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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: 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]

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]

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]

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: 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]

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]

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]

Background: Laparoscopic hernia repair in recent times has gained the most acceptance among both the surgical community and the patient groups, as it has proven benefits of lesser postoperative hospital stay and less pain scores. The incidence of both inguinal and ventral hernias has increased significantly in the present days. Various methods have been postulated by different surgical groups for repairing the same but no there is no standard consensus on managing concomitant inguinal and ventral hernias. The conventional e-TEP requires an extensive dissection with increased operative time. We present our experience in managing cases with both inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti using a modified up to down approach for inguinal hernia followed by down to up approach for the ventral hernia, from a tertiary care center in South India. Materials and methods: We managed 16 cases with simultaneous incidence of inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti between January 2022 and November 2023. Institute ethical committee clearance and informed consent was obtained from all the 16 patients. They were all subjected to an extra peritoneal repair of both the hernias. All the demographic data, intraoperative data, postoperative complications and follow up were digitally stored. All patients were followed up for six months after surgery. Results: Out of 16 patients, 15 were males and 1 was female. The mean age was 48 years and the mean BMI of all the patients was 29.2 kg/m2. The postoperative recovery was smooth in all patients and being discharged within 24 h after surgery. The pain scores of all patients were significantly lower than patients who underwent intraperitoneal repair. Conclusion: e-TEP hernia repair is gaining popularity and has amused the hernia surgical community. Our method of e-TEP RS repair in cases with concomitant inguinal and primary M2/M3 W1 ventral hernias with or without divarication helps in addressing both the hernias in the extra-peritoneal space. Our technique reduces the area of dissection needed for mesh placement and preserves the integrity of abdominal musculature in the upper abdomen when compared with the conventional technique. It further allows extension of the e-TEP inguinal space into the Rectro rectus space without much alteration in the port arrangement allowing simultaneous repair of groin and umbilical hernias. Good knowledge of anatomy and laparoscopic skills are pertinent for safe and effective hernia repair by this technique. [ABSTRACT FROM AUTHOR]

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p <0.01). Operating time was observed to be more with TEP group with mean of 59 ± 17.02 minutes compared with open group which had mean of 44.92±12 minutes. Mean number of analgesic in open cases was 6.65 ± 1.81 whereas in case of TEP group it was 4.35±1.47 over a period of one month. Conclusion: Lichtenstein tension free mesh hernioplasty still remains the gold standard operation done for inguinal hernia. TEP repair has proven to be superior in terms of perioperative hemorrhage and post-operative analgesia requirement. Study concluded that laparoscopic TEP repair of inguinal repair have a considerable clinical advantage over open hernia repair in terms of postoperative pain and analgesia requirement, hospital stay and postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction: Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. Methods: This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. Results: A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). Conclusion: Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship. [ABSTRACT FROM AUTHOR]

Background: Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). Methods: All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. Results: Ten patients were included in this study. The median BMI was 31 (21–40.6) kg/m2. The median height was 1.6 m (1.5–1.89 m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1–6) days. Conclusion: Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team. [ABSTRACT FROM AUTHOR]

Introduction: The introduction of the functional lumen imaging probe (FLIP) has provided objective, real-time feedback on the geometric variations with each component of a hiatal hernia repair (HHR). The utility of this technology in altering intraoperative decision-making has been scarcely reported. Herein, we report a single-center series of intraoperative FLIP during HHR. Methods: A retrospective review of electronic medical records between 2020 and 2022 was conducted and all patients undergoing non-recurrent HHR with FLIP were queried. Patient and hernia characteristics, intraoperative FLIP values and changes in decision-making, as well as early post-operative outcomes were reported. Both diameter and distensibility index (DI) were measured at 40 ml and 50 ml balloon inflation after hiatal dissection, after hiatal closure, and after fundoplication when indicated. Results: Thirty-three patients met inclusion criteria. Mean age was 62 ± 14 years and mean BMI was 28 ± 6 kg/m2. The majority (53%) were type I hiatal hernias. The largest drop in DI occurred after hiatal closure, with minimal change seen after fundoplication (mean DI of 4.3 ± 2. after completion of HH dissection, vs 2.7 ± 1.2 after hiatal closure and 2.3 ± 1 after fundoplication when performed). In 13 (39%) of cases, FLIP values directly impacted intraoperative decision-making. Fundoplication was deferred in 4/13 (31%) patients, the wrap was loosened in 2/13 (15%); the type of fundoplication was altered to achieve adequate anti-reflux values in 2/13 (15%) patients, and in 1/13 (3%) the wrap was tightened. Conclusion: FLIP measurements can be used intraoperatively to guide decision-making and alter management plan based on objective values. Long-term outcomes and further prospective studies are required to better delineate the value of this technology. [ABSTRACT FROM AUTHOR]

Robotic surgery has experienced a boom in the past decade in all fields of surgery, especially general surgery. Hernia surgeries especially have been extensively performed via the robotic approach. In our case series, we detail our initial experience with the new robotic system Versius© for hernia surgery. We have performed transabdominal preperitoneal mesh repair for 14 patients diagnosed with inguinal hernias using this new system. Baseline demographics and pre-, intra-, and postoperative parameters were recorded. All patients were male, with mean age and BMI of 48.5 ± 15.28 years and 22.07 ± 1.54. Most of the patients were American Society of Anesthesiology (ASA) Grade 2. The bedside unit (BSU) set-up times were constant at 31.64 ± 3.73 min. The overall console times were noted to be decreasing with every case operated. Mean hospital stay was 2.57 ± 1.01 days and postoperative pain scores were 2.35 ± 0.49 on the visual analog scale (VAS). We conclude that robotic surgery using the new Versius system is a feasible alternative for inguinal hernias. [ABSTRACT FROM AUTHOR]

Opportunistic salpingectomy (OS) for the primary prevention of ovarian cancer is performed by gynecologists. Advocates have suggested expanding its use to other surgical specialties. General surgeons are the other group to routinely perform intraperitoneal operations in women and could play a role in ovarian cancer prevention. Herein, we review the current evidence and perioperative factors requiring consideration prior to OS implementation in select general surgery cases. A systematic search was conducted for English-language studies evaluating OS during general surgery. The primary outcomes of this study were the feasibility and safety of OS during general surgery procedures. Secondary outcomes included pre-operative considerations (patient selection and the consent process), operative factors (technique and surgical specialty involvement), and post-operative factors (follow-up and management of operative complications). We evaluated 3977 studies, with 9 meeting the eligibility criteria. Few studies exist but preliminary evidence suggests relative safety, with no complication attributable to OS among 140 patients. Feasibility was reported in one study, which showed the capacity to perform OS in 98 out of 105 cholecystectomies (93.3%), while another study reported quick visualization of the fallopian tubes in >80% of cases. All patients in the included studies were undergoing elective procedures, including cholecystectomy, interval appendectomy, colorectal resection, bariatric surgery, and laparoscopic hernia repair. Studies only included patients ≥ 45 years old, and the mean age ranged from 49 to 67.5 years. Gynecologists were frequently involved during the consent and surgical procedures. OS represents a potential intervention to reduce the risk of ovarian cancer. Ongoing studies evaluating the general surgeon's understanding; the consent process; the feasibility, operative outcomes, and risks of OS; and surgeon training are required prior to consideration. [ABSTRACT FROM AUTHOR]

Background: The Erector spinae plane block (ESPB) reduces postoperative pain after several types of abdominal laparoscopic surgeries. There is sparse data on the effect of ESPB in laparoscopic ventral hernia repair. The purpose of this study was to test the postoperative analgesic efficacy of an ESPB for this procedure. Methods: In this prospective, double-blind, randomized controlled study, adult patients undergoing laparoscopic ventral hernia repair were randomly assigned to either bilateral preoperative ESPB with catheters at the level of Th7 (2 × 30 ml of either 2.5 mg/ml ropivacaine or saline), with postoperative catheter top ups every 6 h for 24 h. The primary outcome was rescue opioid consumption during the first hour postoperatively. Secondary outcomes were total opioid consumption at 4 h and 24 h, pain scores, nausea, sedation, as well as Quality of Recovery 15 (QoR-15) and the EuroQol-5 Dimensions (EQ-5D-5L) during the first week. Results: In total, 64 patients were included in the primary outcome measure. There was no significant difference in rescue opioid consumption (oral morphine equivalents (OME)) at one hour postoperatively, with the ESPB group 26.9 ± 17.1 mg versus 32.4 ± 24.3 mg (mean ± SD) in the placebo group (p= 0.27). There were no significant differences concerning the secondary outcomes during the seven-day observation period. Seven patients received a rescue block postoperatively, providing analgesia in five patients. Conclusion: We found no difference in measured outcomes between ESPB and placebo in laparoscopic ventral hernia repair. Future studies may evaluate whether a block performed using higher concentration and/or at a different thoracic level provides more analgesic efficacy. Trial registration: NCT04438369; 18/06/2020. [ABSTRACT FROM AUTHOR]

This document is an abstract from the ANZ Journal of Surgery that covers a range of topics related to hernia surgery. It includes articles, case studies, and research studies on various aspects of hernia repair. The articles discuss standardized approaches to ventral hernia repair, comparisons between laparoscopic and open approaches for groin hernia repair, age-related incidence of incidental findings in female patients, risk factors for contralateral hernia repair, and the safety and effectiveness of different mesh materials. The case studies highlight unique cases and challenges in hernia management, such as pregnant women with hernias, unusual complications after hernia repair, and rare types of hernias. The research studies examine outcomes and techniques for hernia repair, including the use of dynamic closure methods, alternative methods for abdominal wall traction, and the feasibility and safety of laparoscopic approaches. The abstracts cover a range of topics, including the impact of prophylactic mesh placement, re-laparoscopic repair of recurrent hernias, robotic-assisted repair of ureterosciatic hernias, outcomes in elderly patients, the incidence of patent processus vaginalis, and the connections between vascular surgery and hernias. Overall, this document provides a comprehensive overview of current research and case studies in the field of hernia surgery. [Extracted from the article]

Background: Chronic inguinodynia is considered the most disabling complications post-inguinal hernia repair. A novel technique (All-in-One Mesh Hernioplasty) is viable for whole cases of the primary inguinal hernia which utilizes a smaller pre-cut mesh covering whole weak regions of the inguinal canal and is wrapped by a fibro-cremasteric sheath to avoid contact between the prosthesis and neural structures. The present study aimed to compare the outcomes of the Lichtenstein technique and the All-in-One Mesh Hernioplasty technique. Methods: A randomized clinical trial was conducted on 80 patients with a primary inguinal hernia in the Department of General Surgery, Zagazig University Hospitals, Egypt, from January 2018 to January 2020. The patients were categorized equally into 2 groups: group A, involving 40 patients repaired by Lichtenstein technique and group B, involving 40 patients repaired by All-in-One Mesh Hernioplast technique. Results: There was no significant variation (P> 0.05) among the two groups concerning demographic and clinical presentation. There was no significant variation (P> 0.05) among them as regards wound hematoma, infection, seroma, scrotal edema, and urine retention. Chronic groin pain, persistent numbness, and foreign body sensation were less in group B than in group A and this variation was statistically significant (P=0.003), while there was no significant variation (P> 0.05) between them in hospital stay, time of return to work or normal activity, and mean postoperative follow-up. Conclusions: All-in-One Mesh Hernioplasty is a safe and effective technique in repairing the primary inguinal hernia with less postoperative chronic inguinal pain. [ABSTRACT FROM AUTHOR]

Purpose: Some studies have been reported in the past on diaphragmatic hernia (DH) surgery techniques using additive manufacturing (AM) technologies, symptoms of a hernia and post-surgery complications. But hitherto little has been reported on bibliographic analysis (BA) for health monitoring of bovine post-DH surgery for long-term management. Based on BA, this study aims to explore the sensor fabrication integrated with innovative AM technologies for health monitoring assistance of bovines post-DH surgery. Design/methodology/approach: A BA based on the data extracted through the Web of Science database was performed using bibliometric tools (R-Studio and Biblioshiny). Findings: After going through the BA and a case study, this review provides information on various 3D-printed meshes used over the sutured site and available Internet of Things-based solutions to prevent the recurrence of DH. Originality/value: Research gaps exist for 3D-printed conformal sensors for health monitoring of bovine post-DH surgery. [ABSTRACT FROM AUTHOR]

Introduction: Hernia can occur in any site of the body, the common site being the anterior abdominal wall includes epigastric, umbilical, Spigelian and inguinal hernia, the latter being the most commonly encountered hernia in surgical departments. Hernia repair is one of the most commonly performed surgeries in the globe. Hernia surgery has drastically improved from a simple tissue repair method and then prosthetic repair to minimally invasive techniques. Despite the advancement in hernia repair technique and frequency of this surgery, the pain remains an important complication following surgery. Materials and Method: 100 patients included in this study are equally grouped into the lightweight mesh group and heavy-weight mesh group by randomisation. This study is conducted in department of General Surgery, VIMSAR, Sambalpur, Odisha from March 2023 to February 2024 in a prospective manner and single-blinded. Patients were followed up 6 months postoperatively and complications observed were compared and analysed. Result: In the heavy-weight mesh group, the incidence of seroma formation is 20%, chronic post-operative pain and wound infection is 12% each, hematoma formation is 8%, and recurrence and sinus formation is 4% each. In the lightweight mesh group, the incidence of seroma formation is 20%, chronic post-operative pain and wound infection is 8% each, hematoma formation is 4% and no incidence of sinus formation or recurrence. There are no incidences of mesh infection or enterocutaneous fistula in either group. The analysis of data showed that complications observed are more in heavy weight mesh group although the difference in the incidence of complications between the two groups are minimal. Conclusion: There is no discernible difference in the open repair of anterior abdominal wall hernias between the use of lightweight and heavy-weight prosthetic mesh. [ABSTRACT FROM AUTHOR]

BACKGROUND: The notion that gas-bloat syndrome (GBS) after magnetic sphincter augmentation (MSA) is less detrimental has not been substantiated by data. This study aimed to identify the incidence, natural history, risk factors, and impact on outcomes of GBS after MSA. STUDY DESIGN: Records of patients who underwent MSA at our institution were reviewed. GBS was defined as a score of 4 or more on the gas bloat-specific item within the GERD health-related quality-of-life (GERD-HRQL) questionnaire. Preoperative clinical and objective testing data were compared between those with and without GBS at 1 year using univariate followed by multivariable analysis. GBS evolution over time and its impact on outcomes were assessed in those with 1- and 2-year follow-up. RESULTS: A total of 489 patients underwent MSA. At a mean (SD) follow-up of 12.8 (2.1) months, patient satisfaction was 88.8%, 91.2% discontinued antisecretory medications, and 74.2% achieved DeMeester score normalization. At 1 year, 13.3% of patients developed GBS, and had worse GERD-HRQL scores and antisecretory medication use and satisfaction (p < 0.0001). DeMeester score normalization was comparable (p = 0.856). Independent predictors of GBS were bloating (odds ratio [OR] 1.8, p = 0.043), GERD-HRQL score greater than 30 (OR 3, p = 0.0010), and MSA size 14 or less beads (OR 2.5, p = 0.004). In a subgroup of 239 patients with 2-year follow-up, 70.4% of patients with GBS at 1 year had resolution by 2 years. The GERD-HRQL total score improved when GBS resolved from 11 (7 to 19) to 7 (4 to 10), p = 0.016. Patients with persistent GBS at 2 years had worse 2-year GERD-HRQL total scores (20 [5 to 31] vs 5 [3 to 12], p = 0.019). CONCLUSIONS: GBS affects 13.3% of patients at 1 year after MSA and substantially diminishes outcomes. However, GBS resolves spontaneously with quality-of-life improvement. Patients with preoperative bloating, high GERD-HRQL scores, or small MSA devices are at greatest risk of this complication. [ABSTRACT FROM AUTHOR]

Background: The article describes our initial experience using CMR Versius platform for several procedures in general surgery. Methods: Between September 2022 and April 2023, seventy patients underwent robotic surgery in a multi-robotic referral center (San Paolo University Hospital, Milan, Italy). Three surgeons with only laparoscopic experience performed 24 cholecystectomies, 13 inguinal hernia repairs, 9 ventral hernia repairs, 7 right hemicolectomies, 11 left hemicolectomies, 1 sigmoidectomy, 1 ileocecal resection, 1 ventral rectopexy, 1 Nissen fundoplication, 1 total splenectomy, and 1 exploration with multiple biopsies. Results: All surgeries were full-robotic, with only one conversion to laparoscopy. The short length of stay and low rate of severe morbidity are promising findings. Although operative time was lengthened, clinical outcomes were not affected. Conclusions: Our experience demonstrates that the adoption of Versius system is safe and feasible in general surgery. The standardization of port placement and BSU set-up can certainly reduce the operative time. [ABSTRACT FROM AUTHOR]

Background: Improved outcomes with the use of non-absorbable mesh (NAM) for inguinal hernia repairs led to its rapid adoption for hiatal hernia (HH) repairs; however, feared complications occurred, and the trend shifted toward using absorbable mesh (AM). We aimed to analyze the literature assessing objective HH recurrence rates after primary laparoscopic cruroplasty with or without the use of different mesh types. Methods: A systematic literature review with both pairwise and time-organized proportion meta-analyses of articles published between January 1993 and September 2022 was performed using the MEDLINE, EMBASE, and Taylor & Francis databases to identify relevant studies comparing groups undergoing cruroplasty with suture repair (SR) alone, AM, NAM, or partially absorbable mesh (PAM). Studies documenting an objective follow-up ≥ 6 months were included. The primary outcome was the HH recurrence rate confirmed by barium esophagram or upper GI endoscopy. Results: A total of 34 studies met the inclusion criteria, including 6 randomized clinical trials, 25 retrospectives studies, and 3 prospective cohort studies. A total of 2170 subjects underwent laparoscopic HH repair and completed an objective follow-up ≥ 6 months after surgery; the objective recurrence rate was 20.8% (99/477) at a mean follow-up of 25.8 ± 16.4 months for the SR group, 20.6% (244/1187) at 28.1 ± 13.8 months for the AM group, 13.7% (65/475) at 30.8 ± 15.3 months for the NAM group, and 0% (0/31) at 32.5 ± 13.5 months for the PAM group. However, the pairwise meta-analysis revealed that overall mesh use was not superior to SR in preventing long-term HH recurrence. Conclusion: The use of AM does not appear to reduce HH recurrence compared to SR alone. Although the data favors NAM to decrease objective HH recurrence in the mid-term, the long-term (≥ 48 months) recurrence rate was similar with or without any type of mesh. [ABSTRACT FROM AUTHOR]

Objective: To measure hospital quality based on routine data available in many health care systems including the United States, Germany, the United Kingdom, Scandinavia, and Switzerland. Data Sources and Study Setting: We use the Swiss Medical Statistics of Hospitals, an administrative hospital dataset of all inpatient stays in acute care hospitals in Switzerland for the years 2017–2019. Study Design: We study hospital quality based on quality indicators used by leading agencies in five countries (the United States, the United Kingdom, Germany, Austria, and Switzerland) for two high‐volume elective procedures: inguinal hernia repair and hip replacement surgery. We assess how least absolute shrinkage and selection operator (LASSO), a supervised machine learning technique for variable selection, and Mundlak corrections that account for unobserved heterogeneity between hospitals can be used to improve risk adjustment and correct for imbalances in patient risks across hospitals. Data Collection/Extraction Methods: The Swiss Federal Statistical Office collects annual data on all acute care inpatient stays including basic socio‐demographic patient attributes and case‐level diagnosis and procedure codes. Principal Findings: We find that LASSO‐selected and Mundlak‐corrected hospital random effects logit models outperform common practice logistic regression models used for risk adjustment. Besides the more favorable statistical properties, they have superior in‐ and out‐of‐sample explanatory power. Moreover, we find that Mundlak‐corrected logits and the more complex LASSO‐selected models identify the same hospitals as high or low‐quality offering public health authorities a valuable alternative to standard logistic regression models. Our analysis shows that hospitals vary considerably in the quality they provide to patients. Conclusion: We find that routine hospital data can be used to measure clinically relevant quality indicators that help patients make informed hospital choices. [ABSTRACT FROM AUTHOR]

Background: The majority of inguinal hernias are usually paucisymptomatic, so are restored electively. The main purpose of this study is to assess the trends in hernia repair surgery before and during the pandemic period, analyzing an Italian hospital series of 390 patients, in an attempt to quantify the negative impact regarding social costs derived from the Covid‐19 outbreak. Moreover, we want to focus on the concept of apparently minor pathology as hernioplasty which could represent a life‐threatening condition for patients. Methods: The study population consisted of all patients operated for inguinal hernia in a General Surgery Unit from 2019 to 2021, divided into a pre‐pandemic and a pandemic period. Results: The Covid‐19 pandemic increased urgent operations in a complicated setting. A statistically significant difference was found regarding the trend of hospitalization length as well as a strong positive correlation between the severity of hernia and the hospitalization length. Conclusions: During the pandemic, it has been registered a mishandling of inguinal hernias to the detriment of both the healthcare system and patients, due to multifactorial issues and, in particular, to the restrictions imposed by the regional government that erroneously declassed hernia pathology as a minor problem for public health. We do believe that patients, after diagnosis of inguinal hernia, should learn the Taxis maneuver for its feasibility and ease of execution, in order to reduce access to emergencies in many cases and likewise to better pain and discomfort perceived, even in the event of unexpected worldwide healthcare scenario. [ABSTRACT FROM AUTHOR]

The article discusses the repair of para-conduit hernias that occur after minimally invasive oesophagectomy. Para-conduit hernias are becoming more common due to the use of minimally invasive techniques. The article describes a left hiatoplasty approach for repairing these hernias, which involves suturing the left pillar to close the para-conduit space. The technique is illustrated through two case studies, and the authors report successful outcomes with no recurrence of hernias. The article provides detailed instructions for the operative technique and emphasizes the importance of protecting the gastric conduit during repair. [Extracted from the article]

Procalcitonin has been investigated as a marker for bowel ischemia. This study examined the role of procalcitonin in predicting failure of non-operative management (NOM) in bowel obstructions. Patients with bowel obstructions at a single center from August 2022 to January 2023 were prospectively enrolled (n = 79). Lactic acid (LA) and procalcitonin were collected after surgical consultation. The primary outcome was success or failure of NOM. Univariate analysis, multivariable logistic regression, and performance measures of procalcitonin and LA in predicting bowel ischemia was performed. Of 79 patients included, 48 (61%) required operative intervention during index admission. There were no significant differences in demographics, comorbidities, procalcitonin, nor LA between groups. Time from last bowel movement was associated with failure of NOM (OR 1.03 [95% CI 1.01-1.06]; P =.008), though initial procalcitonin or LA was not. Procalcitonin >.3 ng/mL had acceptable sensitivity in screening for bowel ischemia. [ABSTRACT FROM AUTHOR]

Inflammation is much more intrinsic to hernia then is what is generally appreciated. The occurrence of hernias is associated with swelling, stress and inflammation. Surgery remains an important intervention to treat hernias and for many years, post-surgical levels of inflammatory cytokines have been evaluated to compare the different strategies for their comparative advantages. All surgical procedures elicit some sort of inflammatory response and moreover the meshes used for hernia repair are also associated with elevated inflammatory response, although some favor predominantly a pro-inflammatory response while the other meshes favor anti-inflammatory response. An estimated more than 90% of hernia repairs involve some meshes with polypropylene considered as the gold standard. Efforts are underway to modulate polypropylene meshes associated inflammation through use of alternative materials as well as modifications to polypropylene meshes themselves. In the last one decade, miRNAs have entered hernia research and the data on a role of miRNAs in different hernias is slowly emerging, providing the first evidence of epigenetics in hernia. Some reports are connecting miRNAs with inflammation in hernia. All these aspects, such as, surgery-related to mesh-related inflammation as well as miRNA-related inflammation, are discussed in this article to present an up-to-date information on the topic. [ABSTRACT FROM AUTHOR]

Emergency general surgery is a risk factor for postoperative morbidity and mortality. Patients with obesity are at greater risk for complications following ventral hernia repair (VHR). Our study aimed to determine the association of obesity with postoperative outcomes in patients requiring emergency VHR. Our retrospective study used the 2016-2020 National Surgical Quality Improvement Program database to identify patients undergoing emergency VHR. Patients were classified by body mass index (BMI): normal weight 18.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obesity 30-39.9 kg/m2, morbid obesity 40-49.9 kg/m2, and super morbid obesity (SMO) ≥50 kg/m2. The primary outcome of interest was surgical site infection (SSI). From 2016 to 2020, a total 11,593 patients underwent emergency VHR. Patients with higher BMI had increased incidences of postoperative complications. Compared to other patients with obesity, SMO patients had higher rates of SSI (11.5% versus 5.5%, P < 0.001), prolonged ventilatory support (4.0% versus 1.5%, P < 0.001), length of stay ≥4 d (52.7% versus 42.2%, P < 0.001), reoperation (6.4% versus 3.4%, P < 0.001), and readmission (11.3% versus 7.2%, P < 0.001). Super morbid obesity (SMO) patients had increased odds of SSI (odds ratio [OR] 5.55, 95% confidence interval [CI] 3.47-8.88), prolonged ventilatory support (OR 1.92, 95% CI 1.07-3.45), and reoperation (OR 1.97, 95% CI 1.26-3.09) compared to normal weight patients. Patients with BMI ≥50 kg/m2 undergoing emergency VHR have increased overall incidences of SSIs, prolonged mechanical ventilation, reoperation, and readmission, and this remains significant when compared to other patients with obesity. This population is at significant risk for postoperative morbidity, and increased vigilance in perioperative management is imperative to ensure safe, high-quality care. [ABSTRACT FROM AUTHOR]

Patients prescribed higher opioid dosages have a higher risk of persistent opioid use, overdose, and death. There is a lack of standardization for opioid prescribing for acute surgical pain in emergency general surgery (EGS) patients. We hypothesized that implementing a guideline to standardize opioid prescribing would be associated with a decrease in prescribing at hospital discharge for EGS patients without increasing additional postdischarge refills. This was a quasi-experimental study evaluating opioid prescribing by EGS providers before and after the implementation of a prescribing guideline. Patients were assigned to preguideline and postguideline groups based on admission date surrounding the implementation of the guideline. The primary outcome was the proportion of patients receiving an opioid prescription for ≥50 Morphine Milligram Equivalents (MME) per day on hospital discharge. There were 227 patients in the preguideline group and 226 patients in the postguideline group. After guideline implementation, median total MME prescribed decreased from 113 (interquartile range = 75) to 75 (interquartile range = 75, P = 0.03). The proportion of patients receiving a prescription for daily MME ≥50 also decreased from 75% to 25% (P ≤0.01). There were no increases in requested refills (17% versus 16%, P = 0.72) or received refills (14% versus 14%, P = 0.98). Guideline compliance ranged from 75% in ventral hernia repair patients to 94% in laparoscopic cholecystectomy patients. A departmental guideline to standardize postoperative opioid prescriptions was associated with a decrease in the amount of MMEs prescribed to EGS patients without an increase in requested or received refills. • Standardizing opioid prescribing for emergency general surgery patients. • Guideline for opioid prescribing for emergency general surgery patients. • Decreasing postoperative opioid prescribing in emergency general surgery. [ABSTRACT FROM AUTHOR]

Background Repairing of ventral and incisional hernias is a frequently performed surgical intervention in the field of general surgery; this work aimed to compare the extended totally extraperitoneal (eTEP) technique to the intraperitoneal onlay mesh (IPOM) technique for ventral hernias regarding feasibility, cost, operative, and postoperative outcomes of both techniques. Patients and methods This randomized controlled study was conducted on 50 patients complaining of ventral hernia. These patients were admitted to Tanta University Hospitals, Egypt, from January 2021 to January 2023. Patients were divided according to the technique used into two2 equal groups: group eTEP (study group): 25 participants were submitted to eTEP repair. Group IPOM (control group): 25 patients were submitted to IPOM repair. Results Demographic data were insignificantly different between both groups. Operation time was significantly prolonged in group eTEPcompared to group IPOM(P<0.001). Cost and hospital stay were significantly decreased in group eTEP compared with group IPOM(P<0.05). Pain at rest and restriction to normal activity were significantly lower on the first and 14th postoperative days in group eTEP compared with group IPOM (P<0.05). Cosmesis was insignificantly different on the first and 14th postoperative days between both groups. Postoperative seroma, postoperative recurrence, and postoperative ileus were insignificantly different between both groups. Conclusion Both eTEP and IPOM demonstrated safety and efficacy in the treatment of de-novo ventral hernia repair (comparable few complications in both groups with no recurrence in this study) with superiority toward eTEP as evidenced by lower hospital stay, cost, postoperative pain, and early return to normal activity. [ABSTRACT FROM AUTHOR]

Introduction: Any abnormal protrusion of the viscus or a portion of it through a weak spot in the anterior abdominal wall other than the femoral and inguinal regions is referred to as a ventral hernia. A hernia is also defined as an abnormal exit of tissue or an organ, such as the bowel, through the cavity wall where it usually resides. Hernias are divided into two categories depending on their visibility-a) External hernias include those visible from the outside, such as those in the inguinal, epigastric, femoral, and incisional hernias. b) Internal hernia that is not visible from the outside and can exist between two adjacent cavities, such as the abdomen and thorax, or which can herniate into a sub-compartment of a pre-existing cavity, such as a diaphragmatic hernia or a hiatus hernia. Materials and methods: A hospital based-analytical cross-sectional study was conducted for a period of 2 years i.e., from 1st December' 2020 to 30th November' 2022 in the Department of General Surgery at Siddhartha Medical College and General Hospital, Vijayawada. During the study period of 24 months, about ninety four (94) patients with ventral hernias have attended the OPD of Department of Surgery. Among the 94 ventral hernia patients about 63 patients who were in accordance with inclusion criteria were considered. A purposive sampling method was used to select ventral hernia Patients who were between 18-70 years of age. Results: The distribution of patients based on clinical types of ventral hernia, majority 49.2 p.c (31) of the patients were with paraumbilical hernia followed by epigastric hernia among 31.7 p.c (20) of the patients and 19 p.c (12) of the patients were with umbilical hernia respectively. majority 47.6 p.c (30) of the patients had only swelling followed by swelling with pain among 41.3 p.c (26) of the patients, 7.9 p.c (5) of the patients had swelling with irreducibility and 3.2 p.c (2) of the patients had swelling with intestinal obstruction. Conclusion: The incidence of ventral hernias was more among females when compared to males. The operative procedure conducted through laparoscopy for ventral hernia repair gave more promising results than open ventral hernia repair in terms of decreased postoperative pain, complications, duration of hospital stay, and return to normal activity duration. In terms of costeffectiveness, open hernia repair was more beneficial when compared to laparoscopic hernia repair. Still, due to government initiatives towards helping the poor through medical & surgical expenses, laparoscopic hernia repair was more advisable. [ABSTRACT FROM AUTHOR]

Background: Repair of inguinal hernia is one of the most common operations in general surgery. A reducible hernia is usually a longstanding condition, and diagnosis is made clinically, on the basis of typical symptoms and signs. This study was conducted to assess the incidence of inguinal hernias in our geographical area. Methods: 187 patients who had come to the hospital with complaints of swelling in their groin and confirmed to be inguinal hernia were included into the study. Ultrasound for the detection of aneurysm of the abdominal aorta was done for all the patients before the inguinal hernia repair. Results: 129 (69%) patients were males and only 58 out of the 187 patients were females. Most of the patients had primary hernia while 45 (24.1%) of them had recurrent hernia. Most of the patients were between 31-60 years of age followed by 61-75 years. Around 94% of the patients had unilateral hernia and 5.9% had bilateral hernias. Of the unilateral ones, right side was predominant over the left side. 80% of the patients had indirect hernia and direct hernia was seen only among 20% of them. Conclusions: More such studies need to be conducted at various geographical regions to get more number of observations and data to gather the prevalence. [ABSTRACT FROM AUTHOR]

The text discusses the use of biologic mesh in preventing parastomal hernia (PSH) following cystectomy and ileal conduit urinary diversion. The article highlights that PSH is common, with an incidence rate of 25% to 40%. However, a randomized clinical trial did not demonstrate a significant benefit of prophylactic mesh placement within a 2-year follow-up period. The study suggests that future research focusing on high-risk patients, such as obese individuals, may show potential benefits of prophylactic mesh. Additionally, longer follow-up periods could provide further insight into the efficacy of prophylactic mesh, although it may be limited by a decrease in the number of at-risk patients due to mortality or loss to follow-up. [Extracted from the article]

This article, published in 2003, discusses a new surgical technique called Hybrid Parastomal Hernia Endoscopic Repair (HyPER) for treating parastomal hernias. The procedure combines open and laparoscopic approaches and has shown promising outcomes in terms of postoperative complications, recurrence rates, and patient satisfaction. The study included 95 patients and reported a low complication rate. The authors, Marek Szczepkowski, Alicja Przywózka-Suwała, Bartosz Ziółkowski, Piotr Witkowski, and José Perea, provide information about their research and work in this field, as well as their affiliations with medical institutions in Warsaw, Poland, Madrid, Spain, and Salamanca, Spain. Further studies with larger patient populations and longer follow-up are needed to evaluate the long-term effectiveness of the technique. [Extracted from the article]

Background and Objectives: In the previous century, the mere existence of a hernia was sufficient evidence to warrant surgical intervention in order to prevent the potentially fatal complications of obstruction and strangulation. The study's objective was to assess the efficacy and safety of inguinal hernia repair performed under locally administered ultrasound-guided anaesthesia. Material and Methods: This study was conducted at Department of General Surgery, Government Medical College, Karimnagar, Telangana, India from May 2023 to October 2023. It comprised a total of 40 patients with inguinal hernia. Upon admission to the hospital, a comprehensive medical history was obtained and a meticulous clinical examination was conducted. Standard diagnostic procedures such as haemoglobin, total leucocyte count, differential leucocyte count, erythrocyte sedimentation rate, random blood sugar, renal function tests, chest X-ray, and EKG were performed for each case. Results: Patients in group A were between the ages of 19 and 76, while those in group B were between the ages of 22 and 77. Forty patients participated in the study conducted by Song et al. The average age of the patients undergoing local anaesthesia surgery was 42±18 years, whereas the average age of the patients undergoing spinal anaesthesia surgery was 39±14 years. There were 37 men and 3 women among the patients. Our patients' ages and sexes were comparable to those in previous research. The current investigation found that 16 patients in group A and 20 patients in group B had indirect inguinal hernias. Nine patients in group A and five in group B had direct inguinal hernias. We found results that were very consistent with the other investigations. Conclusion: This leads to a more rapid short-term recovery, a more rapid discharge, and fewer difficulties associated with anaesthesia. Perhaps it will one day be the norm when it comes to groyne hernia repairs. [ABSTRACT FROM AUTHOR]

Incisional hernias are a very common problem encountered by a surgeon and has followed abdominal surgery like a shadow for more than a century now. Incisional hernia is a truly iatrogenic hernia. In this prospective study, all patients (50 cases) presenting to the OPD of general surgery in GMC Guntur over a two year period, have been selected ensuring there was no obstructed or strangulated incisional hernias/intra-abdominal malignancies/patients with severe co-morbid conditions (severe cardio-pulmonary disease, un controlled ascites)/pregnant women with incisional hernias/recurrent incisional hernias. The aim was to evaluate the outcome of anatomical and mesh repair of incisional hernia with reference to technical difficulty, convalescence, wound infection and recurrence. A majority of patients were in the age group of 31-40 years and was more common in females than males with a female to male ratio 7.2: 2.8 It was found that 36% of patients had an onset of symptoms within one year of previous surgery, whereas, 22% of patients had an onset between 1-5 years, 14% had onset between 5-10 years and 28% after 10 years. Meanwhile, 88% of patients had hernial defect size of less than 5 cm in diameter, 8% had a defect size in between 5-10 cm, however, and only 4% had a defect size of more than 10 cm in diameter. The study had found 3 patients in the anatomical repair group and 11 patients in the mesh group had developed post operative complications; most common of which were: 1. Wound infection in the anatomical repair group (8%). 2. Seroma was seen in the mesh group (24%). 3. All the 25 cases in each group were followed up for a period of 1 year and no recurrence was noted. [ABSTRACT FROM AUTHOR]

Background: A ventral hernia, excluding femoral and inguinal hernias, is the protrusion of the contents of the abdomen through a defect in the abdominal wall. Objectives: The aim of the current study was to compare laparoscopic and open ventral hernia repair. Materials and Methods: The present prospective randomized hospital-based observational study was conducted in the department of general surgery (I.G.I.M.S.) and included 80 patients of both genders who needed surgical intervention for non-complicated ventral hernias. Results: The mean age of patients in the open group I was 50.83 ± 12.72 years, while the mean age in the laparoscopic group II was 42.90 ± 10.63 years. There were 34 males and 46 females in both the open and laparoscopic groups. Paraumbilical hernias were the most common in both groups, which accounted for 68.75% of all patients involved in the present study. The mean duration of postoperative hospital stay in the open group was 5.32 days, which was longer as compared to the laparoscopic group (2.70 days). Postoperative seroma following laparoscopic repair accounted for 25% versus 10% following open repair. Conclusion: According to the current study, laparoscopic ventral hernia repair offers several advantages over open repair, including less pain following surgery, a shorter hospital stay, faster return to regular activities, a lower risk of wound infection and ileus following surgery, and improved cosmetic results. [ABSTRACT FROM AUTHOR]

INTRODUCTION The purpose of this research was to determine the prevalence of double cystic arteries. The research was a 15-month prospective observational study undertaken at the Department of General Surgery at SCB Medical college and Hospital, Cuttack. This study included 520 patients with symptomatic gallstones with benign gallbladder diseases, gallbladder polyps, previously known gallbladder inflammation, patients without bleeding clotting disorder, patients over the age of 18, and patients who could be given general anaesthesia induction and underwent laparoscopic cholecystectomy surgery. The features and consequences of people with twin cystic arteries were documented and investigated. RESULTS In one year, 520 laparoscopic cholecystectomy procedures were conducted. The research comprised 129 male and 391 female participants. The average age ranged from 21 to 71 years old (53.26). Four male patients (0.77%) and sixteen female patients (3.07%) had two cystic arteries discovered after surgery. These patients had an average age of 53.410.85. According to ultrasound findings, the rationale for surgery in three of the twenty patients with double cystic arteries was gall bladder polyp, while the remainder of the patients had several stones in the gallbladder. In four individuals who did not have gallstones, an epigastric hernia was discovered, and an epigastric hernia repair was done concurrently laparoscopically. Due to bleeding during operation, 4 of the 20 patients (20%) with double cystic arteries were moved from laparoscopic to traditional cholecystectomy. Patients with a double cystic artery spend an average of 5.9 (4-12) days in the hospital, compared to (3.2 days) for patients without a double cystic artery. The average occurrence of a double cystic artery was determined to be 3.84. Conclusion Cystic artery variants may coexist with other abnormalities. Understanding cystic artery differences may help to limit the risk of uncontrolled intraoperative bleeding, extrahepatic biliary damage, and conversion to traditional cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: A major constraint to surgical care delivery in low-resource settings is inadequate workforce availability. Surgical task shifting (TShifting) and task sharing (TSharing), in which non-surgeon clinicians (NSCs) are trained to perform select surgical procedures, have been proposed as one solution. However, patterns of safety and efficacy of surgical TShifting/TSharing are not well-established. This study aims to summarize the current literature and assess clinical outcomes and impact of surgical TShifting/TSharing in sub-Saharan Africa. Methods: A two-tiered systematic, PRISMA-adherent literature review of surgical TShifting/TSharing in sub-Saharan Africa was conducted. Collected data included healthcare settings; types of surgeries performed; attitudes toward NSCs; and categories, training, capacity, clinical outcomes, safety, retention, cost-effectiveness, and supervision of NSCs. A random effects meta-analysis of morbidity and mortality rates between NSCs and surgeons was conducted. Results: Among the 659 abstracts screened, 31 studies met inclusion criteria and were integrated in the final analysis. Eighteen studies (58%) report on the capacity and aptitude of NSCs, 16 (52%) on clinical outcomes and safety, and seven (23%) on attitudes. NSCs performed 1999 (61%) of 3304 total surgical cases studied. The most common operations reported were hernia repair (n = 12, 57%), acute abdominal (n = 12, 57%), and orthopedic procedures (n = 6, 29%). No differences were found between NSC and surgeon case morbidity [315 (16%) vs. 224 (17%); p > 0.05] and mortality [44 (2.2%) vs. 33 (2.5%); p > 0.05] rates. Conclusion: NSCs are increasingly performing surgical tasks in regions of sub-Saharan Africa deficient in trained surgeons and appear to have non-inferior safety outcomes in select programs. [ABSTRACT FROM AUTHOR]

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from − 66.58%, between 2020 and 2019, to − 2.49%, between 2019 and 2018 (mean = − 18.74%; CI =− 46.7%–9.22%; p < 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy. [ABSTRACT FROM AUTHOR]

Purpose: Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, in England there is evidence of wide variation in day-case rates across hospitals. Reducing the extent of this variation has the potential to support more efficient use of resources (e.g., clinician time, hospital beds) and help the recovery of elective surgical activity following the COVID-19 pandemic. The aims of this study were to explore the extent of variation in day-case rates across healthcare providers in England and to evaluate the safety of day-case elective primary inguinal hernia repair surgery. Methods: This was an exploratory, retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 were identified. The exposure of interest was day-case or in-patient stay, and the primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. Results: A total of 413,059 elective primary inguinal hernia repairs were identified over the 8-year study period. Of these, 326,833 (79.1%) were day-case procedures. During the most recent financial year (2021–22), the highest day-case rate for an ICB was 93.8% and the lowest 66.1%. After adjusting for covariates, day-case surgery was associated with significantly lower rates of 30-day emergency readmission (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.58–0.64, p < 0.001) and for the secondary outcomes 180-day mortality and haemorrhage, infection and pain at 30-day post-discharge. Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day-case surgery (OR 0.84, 95% CI 0.74–0.96, p < 0.001) than in ICBs with low rates of day-case surgery, although rates of post-procedural haemorrhage within 30 days of discharge were significantly higher in trusts with high day-case rates (OR 1.20, 95% CI 1.04–1.40, p = 0.015). Conclusions: For the outcomes studied, we found no consistent evidence that day-case elective inguinal hernia repair was unsafe for selected patients. Currently, there is substantial variation between ICBs in terms of delivering day-case surgery. Reducing this variability may help address the current pressures on the NHS in elective surgery. [ABSTRACT FROM AUTHOR]

Purpose: We aimed describe the patient characteristics, surgical details, postoperative outcomes, and prevalence and incidence of obturator hernias. Obturator hernias are rare with high mortality and no consensus on the best surgical approach. Given their rarity, substantial data is lacking, especially related to postoperative outcomes. Methods: The study was based on data from the nationwide Danish Hernia Database. All adults who underwent obturator hernia surgery in Denmark during 1998–2023 were included. The primary outcomes were demographic characteristics, surgical details, postoperative outcomes, and the prevalence and incidence of obturator hernias. Results: We included 184 obturator hernias in 167 patients (88% females) with a median age of 77 years. Emergency surgeries constituted 42% of repairs, and 72% were laparoscopic. Mesh was used in 77% of the repairs, with sutures exclusively used in emergency repairs. Concurrent groin hernias were found in 57% of cases. Emergency surgeries had a 30-day mortality of 14%, readmission rate of 21%, and median length of stay of 6 days. Elective surgeries had a 30-day mortality of 0%, readmission rate of 10%, and median length of stay of 0 days. The prevalence of obturator hernias in hernia surgery was 0.084% (95% CI: 0.071%–0.098%), with an incidence of one per 400,000 inhabitants annually. Conclusions: This was the largest cohort study to date on obturator hernias. They were rare, affected primarily elderly women. The method of repair depends on whether the presentation is acute, and emergency repair is associated with higher mortality. [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]

Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high‐risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions. [ABSTRACT FROM AUTHOR]

Background and Aim: Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline. Methods: Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient's cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration. Results: In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001). Conclusion: Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Groin hernias commonly present acutely in high-risk populations and can be challenging to manage. This retrospective, observational study aimed to report on patient demographics and outcomes, following acute admissions with a groin hernia, in relation to contemporary investigative and management practices. Methods: Adult (≥18 years old) patients who presented acutely with a groin hernia to nine National Health Service trusts in the north of England between 2002 and 2016 were included. Data were collected regarding patient demographics, radiological investigations, and operative intervention. The primary outcome of interest was 30-day inpatient mortality rate. Results: Overall, 6165 patients with acute groin hernia were included (4698 inguinal and 1467 femoral hernias). There was a male preponderance (72.5 per cent) with median age of 73 years (interquartile range (i.q.r.) 58–82). The burden of patient co-morbidity increased over the study period (P < 0.001). Operative repair was performed in 2258 (55.1 per cent) of patients with an inguinal and 1321 (90.1 per cent) of patients with a femoral hernia. Bowel resection was more commonly required for femoral hernias (14.7 per cent) than inguinal hernias (3.5 per cent, P < 0.001) and in obstructed (14.6 versus 0.2 per cent, P < 0.001) or strangulated (58.4 versus 4.5 per cent, P < 0.001) hernias. The 30-day mortality rate was 3.1 per cent for the overall cohort and 3.9 per cent for those who underwent surgery. Bowel resection was associated with increased duration of hospital stay (P < 0.001) and 30-day inpatient mortality rate (P < 0.001). Following adjustment for confounding variables, advanced age, co-morbidity, obstruction, and strangulation were all associated with an increased 30-day mortality rate (all P < 0.001). Conclusion: Emergency hernia repair has high mortality rates. Advanced age and co-morbidity increase both duration of hospital stay and 30-day mortality rate. Acute groin hernia presentations are a common feature of the emergency general surgery workload. This high-volume, retrospective, observational study shows that patients presenting with groin hernias are often elderly and are becoming increasingly co-morbid. Changing patient demographics are influencing investigation and management techniques as demonstrated in this study. [ABSTRACT FROM AUTHOR]