly Japanese HH patients. Methods: We retrospectively evaluated 39 patients who underwent laparoscopic HH repair between 2010 and 2021. We divided them into 2 groups according to age: the "younger" group (< 75 years old, n = 21), and the "older" group (≥ 75 years old, n = 18). The patient characteristics, intraoperative data, and postoperative results were collected. Results: The median ages were 68 and 82 years old in the younger and older groups, respectively, and the female ratio was similar between the groups (younger vs. older: 67% vs. 78%, p = 0.44). The older group had more type III/IV HH cases than the younger group (19% vs. 83%, p < 0.001). The operation time was longer in the older group than in the younger group, but there was no significant difference in blood loss, perioperative complications, or postoperative length of stay between the groups. The older group had significantly more cases of anterior gastropexy (0% vs. 78%, p < 0.001) and less fundoplication (100% vs. 67%, p = 0.004) than the younger group. There was no significant difference in HH recurrence between the groups (5% vs. 11%, p = 0.46). Conclusions: The addition of anterior gastropexy to other procedures is feasible, safe, and potentially effective in elderly Japanese patients with HH. [ABSTRACT FROM AUTHOR]

Introduction While previous studies have analyzed military surgeon experience within military–civilian partnerships (MCPs), there has never been an assessment of how well military providers are integrated within an MCP. The Center for Sustainment of Trauma and Readiness Skills, Cincinnati supports the Critical Care Air Transport Advanced Course and maintains the clinical skills of its staff by embedding them within the University of Cincinnati Medical Center. We hypothesized that military trauma surgeons are well integrated within University of Cincinnati Medical Center and that they are exposed to a similar range of complex surgical pathophysiology as their civilian partners. Materials and Methods After Institutional Review Board approval, Current Procedural Terminology (CPT) codes were abstracted from billing data for trauma surgeons covering University of Cincinnati Hospitals in 2019. The number of trauma resuscitations and patient acuity metrics were abstracted from the Trauma Registry and surgeon Knowledge, Skills, and Abilities clinical activity (KSA-CA) scores were calculated using their CPT codes. Finally, surgeon case distributions were studied by sorting their CPT codes into 23 categories based on procedure type and anatomic location. Appropriate, chi-squared or Mann–Whitney U-tests were used to compare these metrics between the military and civilian surgeon groups and the metrics were normalized by the group's full-time equivalent (FTE) to adjust for varying weeks on service between groups. Results Data were available for two active duty military and nine civilian staff. The FTEs were significantly lower in the military group: military 0.583-0.583 (median 0.583) vs. civilian 0.625-1.165 (median 1.0), P  = 0.04. Per median FTE and surgeon number, both groups performed a similar number of trauma resuscitations (civilian 214 ± 54 vs. military 280 ± 13, P  = 0.146) and KSA-CA points (civilian 55,629 ± 25,104 vs. military 36,286 ± 11,267; P  = 0.582). Although the civilian surgeons had a higher proportion of hernia repairs (P  < 0.001) and laparoscopic procedures (P  = 0.006), the CPT code categories most relevant to combat surgery (those relating to solid organ, hollow viscus, cardiac, thoracic, abdominal, and tissue debridement procedures) were similar between the surgeon groups. Finally, patient acuity metrics were similar between groups. Conclusion This is the first assessment of U.S. Air Force trauma surgeon integration relative to their civilian partners within an MCP. Normalized by FTE, there was no difference between the two groups' trauma experience to include patient acuity metrics and KSA-CA scores. The proportion of CPT codes that was most relevant to expeditionary surgery was similar between the military and civilian partners, thus optimizing the surgical experience for the military trauma surgeons within University of Cincinnati Medical Center. The methods used within this pilot study can be generalized to any American College of Surgeons verified Trauma Center MCP, as standard databases were used. [ABSTRACT FROM AUTHOR]

Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD—25.80 [min]; 95% − 34.31– − 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week. [ABSTRACT FROM AUTHOR]

Background: The da Vinci Single-Port Robot System (DVSP) allows three robotic instruments and an articulated scope to be inserted through a single small incision. It received FDA approval in 2014 and was first introduced in 2018. The aim of this new system was to overcome the limitations of single-incision laparoscopic and robotic surgery. Since then, it has been approved for use only for urologic and transoral surgeries in some countries. It has been used as part of experimental protocols in general surgery. Objective: By obtaining the CE mark at the end of January 2024, DVSP will soon enter the European market. This review aims to comprehensively describe the applications of DVSP in general surgery. Design: A search of PubMed, Embase, and Ebsco databases up to March 2024 was conducted, with registration in PROSPERO (CRD42024536430), following the preferred reporting items for Systematic reviews and Meta-analyses for scoping review (PRISMA-Scr) guidelines. All the studies about the use of DVSP in general surgery were included. Results: Fifty-six studies were included. The following surgical areas of use were identified: transabdominal and transanal colorectal, cholecystectomy, abdominal wall repair, upper gastroesophageal tract, liver, pancreas, breast, and thyroid surgery. The reported surgical and short-term outcomes are promising; a wide range of procedures have been performed safely. Some groups have found advantages, such as faster discharge, shorter operative time, and less postoperative pain compared to multiport robotic surgery. Conclusion: Five years after its initial clinical applications, the use of the DVSP in general surgery procedures has demonstrated feasibility and safety. Hernia repair, cholecystectomy, and colorectal surgery emerge as the most frequently conducted interventions with this robotic system. Nevertheless, there is anticipation for further studies with larger sample sizes and extended follow-up periods to provide more comprehensive insights and data on the long-term outcomes, including the incidence of incisional hernia. [ABSTRACT FROM AUTHOR]

Background: The repair of inguinal hernias is a common surgical procedure. Some patients will need a second operation after developing a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary unilateral surgery. In this systematic review we aim to determine how many adult patients with a unilateral inguinal hernia will develop a MCIH. Methods: This review was reported in line with PRISMA guidelines. We performed a literature review in PubMed Publisher, Embase, Google Scholar and Cochrane Library until May 2021, including articles reporting MCIH after unilateral inguinal hernia repair in adults. As outcome measure, the number of patients diagnosed with a MCIH was registered. Results: A total of 19 articles with a total of 277,288 patients were included. The combined estimate for MCIH after meta-analysis equaled 8.3% (95% CI 7.1%–9.5%), with a high index of heterogeneity (I2 = 97.9%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated at 5.2%, 8.0% and 17.1%, respectively. Conclusion: We suggest that there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. We propose a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement. [ABSTRACT FROM AUTHOR]

Background: The recurrence rate of paraesophageal hernia repair (PEHR) is high with reported rates of recurrence varying between 25 and 42%. We present a novel approach to PEHR that involves the visualization of a critical view to decrease recurrence rate. Our study aims to investigate the outcomes of PEHR following the implementation of a critical view. Methods: This is a single-center retrospective study that examines operative outcomes in patients who underwent PEHR with a critical view in comparison to patients who underwent standard repair. The critical view is defined as full dissection of the posterior mediastinum with complete mobilization of the esophagus to the level of the inferior pulmonary vein, visualization of the left crus of the diaphragm as well as the left gastric artery while the distal esophagus is retracted to expose the spleen in the background. Bivariate chi-squared analysis and multivariable logistic and linear regressions were used for statistical analysis. Results: A total of 297 patients underwent PEHR between 2015 and 2023, including 207 with critical view and 90 with standard repair which represents the historic control. Type III hernias were most common (48%) followed by type I (36%), type IV (13%), and type II (2.0%). Robotic-assisted repair was most common (65%), followed by laparoscopic (22%) and open repair (14%). Fundoplications performed included Dor (59%), Nissen (14%), Belsey (5%), and Toupet (2%). Patients who underwent PEHR with critical view had lower hernia recurrence rates compared to standard (9.7% vs 20%, P <.01) and lower reoperation rates (0.5% vs 10%, P <.001). There were no differences in postoperative complications on unadjusted bivariate analysis; however, adjusted outcomes revealed a lower odds of postoperative complications in patients with critical view (AOR.13, 95% CI.05–.31, P <.001). Conclusion: We present dissection of a novel critical view during repair of all types of paraesophageal hernia that results in reproducible, consistent, and durable postoperative outcomes, including a significant reduction in recurrence and reoperation. [ABSTRACT FROM AUTHOR]

Background: The surgical management of midline ventral hernias complicated by concomitant diastasis recti presents a significant clinical challenge. The Endoscopic Onlay Repair (ENDOR) offers a minimally invasive solution, effectively addressing both conditions. This study focuses on describing the adaptation of ENDOR to a robotic platform, termed R-ENDOR, aiming to report initial outcomes along with other established robotic surgical approaches. Methods: This retrospective case series study included consecutive adult patients who underwent R-ENDOR approach from October 2018 to April 2023, performed by a single surgeon. A comprehensive description of the surgical technique is included. Patient demographics, operative, and hernia-specific characteristics, as well as clinical outcomes are described. Results: A total of 15 patients undergoing R-ENDOR for ventral hernia repair with diastasis recti plication were included. The median age was 59 years (IQR 42–63), with 60% (n = 9) female patients. The majority (86%, n = 13) had an ASA score of ≤ 2, and the median BMI was 24 kg/m2, with 20% (n = 3) classified as obese. Median hernia size was 2 cm (IQR 2–2.25), with a median diastasis length of 19 cm (IQR 15–21.5) and width of 4 cm (IQR 3–6). The median operative time was 129 min (IQR 113–166). Most repairs (93%, n = 14) were reinforced with mesh, predominantly self-fixating (73.3%, n = 11). Eighty percent of patients (n = 12) were discharged on the same day, with a median follow-up of 153 days (IQR 55–309). Notable complications included clinically significant seromas in 20% of patients (n = 3), long-term hypoesthesia in 40% (n = 6), and readmission in one patient (6.6%) for surgical site infection (SSI) requiring IV antibiotic therapy. Conclusion: Midline ventral hernias associated to diastasis recti can be managed robotically by ENDOR with safe and consistent 90-day outcomes in a carefully selected group of patients. [ABSTRACT FROM AUTHOR]

Background: Hiatal hernia (HH) is a common condition. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of HH. Methods: Systematic reviews were conducted for four key questions regarding the treatment of HH in adults: surgical treatment of asymptomatic HH versus surveillance; use of mesh versus no mesh; performing a fundoplication versus no fundoplication; and Roux-en-Y gastric bypass (RYGB) versus redo fundoplication for recurrent HH. Evidence-based recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluations methodology by subject experts. When the evidence was insufficient to base recommendations on, expert opinion was utilized instead. Recommendations for future research were also proposed. Results: The panel provided one conditional recommendation and two expert opinions for adults with HH. The panel suggested routinely performing a fundoplication in the repair of HH, though this was based on low certainty evidence. There was insufficient evidence to make evidence-based recommendations regarding surgical repair of asymptomatic HH or conversion to RYGB in recurrent HH, and therefore, only expert opinions were offered. The panel suggested that select asymptomatic patients may be offered surgical repair, with criteria outlined. Similarly, it suggested that conversion to RYGB for management of recurrent HH may be appropriate in certain patients and again described criteria. The evidence for the routine use of mesh in HH repair was equivocal and the panel deferred making a recommendation. Conclusions: These recommendations should provide guidance regarding surgical decision-making in the treatment of HH and highlight the importance of shared decision-making and consideration of patient values to optimize outcomes. Pursuing the identified research needs will improve the evidence base and may allow for stronger recommendations in future evidence-based guidelines for the treatment of HH. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative prescription opioid use is a known risk factor for persistent opioid use. Despite the increased utilization of robotic-assisted surgery (RAS) for inguinal hernia repair (IHR), little is known whether this minimally invasive approach results in less opioid consumption. In this study, we compare long-term opioid use between RAS versus laparoscopic (Lap) versus open surgery for IHR. Methods: A retrospective cohort study of opioid-naïve patients who underwent outpatient primary IHR was conducted using the Merative™ MarketScan® (Previously IBM MarketScan®) Databases between 2016 and 2020. Patients not continuously enrolled 180 days before/after surgery, who had malignancy, pre-existing chronic pain, opioid dependency, or invalid prescription fill information were excluded. Among patients exposed to opioids peri-operatively, we assessed long-term opioid use as any opioid prescription fill within 90 to 180 days post-surgery. Secondary outcomes were controlled substance schedule II/III opioid fill, and high-dose opioid fill defined as > 50 morphine milligram equivalent per day. An Inverse-probability of treatment weighted logistic regression was used to compare outcomes between groups with p-value of < 0.05 considered statistically significant. Results: A total of 41,271 patients were identified (2070 (5.0%) RAS, 16,704 (40.5%) Lap, and 22,497 (54.5%) open surgery). RAS was associated with less likelihood of prescription fills for any opioid (OR 0.78, 95% CI 0.60 to 0.98 versus Lap; OR 0.67, 95% CI 0.52 to 0.85 versus open), and schedule II/III opioid (OR 0.74, 95% CI 0.56 to 0.96 versus Lap; OR 0.68, 95% CI 0.51 to 0.88 versus open), but comparable high-dose opioid fill (OR 0.95, 95% CI 0.54 to 1.55 versus Lap; OR 0.96, 95% CI 0.56 to 1.52 versus open). Lap and open surgery had no significant difference. Conclusion: In this cohort of patients derived from a national commercial claims dataset, patients undergoing RAS had a decreased risk of long-term opioid use compared to laparoscopic and open surgery patients undergoing IHR. [ABSTRACT FROM AUTHOR]

Background: Hiatal hernia (HH) is estimated to affect between 20 and 50% of patients undergoing bariatric surgery. However, there is no consensus regarding the preoperative assessment and intraoperative repair of HH. The aim of this study was to evaluate the variation in surgeon assessment and repair of HH during bariatric surgery across a multi-hospital healthcare system. Methods: A retrospective cohort analysis was conducted using data obtained from the metabolic and bariatric accreditation quality improvement program (MBSAQIP) and institutional medical records. All adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Preoperative assessment of HH was defined as either EGD or upper GI/Esophagram (UGI) within one year of surgery. Surgeons were evaluated individually and by hospital. Chi-square analysis and ANOVA were performed. Results: From January 2018 to February 2023, 3,487 bariatric surgeries were performed across 4 hospitals and 11 surgeons (2481 SG and 1006 RYGB). HH were concurrently repaired during 24% of operations. The rate of HH repair in SG was 25 and 22% in RYGB (p = 0.06). Preoperatively, 41% of patients underwent EGD and 23% had an UGI. HH was diagnosed in 22% of EGDs. Patients who underwent preoperative EGD had higher rates of HH repair than those without a preop EGD (33% vs. 17%; p < 0.001). The rate of preoperative EGD utilization by surgeon varied significantly from 3 to 92% (p < 0.001) as did HH repair rates between surgeons (range 8–57%; p < 0.001). Even among patients with a preoperatively diagnosed HH, the repair rate ranged 20–91% between individual surgeons (p < 0.001). Conclusion: Within a healthcare system there was significant heterogeneity in approach to assessment and repair of HH during bariatric surgery. This appears to be mediated by multiple factors, including utilization of preoperative studies, individual surgeon differences, and differences between hospitals. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, leading to bladder outlet obstruction (BOO) and associated urinary symptoms. With increasing life expectancy, the incidence of BPH and its co-morbidities, like inguinal hernia, has risen. This study explores the efficacy of combining transurethral resection of the prostate (TURP) and inguinal hernioplasty in a single surgical session to address both conditions, potentially reducing the need for multiple hospitalizations and surgical interventions. Methods: This retrospective study at Chi Mei Medical Center included patients from 2014 to 2023 who underwent concurrent TURP and inguinal hernioplasty. A total of 85 patients met the criteria defined for this study. Preoperative, intraoperative, and postoperative characteristics were meticulously documented. Outcomes evaluated included the duration of the surgery, incidence of intraoperative and postoperative complications, duration of Foley catheterization, length of hospital stay, and treatment efficacy. Additionally, we conducted a comparative assessment of the surgical outcomes between two distinct techniques for inguinal hernia repair: open hernioplasty and laparoscopic hernioplasty (LH). Results: In 85 patients who met the criteria, the mean age was 71.1 ± 7.8 years. The study reported no significant intraoperative complications, and postoperative care was focused on monitoring for blood loss, infection, and managing pain. The average postoperative hospital stay was 2.9 ± 1.0 days and the mean duration of catheterization was 51.6 ± 16.7 h, with a minimal complication rate observed during the one-year follow-up. A significant reduction in both operative duration and catheterization interval was observed in patients undergoing LH as opposed to those receiving open hernioplasty. Conclusion: Concurrent TURP and inguinal hernioplasty effectively manage BOO due to BPH and inguinal hernias with minimal complications, suggesting a viable approach to reducing hospital stays and surgical interventions. Laparoscopic techniques, in particular, offer benefits in operative efficiency and recovery time, making combined surgery a feasible option for selected patients. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair (IHR) is a common surgical procedure worldwide. Although IHR can be performed by the minimally invasive method, which accelerates recovery, postoperative urinary retention (POUR) remains a common complication that significantly impacts patients. Thus, it is essential to identify the risk factors associated with POUR to diminish its negative impact. Methods: We conducted a single-center retrospective review of elective IHR from 2018 to 2021. POUR was defined as the postoperative use of straight catheter or placement of an indwelling catheter to relieve the symptoms. Adjusted multivariate regression analysis was performed to address the associations of clinicodemographic, surgical, and intraoperative factors with POUR. Results: A total of 946 subjects were included in the analysis after excluding cases of emergent surgery, recurrent hernia, or concomitant operations. The median age was 68.4 years, and 92.0% of the patients were male. Twenty-three (2.4%) patients developed POUR. In univariate analysis, POUR in comparison with non-POUR was significantly associated with increased age (72.2 versus 68.3 years, P = 0.012), a greater volume of intraoperative fluid administered (500 versus 400 ml, P = 0.040), and the diagnosis with benign prostate hypertrophy (34.8% versus 16.9%, P = 0.025). In the multivariate model, both increased age (odds ratio [OR] 1.04, 95% CI 1.01–1.08; P = 0.049) and a greater volume of intraoperative fluid administered (OR 1.12 per 100-mL increase, 95% CI 1.01–1.27; P = 0.047) were significantly associated with the occurrence of POUR. Conclusions: We found that increased age and a greater volume of intraoperative fluid administered were significantly associated with the occurrence of POUR. Limiting the administration of intraoperative fluid may prevent POUR. From the perspective of practical implications, specific guidelines or clinical pathways should be implemented for fluid management and patient assessment. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernias are highly prevalent worldwide and its surgical repair is one of the most common procedures in general surgery. The broad use of mesh has decreased the recurrence rates of inguinal hernia to acceptable levels, thus centering the attention on Quality of Life as a pivotal postoperative outcome. Carolinas Comfort Scale is a well-studied questionnaire designed to identify Quality of Life changes following hernia repair with mesh techniques. The aim of this study is to validate the CCS in Brazilian Portuguese for inguinal hernias. Methods: The original CCS was translated into Brazilian Portuguese according to cross-cultural adaptation guidelines. We conducted a cross-sectional study in individuals aged 18 and above who had undergone inguinal laparo-endoscopic hernia repair for at least 6 months prior, between January 2019 and August 2022, at a Brazilian tertiary hospital. Participants answered an online survey containing the Brazilian CCS and the generic Patient-Reported Outcome Measure (PROM) Short-Form Health 36 (SF-36). Participants answered the same questionnaires in the follow-up after at least three weeks, with an additional question about satisfaction with surgery results. Results: The survey was completed by 115 patients, of whom 78 (67%) responded to the follow-up questionnaire after 3 to 10 weeks. CCS showed excellent internal consistency, with Cronbach's α of 0.94. Intraclass correlation coefficient ranged from 0.60 to 0.82 in the test-retest analysis. Compared to SF-36, a strong correlation was observed in the physical functioning dimension, and a moderate correlation was found in role-physical and bodily pain (Pearson's Coefficient Correlation = 0.502, 0.338 and 0.332 respectively), for construct analysis. The mean CCS score was significantly lower (p < 0.001) among satisfied patients compared to the unsatisfied ones. Conclusion: The Brazilian version of CCS is a valid and reliable method to assess long-term quality of life after inguinal laparo-endoscopic hernia repair. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the effects of preoperative listening to patient-preferred music and classical music on postoperative anxiety and recovery. Methods: A prospective, randomized controlled, single-blind study included 255 patients who were scheduled for elective inguinal hernia operation under general anesthesia. Spielberger state State-Trait Anxiety Inventory form 1,2 (STAI-I, STAI-II), Quality of Recovery Score-40 (QoR-40) were applied in the preoperatively. In the preoperative period, the preferential music group (group P) patients listened to their favorite music, while patients in the classical music group (group C) listened to classical music, music was not played in the control group (group N). STAI-I, QoR-40 questionnaire, pain status, and patient satisfaction in the postoperative period were recorded by a blinded investigator. Results: A total of 217 patients participated in the study analysis. Postoperative STAI-1 score was lower in group P than in group N (p = 0.025) and was similar among other groups. The postoperative QoR-40 score was significantly higher in group P than in group N (p = 0.003), and it was similar between the other groups. While SBP, DBP and HR premusic and post-music changes were significant, there was no difference in other groups. There was no difference between the groups in the NRS score. The patient satisfaction score was significantly higher in group P. Conclusions: Preoperative patient-preferred music application reduces postoperative anxiety and improves recovery quality compared to classical music. In addition, regulation of hemodynamic data and patient satisfaction increase in a preferential music application, but pain scores do not change. Trial registration: NCT04277559|https://www.clinicaltrials.gov/ [ABSTRACT FROM AUTHOR]

Purpose: To report perioperative and long-term postoperative outcomes of cystectomy patients with ileal conduit (IC) urinary diversion undergoing parastomal hernia (PSH) repair. Method: We reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence. Results: Thirty-six patients with a median (IQR) age of 79 (73–82) years were included. The median time between cystectomy and PSH repair was 30 (14–49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7–47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7–24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence. Conclusions: In this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches. [ABSTRACT FROM AUTHOR]

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

The treatment of parastomal hernias (PSH) represents a major challenge in hernia surgery. Various techniques have been reported with different outcomes in terms of complication and recurrence rates. The aim of this study is to share our initial experience with the implantation of the DynaMesh-IPST-R and -IPST, intraperitoneal funnel meshes made of polyvinylidene fluoride (PVDF). This is a retrospective observational cohort study of patients treated for PSH between March 2019 and April 2023 using the chimney technique with the intraperitoneal funnel meshes IPST-R or IPST. The primary outcome was recurrence and the secondary outcomes were intraoperative and postoperative complications, the latter assessed using the Clavien–Dindo classification. A total of 21 consecutive patients were treated with intraperitoneal PVDF funnel meshes, 17 with IPST-R and 4 with IPST. There were no intraoperative complications. Overall, no complications occurred in 61.9% (n = 12) of the patients. Major postoperative complications (defined as Clavien–Dindo ≥ 3b) were noted in four cases (19.0%). During the mean follow-up period of 21.6 (range 4.8–37.5) months, one patient (4.8%) had a recurrence. In conclusion, for the treatment of parastomal hernias, the implantation of IPST-R or IPST mesh has proven to be efficient, easy to handle, and very safe. In particular, the low recurrence rate of 4.8%, which is in line with the current literature, is convincing. However, a larger number of patients would improve the validity of the results. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for evaluating the efficacy of Intrathecal levobupivacaine and bupivacaine among patients undergoing inguinal hernia surgery under spinal anesthesia. Materials & methods: A total of 50 patients were enrolled and were randomized into two study groups as follows: Group 1- intrathecal isobaric levobupivacaine, and Group 2- intrathecal hyperbaric racemic bupivacaine. Complete demographic and clinical details of all the patients was obtained. Anthropometric examination of all the patients was done. Patients having history of any systemic illness, or any known drug allergy were excluded. Complete baseline hemodynamic and biochemical profile at baseline was evaluated. All the patients underwent type of spinal according to their respective study groups. Quality of anesthesia was assessed. Motor and sensory block characteristics were also evaluated. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients of the group 1 and group 2 was 43.8 years and 45.1 years respectively. Majority proportion of patients of both the study groups were males. Among patients of group 1, excellent and satisfactory anesthesia was seen in 84 percent and 16 percent of the patients respectively. Among patients of group 2, excellent and satisfactory anesthesia was seen in 88 percent and 12 percent of the patients respectively. Mean onset of sensory and motor block were similar for both the study groups. However; mean duration of motor block was significantly lower in group 1 (176.3 mins) in comparison to group 2 (191.7 mins). Conclusion: Levobupivacaine offered high quality of anesthesia among patients having spinal anesthesia with shorter duration of motor block, allowing quicker recovery. [ABSTRACT FROM AUTHOR]

Background: Hernia repair surgery is one of the most commonly performed surgical interventions worldwide, aimed at relieving symptoms and improving quality of life. Despite its prevalence, the impact on patient satisfaction and quality of life post-surgery remains a critical area of study. Methods: This study employed a prospective cohort design involving 200 patients who underwent hernia repair surgery. Data were collected preoperatively and at three months postoperatively to evaluate changes in patient satisfaction and quality of life. The Patient Satisfaction Questionnaire and the Hernia-Related Quality-of-Life Survey were utilized as the primary assessment tools. Results: The findings revealed significant improvements in both patient satisfaction and quality of life following hernia repair surgery. The majority of patients reported high levels of satisfaction with the surgical outcome and a marked improvement in their daily activities and pain levels. Conclusion: Hernia repair surgery significantly enhances patient satisfaction and quality of life. These outcomes underscore the importance of surgical intervention and provide a benchmark for patient expectations regarding hernia surgery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery has become a preferred choice for abdomino-pelvic procedures due to its advantages over open procedures, including smaller incisions, reduced postoperative pain, and faster recovery. Common laparoscopic surgeries at CDSIMER (Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research) in the Department of General Surgery include Laparoscopic Cholecystectomy, Laparoscopic Appendicectomy, and Laparoscopic Hernia Repair. However, the creation of pneumoperitoneum during laparoscopic surgery, achieved by insufflating carbon dioxide, can lead to increased intraperitoneal pressure and alterations in pulmonary function and hemodynamic measurements. This study aims to investigate the effects of pneumoperitoneum on liver enzymes and their clinical implications. Materials and Methods: This prospective study involved 134 patients undergoing various laparoscopic surgeries over six months at CDSIMER. Serum AST (Aspartate Aminotransferase) and ALT(Alanine Aminotransferase) levels were assessed preoperatively and twice postoperatively within the first and third days. Patients with preexisting liver disease, long-term use of hepatotoxic drugs, or complications such as CBD injury, obstruction, infection, leakage, or high-grade fever during or after surgery were excluded Results: Individuals who underwent normal pressure laparoscopic surgery, demonstrate higher AST and ALT values and greater variability compared to individuals, who underwent lowpressure laparoscopic surgery. This indicates potentially different levels of liver stress or damage between the two groups, possibly related to the surgical technique used. Conclusion: Laparoscopic surgery causes transient elevation in liver enzymes which directly correlated with intraperitoneal pressure used and duration of pneumoperitoneum Therefore low pressure laparoscopic surgery is ideal and should be preferred over high pressure wherever possible. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair is one of the most frequently performed elective surgeries in general surgery. However, this surgery may sometimes encounter complications such as incarceration and especially strangulation, which require urgent surgical intervention. In such emergency cases, severe conditions may occur, ranging from simple hernia repair to bowel resection, which may lead to high morbidity and even mortality. Parasitic infections occurring during or after surgery have rarely been reported in the literature. In this case report, we wanted to emphasize the importance of the Taenia saginata (T. saginata) helminth parasite removed by the nasogastric route. A 66-year-old female patient who came to the emergency room with complaints of nausea and vomiting was diagnosed with ileus due to an incarcerated hernia and, therefore, underwent small bowel resection. During aspiration of stomach content, a gastrointestinal parasite wrapped around a nasogastric tube was found. Macroscopic and microscopic examinations revealed that this parasite was T. saginata. After oral intake was deemed appropriate, anthelmintic treatment was administered, and the patient’s general condition improved, and she was discharged. It should be kept in mind that T. saginata parasitic infection, which cannot be detected in clinical and laboratory tests and occurs coincidentally, may contribute to the development of incarceration in inguinal hernia patients living in areas with low socio-economic status, especially where sanitation is inadequate, consumption of raw or undercooked meat is common. [ABSTRACT FROM AUTHOR]

Mesh-augmented hernia repair is the gold standard in abdominal wall and hiatal/diaphragmatic hernia management and ranks among the most common procedures performed by general surgeons. However, it is associated with a series of drawbacks, including recurrence, mesh infection, and adhesion formation. To address these weaknesses, numerous biomaterials have been investigated for mesh coating. Platelet-rich plasma (PRP) is an autologous agent that promotes tissue healing through numerous cytokines and growth factors. In addition, many reports highlight its contribution to better integration of different types of coated meshes, compared to conventional uncoated meshes. The use of PRP-coated meshes for hernia repair has been reported in the literature, but a review of technical aspects and outcomes is missing. The aim of this comprehensive review is to report the experimental studies investigating the synergistic use of PRP and mesh implants in hernia animal models. A comprehensive literature search was conducted across PubMed/Medline, Web of Science, and Scopus without chronological constraints. In total, fourteen experimental and three clinical studies have been included. Among experimental trials, synthetic, biologic, and composite meshes were used in four, nine, and one study, respectively. In synthetic meshes, PRP-coating leads to increased antioxidant levels and collaged deposition, reduced oxidative stress, and improved inflammatory response, while studies on biological meshes revealed increased neovascularization and tissue integration, reduced inflammation, adhesion severity, and mechanical failure rates. Finally, PRP-coating of composite meshes results in reduced adhesions and improved mechanical strength. Despite the abundance of preclinical data, there is a scarcity of clinical studies, mainly due to the absence of an established protocol regarding PRP preparation and application. To this point in time, PRP has been used as a coating agent for the repair of abdominal and diaphragmatic hernias, as well as for mesh fixation. Clinical application of conclusions drawn from experimental studies may lead to improved results in hernia repair. [ABSTRACT FROM AUTHOR]

Introduction: Early after its adoption, minimally invasive surgery had limited usefulness in emergent cases. However, with improvements in equipment, techniques, and skills, laparoscopy in complex and emergency operations expanded substantially. This study aimed to examine the trend of laparoscopy in incarcerated or strangulated ventral hernia repair (VHR) over time. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for laparoscopic repair of incarcerated and strangulated hernias (LIS-VHR) and compared over 2 time periods, 2014-2016 and 2017-2019. Results: The utilization of laparoscopy in all incarcerated or strangulated VHR increased over time (2014-2016: 39.9% (n = 14 075) vs 2017-2019: 46.3% (n = 18 369), P <.001). Though likely not clinically significant, demographics and comorbidities statistically differed between groups (female: 51.7% vs 50.0%, P =.003; age 54.5 ± 13.7 vs 55.4 ± 13.8 years, P <.001; BMI 34.9 ± 8.0 vs 34.6 ± 7.8 kg/m2, P <.001). Patients from 2017 to 2019 were less comorbid (18.9% vs 16.8% smokers, P <.001; 18.2% vs 17.3% diabetic, P =.036; 4.6% vs 4.1% COPD, P =.021) but had higher ASA classification (III: 43.3% vs 45.7%; IV: 2.5% vs 2.7%, P <.001). Hernia types (primary, incisional, recurrent) were similar in each group. Operative time (89.7 ± 59.3 vs 97.4 ± 63.4 min, P <.001) became longer but length-of-stay (1.4 ± 3.3 vs 1.1 ± 2.6 days, P <.001) decreased. There was no statistical difference in surgical complications, medical complications, reoperation, or readmission rates between periods. Conclusion: Laparoscopic VHR has become a routine method for treating incarcerated and strangulated hernias, and its utilization continues to increase over time. Clinical outcomes have remained the same while hospital stays have decreased. [ABSTRACT FROM AUTHOR]

The field of hernia surgery has seen many recent advances and continues to evolve. Care of the hernia patient begins preoperatively by ensuring adequate preparation for surgery with surgeons now having the opportunity to accurately predict risk which can aid with informed consent. Imaging studies can now help surgeons diagnose and plan hernia surgery on an individual level based on hernia characteristics as well as abdominal wall musculature. In the operating room, new technology and surgical techniques have allowed surgeons to become increasingly sophisticated with goals of reducing tension on midline closures, utilizing minimally invasive and robotic techniques, and availability of new and varied mesh prosthetics. While modest improvements in outcomes have been witnessed by these advances, there is still opportunity for improvement which will be realized by continued research, use of registries, and education and training. Hernia prevention strategies focusing on minimally invasive surgery, laparotomy closure, and the use of prophylactic mesh will also help with the burden of incisional hernias. These advances in hernia surgery have led to the new field of Abdominal Core Health which helps represent this evolving and growing new subspecialty of general surgery. [ABSTRACT FROM AUTHOR]

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

Introduction: Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients. Patients and methods: All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences. Results: Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2–3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien–Dindo classification. There were no recurrences. Conclusion: Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names]. [ABSTRACT FROM AUTHOR]

Background: With the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied. Methods: We conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization. Results: Among 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001). Conclusions: The study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques. [ABSTRACT FROM AUTHOR]

Background: Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the technological aspects of the robotic system but also enhancing surgical proficiency in manipulating robotic instruments. Furthermore, procedural expertise in specific surgeries is critical. Minimally invasive inguinal hernia repair is particularly suitable as an initial procedure for human application. The development of a comprehensive training model for this type of repair is a crucial element of such an educational pathway. Method: Anatomical dissections were carried out on pigs to assess both the similarities and differences between pig and human anatomy. A structured minimally invasive inguinal hernia repair was performed to determine the suitability of the porcine inguinal region for training purposes. Results: A detailed anatomical description of the porcine inguinal region is outlined, to provide a framework for assessing the critical view of the porcine myopectineal orifice. By integrating the human 'ten golden rules' for safe and effective minimally invasive inguinal hernia repair, the standardized porcine integrated robotic inguinal hernia training (SPIRIT) model describes a step-by-step approach to practice surgical techniques in a realistic setting. Conclusion: The SPIRIT model is designed to be a well-structured training model for minimally invasive inguinal hernia repair and incorporates the specific surgical steps as encountered in a human patient. [ABSTRACT FROM AUTHOR]

Background/Objectives: The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis. Objectives: highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period. Methods: Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment. Results: Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2–48]. Median BMI is 27.12 [range 22.3–31.24], with a female–male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect. Conclusions: Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient. [ABSTRACT FROM AUTHOR]

Purpose: The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for groin hernia repair. Source: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of TAPP and TEP techniques separately. Statistical analysis was performed with R Studio. Principal findings: 81 studies were screened and 19 were thoroughly reviewed. Six studies were included, of which two compared TIPP with TEP technique, two compared TIPP with TAPP, and two compared TIPP with both TEP and TAPP techniques. We found lower recurrence rates for the TEP technique compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). Also, we found lower seroma rates for TIPP group on the overall analysis (RR 0.21; P = 0.002). We did not find statistically significant differences regarding overall recurrence (RR 1.6; P = 0.19), chronic pain (RR 1.53; P = 0.2), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.29; P = 0.76) between MIS and TIPP. No statistically significant differences were found in the subgroup analysis of TAPP technique for all the outcomes. Conclusion: Our systematic review and meta-analysis found no differences between TIPP and MIS approaches in the overall analysis of recurrence, SSI, and chronic pain rates. Further research is needed to analyze individual techniques and draw a more precise conclusion on this subject. PROSPERO registration: ID CRD42024530107, April 8, 2024. [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting. Methods: Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score. Results: 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20–48). Median post-operative score was 4 (IQR 1–11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0–10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11–40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41–90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score. Conclusions: LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach. [ABSTRACT FROM AUTHOR]

Purpose: We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure. Methods: This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used. Results: Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3–0.9]; 90 days, 0.5 [0.3–0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3–0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9–6.6] vs. 8.2[7.3–9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5–3.4]; P = 0.4793). Conclusions: This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay. [ABSTRACT FROM AUTHOR]

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

Purpose: This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO). Methods: This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups. Results: Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77–87) and 70 min (range, 60–94), respectively, and the median blood loss was 5 mL (range, 1–5) and 2 mL (range, 1–5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5–12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042). Conclusion: Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed. [ABSTRACT FROM AUTHOR]