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Introduction: Experimental data show that large-pored meshes reduce foreign body reaction, inflammation and scar bridging and thus improve mesh integration. However, clinical data on the effect of mesh porosity on the outcome of hernioplasty are limited. This study investigated the relation of pore size in polypropylene meshes to the outcome of Lichtenstein inguinal hernioplasty using data from the Herniamed registry. Methods: This analysis of data from the Herniamed registry evaluated perioperative and 1-year follow-up outcomes in patients undergoing elective, primary, unilateral Lichtenstein inguinal hernia repair using polypropylene meshes. Patients operated with a non-polypropylene mesh or a polypropylene mesh with absorbable components were excluded. Polypropylene meshes with a pore size of 1.0 × 1.0 mm or less were defined as small-pored meshes, while a pore size of more than 1.0 × 1.0 mm was considered large-pored. Unadjusted analyses and multivariable analyses were performed to investigate the relation of pore size of polypropylene meshes, patient and surgical characteristics to the outcome parameters. Results: Data from 22,141 patients were analyzed, of which 6853 (31%) were operated on with a small-pore polypropylene mesh and 15,288 (69%) with a large-pore polypropylene mesh. No association of mesh pore size with intraoperative, general or postoperative complications, recurrence rate or pain requiring treatment was found at 1-year follow-up. A lower risk of complication-related reoperation tended to be associated with small-pore size (p = 0.086). Furthermore, small-pore mesh repair was associated with a lower risk of pain at rest and pain on exertion at 1-year follow-up. Conclusion: The present study could not demonstrate an advantage of large-pore polypropylene meshes for the outcome of Lichtenstein inguinal hernioplasty. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension‐free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient‐reported outcomes, particularly health‐related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. Methods: This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF‐36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t‐tests for comparisons, with significance set at a p‐value <.05. Results: A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Conclusion: Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively. [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]

Background: The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. Methods: Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. Results: No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5–45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8–42.5) minutes vs. 54.0 (IQR: 46.0–62.0) minutes, P < 0.001) was significantly shorter for TREPP. Conclusion: This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions. [ABSTRACT FROM AUTHOR]

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]

Background: The research for ideal technique for Hernia correction would have preferably less complication rates and low recurrences. In recent studies laparoscopic hernia repair has been preferred and has gained vast acceptance among surgeons. Both laparoscopic(TEP) repair and open hernia repair have shown to be better outcome in many studies. Material and Methods: This was a hospital based prospective comparative observational study in which 100 (50 each) subjects with a diagnosis of inguinal hernia those were willing to participate were taken for each of two groups i.e. laparoscopic totally extra peritoneal (TEP group) and Lichtenstein open tension-free mesh repair (Lichtenstein group). Results: TEP was associated with shorter operative time, shorter hospital stay and cosmetically better compared to Lichtenstein hernioplasty. The mean pain score in the TEP group was significantly less than the Lichtenstein group on all occasions up to 2nd week post-operatively. There was no conversion from TEP to open Lichtenstein repair. The hospital stay in Lichtenstein group was significantly longer compared to TEP group (p= 0.042). Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernias by an experienced surgeon for those desiring less pain, better cosmetic results, less postoperative complications, less hospital stay and early return to work. [ABSTRACT FROM AUTHOR]

This study aimed to compare the results of open Lichtenstein repair (OLR) and laparoscopic total extraperitoneal (TEP) repair methods in inguinal hernia (IH). Between January 2017 and December 2018, 201 patients who underwent TEP and OLR methods for IH in our hospital were retrospectively analyzed. TEP was performed in 98 of these patients and OLR was performed in 103 patients. The patients were evaluated in terms of age, gender, hernia type, operation time, early and late postoperative complications, length of hospital stay and accompanying diseases. One hundred forty-five (72.5%) of 201 patients had right IH and 56 (27.5%) had left IH. TEP group and OLR group were similar in terms of age, gender, hernia type and comorbidity. Our mean follow-up period was 24(18-36) months. The average operation time was 61.2 (40-80) minutes in TEP and 55.4 (45-70) minutes in the OLR group; It was significantly longer in the TEP group (P<0.05). Postoperative early complications were 7 (7.1%) in TEP and 10 (9.8%) in OLR, the difference was not significant. Postoperative recurrence was detected in 2(2.04%) cases in TEP and in 2(1.94%) cases in OLR, and no significant difference was found. The length of hospitalstay is equal in both groups. In our study, although the operative time was longer in the TEP group than in the OLR, no difference was observed between the length of hospital stay, postoperative complications and recurrence rates. We believe that TEP method will be applied in a shorter time as experience and experience increase. [ABSTRACT FROM AUTHOR]

Introduction: Transabdominal Preperitoneal (TAPP) and Lichtenstein tension-free repair are well-established methods for inguinal hernia treatment. There is a need to establish the short-term outcomes of both procedures. Aim: To determine the short-term outcomes of Lichtenstein and TAPP hernia surgery. Materials and Methods: A prospective cohort study was conducted in the Department of Surgery at Father Muller Hospital, Mangaluru, Karnataka, India from November 2020 to May 2022. A total of 30 male patients underwent TAPP and 30 male patients underwent Lichtenstein repair. Polypropylene mesh (Trulene macropore, Healthium Medtech, India) was used in both groups. Postoperative pain, early ambulation, number of days stayed in the hospital postoperatively, time taken to return to work, cost-analysis, and operating time were assessed between the groups using mean, percentage, Student's t-test for continuous data, and Pearson Chi-square test for categorical variables. Results: The mean age of patients was 60.83±13.84 years in the TAPP group and 56.67±13.99 years in the Lichtenstein group, respectively. The Visual Analogue Scale (VAS) score at 24 hours was higher in the Lichtenstein group (p-value <0.001). Ambulation occurred on Postoperative Day 1 (POD1) in the TAPP group whereas it was on POD2/3 in the Lichtenstein group (p-value <0.001). The Length of Stay (LOS) in the hospital was higher in the Lichtenstein group (p-value 0.063). A total of 50% of the patients in the TAPP group returned to work by POD5, whereas 33.3% and 43.3% of patients in the Lichtenstein group returned to work by POD10 and POD11, respectively, with a p-value of 0.016. The cost was in the range of 30,000-45,000 rupees for the TAPP group (86.7% of patients) and 15,000- 30,000 rupees for the Lichtenstein group (63.3% of patients) respectively, with a p-value <0.001. Conclusion: Laparoscopic surgery (TAPP) is superior to Lichtenstein repair despite higher fixation device costs because it is associated with shorter hospital stays, less pain, and earlier return to regular activities. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment of an inguinal hernia, in which abdominal contents protrude through the inguinal canal, is a common medical operation. Persistent or recurring pain in the inguinal area after surgery, known as inguinodynia, may be difficult for patients and physicians to treat. The purpose of this study is to investigate inguinodynia after inguinal hernioplasty surgeries, as well as the variables that contribute to its development. Methods: A retrospective analysis was conducted on 200 patients who had inguinal hernioplasty at Bihar Hospital. Demographic and clinical data were extracted from electronic health records, including patient characteristics, surgical procedures, mesh types, and pain ratings. Logistic regression analysis was used to investigate the incidence of inguinodynia after different surgical operations. Results: During the postoperative visit, forty (20%) of the 200 patients experienced inguinal pain. Although there was a trend in the predicted direction, no statistically significant links were discovered between the different surgical procedures and inguinodynia. Inguinodynia was the most prevalent following TAPP repairs (37.5%), followed by TEP (25%), Lichtenstein (25%), and stress (12.5%). In a nonsignificant trend, logistic regression analysis favors certain procedures. Conclusion: This study explains why some people develop inguinodynia after inguinal hernia surgery. The observed patterns indicate that the surgical procedure may influence inguinodynia rates, however statistical significance was not achieved. These findings have implications for post-operative pain management, preoperative counselling, and clinical decision-making. More research with larger cohorts is required to verify these findings and better understand the complexities. [ABSTRACT FROM AUTHOR]

Background and objective: To assess the safety and efficacy of inguinal hernia repair using local anaesthesia guided by ultrasound. To evaluate the efficacy of ultrasoundguided local anaesthesia against spinal anaesthesia for inguinal hernia repair, specifically in terms of postoperative discomfort, complications, and length of hospital stay. Method: The study encompassed a total of 60 instances of inguinal hernia. Upon admission to the hospital, a comprehensive medical history was obtained and a meticulous clinical examination was conducted. Every case had a set of routine investigations, which included testing for haemoglobin, total leukocyte count, differential leukocyte count, erythrocyte sedimentation rate, random blood sugar, renal function, chest X-ray, and EKG. Result: The mean age in group A was 48.09 and 43.56 for group B. pain in group A was moderate for 23 individuals and 13 subjects in group B. Post-operative complications were wound sepsis, testicular pain for group A and sepsis and urinary retention in group B. mean of analgesic dose in group A is 3.1 and 4.35 in group B. VAS Score showed 0.035 significance in study. Conclusion: The utilisation of Lichtenstein tension-free hernioplasty, conducted with the administration of local anaesthesia and guided by ultrasonography, has ushered in a novel age in hernia surgery, thereby eradicating the potential for significant complications. [ABSTRACT FROM AUTHOR]

Background This study was conducted to compare the study between LMR (Lichtenstein Tension-Free Mesh Repair) and MBR (Modified Bassini's Repair) of inguinal hernias in a tertiary care center. Methods This was an 18-month hospital-based comparative randomized study conducted to study the clinical presentation, risk factors, and complications of surgical procedures at Basaveshwara Medical College and Hospital, Chitradurga. It was carried out with written informed consent from study participants and approval from the institutional ethics committee. The study involved 60 patients, 30 of whom were in group LMR (Lichtenstein's Tension-Free Mesh Repair) and 30 of whom were in group MBR (Modified Bassini's Repair). Results There was a significant and suggestive difference in pain scores on the 30th postoperative day, with the Lichtenstein group having more pain than the modified Bassini's group. The incidence of postoperative haemorrhages was nearly the same after both surgeries. Seromas occurred a little more frequently after Lichtenstein's repair than after Bassini's surgery, possibly because the former involved the use of a prosthesis. Post-operative wound infection was detected only after mesh repair and not after anatomical repair, with mesh (foreign body) once again being the cause. Individuals who underwent Lichtenstein's mesh hernioplasty experienced no recurrences, but individuals who had modified Bassini's surgery experienced two (6.6%) recurrences. Conclusion Lichtenstein's tension-free mesh hernioplasty was found to give superior results than Bassini's repair, with no significant increase in postoperative complications and a shorter hospital stay due to technical simplicity, a smaller dissection, and early ambulation with an acceptable post-operative rehabilitation. It was easier for trainee surgeons to learn than Bassini's repair. Nonetheless, Bassini's repair has the benefit of being reasonably priced and is still helpful in situations where using mesh for repair is prohibited, such as contaminated scenarios, and in situations where a strangulated inguinal hernia occurs. To avoid surgical difficulties in the correction of inguinal hernias, situations must be customised using a tailored strategy. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to perform a systematic review and meta-analysis comparing postoperative outcomes in inguinal hernia repair with TIPP versus Lichtenstein technique. Methods: Cochrane Central, Scopus, and PubMed were systematically searched for studies comparing TIPP and Lichtenstein´s technique for inguinal hernia repair. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, the Visual Analogue Pain Score, chronic pain, paresthesia rates, and recurrence. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if I2 > 25%. Results: 790 studies were screened and 44 were thoroughly reviewed. A total of nine studies, comprising 8428 patients were included, of whom 4185 (49.7%) received TIPP and 4243 (50.3%) received Lichtenstein. We found that TIPP presented less chronic pain (OR 0.43; 95% CI 0.20–0.93 P = 0.03; I2 = 84%) and paresthesia rates (OR 0.27; 95% CI 0.07–0.99; P = 0.05; I2 = 63%) than Lichtenstein group. In addition, TIPP was associated with a lower VAS pain score at 14 postoperative day (MD − 0.93; 95% CI − 1.48 to − 0.39; P = 0.0007; I2 = 99%). The data showed a lower operative time with the TIPP technique (MD − 7.18; 95% CI − 12.50, − 1.87; P = 0.008; I2 = 94%). We found no statistical difference between groups regarding the other outcomes analyzed. Conclusion: TIPP may be a valuable technique for inguinal hernias. It was associated with lower chronic pain, and paresthesia when compared to Lichtenstein technique. Further long-term randomized studies are necessary to confirm our findings. Study registration A review protocol for this meta-analysis was registered at PROSPERO (CRD42023434909). [ABSTRACT FROM AUTHOR]

Introduction: Over the course of the past several years, several improvements have been made to the traditional Lichtenstein's hernioplasty approach to reduce the likelihood of post-operative complications and eliminate the possibility of chronic pain. Earlier, mesh fixation was used to be done by suture application. However recently, different non-traumatic alternative methods of mesh fixation like tissue compatible glues are being considered. Methods: The present randomized control study included a total of 60 patients, randomized equally (n=30 each) into two groups. Patients in group A were operated on for hernia repair using polypropylene 2-0 sutures for mesh fixation while in group B N-Butyl-2 cyanoacrylate glue was used for mesh fixation. Results: Mesh fixation time was significantly more in patients with propylene sutures than in glue (p=0.001). Total surgery time was also more for patients of propylene suture group with unilateral (73.38±10.75vs 65.42±21.31, p=<0.001) or bilateral (149±51.19vs 136±30.93, p=0.606) hernia, however in patients with bilateral hernia the difference was not statistically significant. Post-operative pain, analgesia requirement, time taken to return to normal activity, and postoperative complications like seroma, hematoma, and local numbness were not statistically significant. Conclusions: the use of a synthetic tissue adhesive N-butyl-2-cyanoacrylate glue is a feasible option for mesh fixation in patients with simple inguinal hernias undergoing Lichtenstein's hernioplasty, without adversely affecting the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic postoperative inguinal pain (CPIP) is a common complication after inguinal hernia surgery and occurs in up to 10–14% of cases. CPIP has a significant impact on daily life, work ability and thus compromises quality of life. The aim of this retrospective study was an in-depth analysis of patients undergoing inguinal hernia repair to further refine the prediction of the onset of CPIP reliably. Methods: A single center retrospective analysis of patients with who underwent open or minimally invasive inguinal hernia repair from 2016 to 2021 was carried out. Complication rates, detailed analysis of postoperative pain medication and quality of life using the EuraHS Quality of Life questionnaire were assessed. Results: Out of 596 consecutive procedures, 344 patients were included in detailed analyses. While patient cohorts were different in terms of age and co-morbidities, and the prevalence of CPIP was 12.2% without differences between the surgical procedures (Lichtenstein: 12.8%; TEP 10.9%; TAPP 13.5%). Postoperative pain was evaluated using a newly developed analgesic score. Patients who developed CPIP later had a significant higher consumption of analgesics at discharge (p = 0.016). As additional risk factors for CPIP younger patient age and postoperative complications were identified. Conclusion: The prospective use of the analgesic score established here could be helpful to identify patients that are at risk to develop CPIP. These patients could benefit from a structured follow-up to allow early therapeutic intervention to prevent chronification and restore the quality of life. [ABSTRACT FROM AUTHOR]

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

Introduction: The Lichtenstein repair has been synonymous with "open" inguinal hernia repair (IHR) for 40 years. However, international guidelines have suggested that posterior mesh placement results in advantageous biomechanics and reduced risk of nerve-related chronic pain. Additionally, the use of local anesthetics has been shown to reduce postoperative pain and complication risks. An open transrectus preperitoneal/open preperitoneal (TREPP/OPP) repair combines posterior mesh placement with the use of local anesthetic and as such could be the ideal repair for primary inguinal hernia. Using the Abdominal Core Health Quality Collaborative (ACHQC) registry, we compared open anterior mesh with open posterior mesh repairs. Methods: We performed a propensity score matched analysis of patients undergoing open IHR between 2012 and 2022 in the ACHQC. After 1:1 optimal matching, both the TREPP/OPP and Lichtenstein cohorts were balanced with 451 participants in each group. Outcomes included patient-reported quality of life (QoL), hernia recurrence, and postoperative opioid use. Results: Improvement was seen after TREPP/OPP in EuraHS QoL score at 30 days (OR 0.558 [0.408, 0.761]; p = 0.001), and the difference persisted at 1 year (OR 0.588 [0.346, 0.994]; p = 0.047). Patient-reported opioid use at 30-day follow-up was significantly lower in the TREPP/OPP cohort (OR 0.31 [0.20, 0.48]; p < 0.001). 30-day frequency of surgical-site occurrences was significantly higher in the Lichtenstein repair cohort (OR 0.22 [0.06–0.61]; p = 0.007). There were no statistically significant differences in hernia recurrence risk at 1 year, or rates of postoperative bleeding, peripheral nerve injury, DVTs, or UTIs. Conclusion: Our analysis demonstrates a benefit of posterior mesh placement (TREPP/OPP) over anterior mesh placement (Lichtenstein) in open inguinal hernia repair in patient-reported QoL and reduced opioid use. [ABSTRACT FROM AUTHOR]

Introduction: The Desarda autologous tissue repair is comparable to the Lichtenstein hernioplasty for inguinal hernia regarding recurrence, chronic groin pain, and return to work activities. This study was designed to establish the outcomes of Desarda's repair versus Lichtenstein's hernioplasty concerning post-operative recovery to normal gait and its feasibility under local anesthesia (LA). Materials and methods: This study was a single-center, prospective, double-blinded, non-inferiority, randomized trial. Patients undergoing open hernia repair for primary inguinal hernia were included. Patients were randomly assigned and followed up for 2 years. The primary endpoint was the time to return to normal gait post-surgery with comfort (non-inferiority margin fixed as 0.5 days). The secondary outcomes studied were post-operative pain score, the time required to return to work (all previously performed activities), and surgical-site occurrences (SSO). Results: One hundred ten eligible patients were randomly assigned [56 patients (50.9%) in the Desarda group and 54 patients (49.1%) in the Lichtenstein group]. All the procedures were safely performed under LA. The median (interquartile range) time for resuming gait post-surgery with comfort was 5 days in the Desarda vs 4 days in Lichtenstein's arm (P = 0.16), thereby failing to demonstrate non-inferiority of Desarda against Lichtenstein hernioplasty. However, there were no significant differences in days to return to work, SSO, chronic groin pain, and recurrence within two years of surgery. Conclusions and relevance: This study could not demonstrate the non-inferiority of the Desarda repair versus Lichtenstein hernioplasty regarding the time taken to return to normal gait. Comparing the days to return to work, pain score, SSO, and chronic groin pain, including recurrence rate, Desarda repair faired equally with Lichtenstein hernioplasty, thereby highlighting its feasibility and efficacy under LA. Trial registration: ClinicalTrials.gov Identifier: NCT03512366. [ABSTRACT FROM AUTHOR]

Purpose: Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry. Methods: Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP. Results: After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02). Conclusion: This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs. [ABSTRACT FROM AUTHOR]

Introduction groin hernia repair is a common surgical procedure performed. Open hernia surgery is well accepted standard approach to inguinal hernia. Unilateral groin hernia repair is commonly performed under local anesthesia [1]. Simultaneous bilateral open groin hernia under local anesthesia is not well documented Many patients with bilateral groin hernia are unfit for general anesthesia. Hence simultaneous open groin hernia surgery under local anesthesia is a preferred and safe procedure [1, 2]. We report our experience with concomitant bilateral inguinal hernia surgery under the local anesthesia method. We reviewed prospective data of patients with bilateral inguinal hernias for whom both sides of hernia surgery were performed between 2021-2022. Data collected were analyzed for patient demographics, visual analog pains score, surgery time volume of local anesthetic-solution, patient compliance, and complication. Bilateral Lichtenstein's mesh hernioplasty was performed in all inguinal patients' hernia using a local anesthetic solution. The mixture comprised 0.5% bupivacaine 30 ml + adrenaline and 2% lignocaine with an adrenaline 20 ml + 0.9% normal saline 50 ml & 6 ml of 8.6% Sodium bicarbonate. Result: The study included 24 patients 92% of patients were male and only two male-patients' ages ranged between 35-81 years and BMI of 18-30 (mean 24). The average surgery time was 65 min (35-120min) median operating time was 60 min. The mean pain of 24 on the VAS o-100 scale. Patient satisfaction score (0-100scale) ranging from 50-100 (median 90). Conclusion: The study showed that simultaneous bilateral open mesh hernioplasty under local anesthesia can be performed safely with good patient satisfaction. Bilat open inguinal hernia repair is a good option in patients who otherwise are not fit for general anesthesia & Simultaneous bilateral inguinal hernia surgery can be performed safely. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of inguinal hernia is one of the most common procedures in surgery. Various techniques can be used to repair inguinal hernias, but the two most commonly used are the Shouldice surgical technique, modified by the Berliner Darn and Lichtenstein techniques, as a non-extension technique. However, despite the long tradition of surgical hernia treatment, there is still no consensus on the best or most appropriate surgical technique for elective inguinal hernia repair. Therefore, it remains a challenge for surgeons to choose the appropriate hernia repair method on a case-by-case basis that results in low complications and faster recovery. The aim of this study is to compare the efficiency of the Shouldice surgical technique modified by the Berliner Darn and Lichtenstein techniques in the treatment of hernias with respect to certain post-operative parameters. Methods: A prospective and cohort study was conducted at the Clinical Hospital in Tetovo. The study included 100 patients diagnosed with inguinal hernia and treated in hospital. The monitored patients were divided into two groups according to the technique used: 50 patients treated with Shouldice technique modified by Berliner Darn and 50 patients treated with Lichtenstein technique. In addition, we based the selection of the groups mainly on the reproductive age of the patients. Only male patients were treated in both groups, as there were very few female cases during the study period. Results: Patients operated on with the Lichtenstein technique were more mobile postoperatively, post-operative pain was less severe and return to daily and occupational activities and length of hospital stay were significantly shorter than with the Shouldice technique. Conclusion: The Lichtenstein tension-free surgical technique is more efficient and adequate than the modified Shouldice technique according to Berliner Darn in terms of post-operative pain intensity, length of hospital stay, return to daily activities, and return to work. [ABSTRACT FROM AUTHOR]

The article describes a clinical case of a patient with a deep supraforaminal hernia, a rare variant of interparietal hernia in the inguinal region. During surgery, an indirect inguinal hernia type IIIB and a lobulated and pedunculated preperitoneal lipoma were found. The hernia was repaired using the plug technique and the region was reinforced with another mesh using the Lichtenstein technique. The patient recovered successfully and there have not been many reports on this variant of hernia. [Extracted from the article]

Purpose: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. Methods: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. Results: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4–0.9). The pooled recurrence rate was 1.4% (95% CI 1.05–1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9–3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2–83.47)]. Conclusion: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence. [ABSTRACT FROM AUTHOR]

Background and objectives: Inguinal hernia repair is the most frequently performed operation in any general surgical unit. Reports on the outcome of inguinal hernia surgery show that recurrence rate 5 years after operation can vary from 0.1 to over 20%. The aim of the present study is to compare Lichtenstein’s tension free hernia repair with the Modified Bassini’s herniorraphy in terms of immediate complications like technical difficulty, seroma formation, wound infection rate, recurrence rate at one year and chronic pain. Methods:100 cases admitted to BELAGAVI INSTITUTE OF MEDICAL SCIENCES BELGAVI DISTRICT HOSPITAL from June 2021 to May 2022 with primary unilateral inguinal hernia were randomly subjected either to Modified Bassini’s herniorraphy or Lichtenstein hernioplasty. All the hernia repairs were performed under spinal anaesthesia. In case, of any associated conditions like hypertension, diabetes mellitus were present, treatment was first given for these associated conditions. A note was taken of any technical difficulty during surgery.The patients were followed in the surgical OPD at 1 month, 6 months and 1 year for time taken to return to normal activities, chronic groin pain, patient’s satisfaction and recurrence. Results:Technical difficulty was encountered in 4 patients (i.e. 8%) undergoing Modified Bassini’s herniorraphy. No technical difficulty was encountered in any of the patients in Lichtenstein group. At 1 month follow up, 20 patients (i.e. 40%) of Modified Bassini’s herniorraphy group patients had mild pain whereas 14 patients (i.e. 28%) had mild pain in the Lichtenstein group. However, none of the patients in X any of the two groups had any degree of pain at 6 months and 1 year. There was one recurrence (i.e. 2%) in Modified Bassini’s herniorraphy. However, no recurrence was seen in Lichtenstein group. Time to return to work was relatively shorter in Lichtenstein group. Interpretation and Conclusion: Lichtenstein is a easy, straightforward technique for inguinal hernia repair with fewer recurrences, less hospital stay and less duration of surgery. However, amongst the pure tissue repairs Modified Bassini’s herniorraphy still remains relevant. [ABSTRACT FROM AUTHOR]

Introduction: This article provides a detailed breakdown of the analytical data gathered from contrasting inguinal operations done under local and spinal anaesthetic, so that readers can reach an informed judgement on the relative merits of these two approaches. Materials and Methods: This prospective, analytical investigation compared the outcomes of surgeries performed under local versus spinal anaesthesia patients with uncomplicated unilateral inguinal hernia. Cost-effectiveness, patient satisfaction, and the incidence of problems during and after surgery were among the outcomes tallied and statistically examined. Results: Patients in Group 2 were, on average, 43.2152.50 years old, while those in Group 1 were, on average, 45.2514.99 years old. The median time needed for surgery was the same in both groups, with no statistically significant difference (p>0.05). In both groups, postoperative complications were similar, with the exception of those related to spinal anaesthesia. The pain relief from local anaesthesia was better in the first twenty-four hours. The median length of time patients spent in the hospital recovering from surgery was lower in the local anaesthesia group. Time spent away from the workforce was shorter for Group 1 than Group 2. Conclusion: Repairing an inguinal hernia using local anaesthesia is a tried and true method with a low risk/high reward ratio. This method will improve the amount and quality of surgical procedures performed in India, where the demand for care much exceeds the country's current capacity to provide it. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is most frequently preformed surgeries by most of the general surgeons worldwide. Pain is the most common symptom post operative in both immediate and chronic phase. Pain management in these patients, especially in the immediate post operative time, is major concern for both patients and the medical fraternity. Material & Methods: A comparative study to evaluate the post operative pain in management of open inguinal hernia repair with and without inguinal nerve block was conducted at Dept. of General Surgery in Santosh Medical College and Hospital, Ghaziabad on patients admitted in Dept of General Surgery from September 2020 to August 2021. All patients underwent Lichtenstein tension free mesh repair for inguinal hernia. Half the patients randomly selected were given inguinal nerve block using 0.25% levobupivicaine. Results: Nerve blocks have been used for chronic pain managements in past in post op inguinal hernia repair surgeries. Present study deals with pain management in immediate post- operative pain management. It shows significant difference is noted in patients receiving the nerve block not only in pain but also comfort levels, post operative mobility, day of discharge and retention of urine. Conclusion: Use of nerve blocks in patients undergoing open inguinal hernia repair is beneficial for the patient with improved outcome. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post‐spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. Methods: This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension‐free — Lichtenstein — inguinal hernia repair operation with only TAP block application. This retrospective case‐control study received ethics committee approval (decision number 21‐5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. Results: We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia‐related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. Conclusion: Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients. Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients. [ABSTRACT FROM AUTHOR]

Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed at analyzing the feasibility of the extraperitoneal approach, by routine for this team/ and answering the question of whether this type of approach can be considered a safe one. Although indications for an intra- or extraperitoneal approach largely overlap, it may also be a matter of surgeon preference in choosing one technique. Methods: The study was retrospective, conducted on a group of 493 patients operated on for inguinal hernia in the clinic, by a single operating team, between January 2012 and March 2022. Results: It was proven that out of the 493 surgeries for inguinal hernia, 95.1% (n = 469) were operated upon by laparoscopic TEP (total extra peritoneal patch plasty approach); 1.62% (n = 8) by laparoscopic TAPP (transabdominal intraperitoneal); and 3.24% (n = 16) by the open, anterior approach (Lichtenstein). There were no intraoperative complications recorded in any of the procedures, while postoperative complications were found in 10.23% of cases (n = 48) in the extraperitoneal approach, and recurrences after the TEP approach were recorded in 0.40% of cases (n = 2). Conclusions: For correctly selected cases, TEP hernia surgery can be considered a safe and reliable approach. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia occurs in about 15% of adult population and inguinal hernia repair is one of the most commonly performed surgical procedure. In the era of minimal invasive surgery, hernia repair has seen a paradigm shift from open to laparoscopic technique. Objectives: To assess the outcome of drain placement Vs no drain use, in patients undergoing open mesh repair of inguinal hernias. Methods: This is a prospective study comprising of 50 patients of inguinal hernia over a period of 23 months. The patients were randomized into 2 groups – With and without the use of drains. The patients underwent open inguinal hernia mesh repair by a standardized method. The outcome of seroma formation, hematoma formation, infection at surgical site, and duration of hospital stay was recorded and analyzed. Results: In the present study 16% of cases in drainage group and 20% in non-drainage group developed post operative wound infection. P value is insignificant. The mean post operative hospital stay in drainage group was 9.7 days and in non-drainage group was 6.7 days. Conclusion: The early post operative complications like seroma, hematoma, wound infection rates are similar in both drainage and non-drainage groups. So, it appears that suction drain usage can be restricted in Lichtenstein’s tension free mesh repair in simple inguinal hernias unless hernia is complicated or there is extensive dissection. [ABSTRACT FROM AUTHOR]

Objective: To compare Desarda tissue-based repair with the traditional Lichtenstein hernioplasty in terms of complications, operative time and cost-effectiveness. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Surgical Department Combined Military Hospital, Mailsi Pakistan, from Dec 2019 to Dec 2020. Methodology: Lichtenstein (Group-I) and Desarda (Group-II) were randomly allocated to 140 patients with inguinal hernia, 70 in each Group, respectively. Both Groups were compared in terms of postoperative complications, cost evaluation and operative time. Results: The mean operative time in Group-I was 54.5±4.09 minutes, whereas in Group-II, it was 70.24±5.30 minutes. The mean cost estimated in Group-I was 4400±225 rupees, while in Group-II, it was 850±150 rupees, respectively. Desarda's repair was comparable to Lichtenstein's hernioplasty in terms of postoperative complications. Conclusion: Desarda's hernia repair is more cost-effective than the Lichtenstein procedure for treating inguinal hernia. Reduced surgical time, faster restoration to normal gait, and return to work are all the possible benefits of the Lichtenstein repair. Furthermore, Lichtenstein hernioplasty is a better option in patients with weak external oblique aponeurosis. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repairs are one of the most common procedures performed in general surgery departments. Various techniques have been used to repair inguinal hernias. But now only 3 methods are generally accepted as the best evidence-based treatment options for inguinal hernia repair: the Shouldice technique, Lichtenstein tension-free repair and laparoscopic repair either via the transabdominal preperitoneal (TAPP) approach or the totally extraperitoneal (TEP) approach. There is limited number of studies that have compared the effects of both techniques on the spermatic cord and testicular functions in long term. Objective: The aim of the current work was to compare the effect of laparoscopic inguinal hernioplasty either totally extraperitoneal (TEP) approach or transabdominal preperitoneal (TAPP) approach on testicular blood flow and volume on the same side of the hernia repair. Patients and methods: This prospective study was performed on 47 male patients admitted to general surgery ward at Mansoura University Hospital between February 2019 and February 2020 with clinically diagnosed inguinal hernias and fulfilling the eligibility criteria. The study population was distributed into 2 groups by computer generating program; Group A that included 28 patients with inguinal hernia who were operated by laparoscopic techniques (TAPP) approach and group B that included 19 patients with inguinal hernia who were operated laparoscopically by (TEP) approach. Results: There is non-statistically significant higher improvement in resistive index (RI) in TEP group than TAPP at levels of Testicular and Capsular Artery but the same percentage of improvement at the level of intratesticular artery. Conclusion: It could be concluded that laparoscopic inguinal hernioplasty either TAPP or TEP approaches are safe regarding testicular blood flow but also, they improve it. [ABSTRACT FROM AUTHOR]

Background: Mesh placement and subsequent fixation are an important aspect of hernia surgery. Different methods are available in modern days for fixing the mesh in inguinal hernioplasty surgery in both open and laparoscopic approach. However, sutures are still preferred by most of the surgeons because of its easy availability and cost- effectiveness. Conventionally, non-absorbable sutures are used to fix mesh. Aims and Objectives: The objective of our present study is to compare the post-surgical outcomes of mesh fixation with monofilament non-absorbable sutures versus monofilament delayed absorbable sutures. Materials and Methods: This prospective and randomized study was conducted at the Department of Surgery, ESIC-PGIMSR, Joka during the period of January 2017 –March 2019. Total 160 patients having unilateral uncomplicated inguinal hernia were included in this study; operated by the same surgical team. The patients were divided into two groups, each of 80 patients. In Group I, mesh fixation was done with delayed absorbable sutures whereas, in Group II, mesh was fixed with non-absorbable sutures. The data were analyzed with appropriate statistical tests such as Chi-square test and P < 0.05 that were considered as statistically significant. Results: The development of post-operative pain was more common in Group II. The difference was statistically significant at 6 months post-operative time (P =0.042). When we compared the post-operative par esthesia in both surgical groups, more number of patients developed it in Group II but no significant statistical difference was observed (P-value came as 0.784, 0,221, and 0.385 after analyzing 3 months, 6 months, and 1 year data, respectively). Regarding other complications such as h ematoma, wound infection, seroma formation, and scrotal/ cord edema, no statistically significant differences were observed in either group (P-values were 0.339, 0.149, 0.313, and 0.117, respectively). No patient developed chronic discharging sinus post operatively in either group. No recurrence was noted in any patients included in this study, after 1 year of follow- up. Conclusion: Using delayed-absorbable suture material with air knotting technique for mesh fixation in Lichtenstein tension-free open inguinal hernioplasty causes less chance of post-operative inguinal pain and pare sthesia. Hence, it is a good alternative choice for surgeons; in terms of safety and efficacy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of laparoscopic preperitoneal hernia repair (TAPP) and Lichtenstein hernia repair for inguinal hernia on serum testosterone concentration and matrix metalloproteinase-2 (MMP-2). Methods: From January 2017 to January 2021, 80 patients with inguinal hernia were selected, and they were divided into TAPP group (n=44) and Lichtenstein group (n=36) by random number table, and the two groups of surgical indicators and surgery were recorded. For post-operative complications and recurrence rates, serum testosterone and MMP-2 levels were measured before and 1 month after surgery. Results: The amount of intraoperative blood loss and postoperative anal exhaust time in TAPP group were lower than those in Lichtenstein group (P<0.05), and there was no difference in the operative time between the two groups (P>0.05). The postoperative hospital stay in TAPP group was shorter than that in Lichtenstein group, and the hospitalization cost was higher than that in Lichtenstein group (P<0.05). There was no difference in postoperative recurrence rate between the two groups (P>0.05). The incidence of scrotal edema in TAPP group was lower than that in Lichtenstein group (P<0.05), but there was no difference in other complications among groups (P>0.05). There was no change in serum testosterone in both groups before and after operation (P<0.05). The level of MMP-2 in both groups was decreased after surgery (P<0.05), but there was no difference between groups (P>0.05). Conclusion: Both surgical methods have no damage to the testicular function of patients with inguinal hernia, and both can effectively reduce the serum MMP-2 level, prevent the recurrence of the inguinal hernia, and are safe and effective. In contrast, the laparoscopic ATPP has less trauma and the operation The recovery is faster, but the operation is more difficult and costly. The two surgical methods have their own advantages and disadvantages. The surgical method needs to be selected according to the actual situation of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Chronic groin pain is the most common and irritating post-operative complication after Lichtenstein mesh hernioplasty for inguinal hernia surgery. The occurrence and handling of chronic groin pain has posed a significant challenge to surgeons around the globe. An effort to reduce chronic groin pain we designed this study to compare the possible influence of delayed absorbable suture used for mesh fixation in tension free inguinal hernia repair on the rate of chronic groin pain. Material and Methods: Prospective study conducted in Surgical Unit-Ill, Abbasi Shaheed Hospital, Karachi. It includes all the male patients ages 18 years and above admitted for elective inguinal hernia mesh repair. Half of the patients (Group A) mesh fixation was done with polypropyelene non-absorbable monofilament sutures and in other half (Group B) polygla-ctin delayed absorbable braided sutures are used. Post-operative chronic pain was assessed using Visual Analogue Scale (VAS) at the time of discharge, post-operative day 07,1 month and 3 months follow up. Results: There were 156 patients admitted in the Surgical Unit-Ill for elective surgery of inguinal Lichtenstien hernioplasty from July 2018 to June 2021 which were included in this study. Majority of our patients were of old age, with mean age was 49.1 years (range 18-74 years). 93(60%) patients are between 40 and 60 years of age. 87(56%) patients had Right, 55(35%) of patients had Left and 14(9%) patients had bilateral inguinal hernia. 06(4%) patients had recurrent inguinal hernias. Chronic pain at 3-months follow up was present in 25 patients constituting 16% of all patients undergoing hernia repair. Patients were divided into groups of No (0), mild (1-3), moderate (4-6), and severe pain (>6) on basis of 10 point Visual Analogue Scale (VAS) score. It was found that majority, 14-patients had mild pain, 7-patients had moderate pain, and 4-patients had severe pain 3-months after hernioplasty. Chronic groin pain was occurred in 20.51% and 11.53% in Group-A and Group-B respectively. Conclusion: In present study, we have found more incidence of post-operative pain in nonabsorbable suture group as compared to absorbable suture group at different time intervals. A 3-months follow-up provided evidence that the use of absorbable sutures for mesh fixation decreases groin pain in patients after inguinal hernia repair with similar recurrence rate. [ABSTRACT FROM AUTHOR]

To compare the curative effect of laparoscopic transabdominal preperitoneal hernia repair (TAPP) and Lichtenstein's tension-free hernia repair of two types of surgery in the treatment of elderly patients with inguinal hernia. Methods: Clinical data of 118 elderly patients（≥ 60 years) with inguinal hernia in department of Thyroid and Hernia Surgery in Yueyang Hospital of integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine from August 2018 to July 2020were retrospectively analyzed. According to different surgical methods, 68 patients received TAPP as the TAPP group, and 50 patients received Lichtenstein's tension-free hernia repair as the Lichtenstein group. The operative time, intraoperative blood loss, post operative visual analog scale (VAS) score, exhaust time, hospital stay and postoperative short-term and long-term complication rate were compared between the two groups. There was no significant difference in operation time between the two groups (P>0.05). The intraoperative blood loss, exhaust time and hospital stay in the TAPP group were significantly lower than those in the Lichtenstein group (P<0.05).The VAS scores of incision at different time points after operation in TAPP group were significantly lower than those in Lichtenstein group (P<0.05). The incidence of short-term complications in the TAPP group was significantly lower than that in the Lichtenstein group(P<0.05). There was no significant difference in the incidence of long-term complications between the two groups (P>0.05). Compared with Lichtenstein's tension-free hernia repair, TAPP is a safe and effective surgical method for the treatment of elderly patients with inguinal hernia, which can reduce postoperative pain, faster recovery and lower complication rate, and which is worthy of promotion and application. [ABSTRACT FROM AUTHOR]

Background: Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during minimally invasive inguinal hernia repair. Therefore, it suggested that an open anterior technique should be used rather than a minimally invasive posterior technique in these patients. Methods: In this single-center study, a retrospective analysis of a prospectively maintained database was performed. All patients undergoing inguinal hernia repair after previous transabdominal prostatectomy were included in this analysis, and the feasibility, safety, and short-term outcomes of open and robotic-assisted laparoscopic inguinal hernia repair were compared. Results: From 907 inguinal hernia operations performed between March 2015 and March 2020, 45 patients met the inclusion criteria. As the number of patients treated with conventional laparoscopy was very low (n = 2), their data were excluded from statistical analysis. An open anterior repair with mesh (Lichtenstein) was performed in 21 patients and a robotic-assisted laparoscopic posterior transabdominal repair (rTAPP) in 22. Patient characteristics between groups were comparable. A transurethral urinary catheter was placed during surgery in 17 patients, most often in the laparoscopic cases (15/22, 68.2%). In the rTAPP group, a higher proportion of patients was treated for a bilateral inguinal hernia (50%, vs 19% in the Lichtenstein group). There were no intraoperative complications and no conversions from laparoscopy to open surgery. No statistically significant differences between both groups were observed in the outcome parameters. At 4 weeks follow-up, more patients who underwent rTAPP had an asymptomatic seroma (22.7% vs 5% in the Lichtenstein group) and two patients were treated postoperatively for a urinary tract infection (4.7%). Conclusion: A robotic-assisted laparoscopic approach to inguinal hernia after previous transabdominal prostatectomy seems safe and feasible and might offer specific advantages in the treatment of bilateral inguinal hernia repairs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate driving ability (brake reaction time, BRT) after right-sided hernia repair. It was assumed that postoperatively BRT would be impaired as compared to the preoperative reference and healthy controls. Methods: BRT was prospectively collected from 30 patients undergoing hernia repair [Lichtenstein or total extraperitoneal endoscopic procedure (TEP)]. BRT was measured with a driving simulator preoperatively and on postoperative days 2 and 14. After receiving a visual stimulus, the patients had to apply the brake pedal with 160 N. The average of ten runs was used as the patient's BRT value. Results: Thirty patients completed all measurements. In the Lichtenstein group, BRT was significantly impaired as compared to the patient's preoperative values (p = 0.021). Two weeks after surgery BRT had returned to the preoperative level (p = 0.859). BRT in the Lichtenstein group was also significantly impaired 2 days postoperatively as compared to the BRT of 60 healthy controls (p = 0.001). In the TEP group, no impaired BRT was detected. Conclusions: Based on our finding of significantly impaired BRT in patients following right-sided Lichtenstein hernia repair, it seems wise to recommend that such patients refrain from driving for 2 weeks after surgery. No such impairment was found in patients following TEP surgery. Consequently, it is deemed safe for them to resume driving 2 days after the procedure. [ABSTRACT FROM AUTHOR]

Background: While elective inguinal hernia repair (IHR) in octogenarians carries a low 30-day mortality rate, long-term outcomes are uncharted. If on average, veteran octogenarians are expected to succumb to pre-existing cardiopulmonary disease within a year of diagnosis, watchful waiting might be advisable. This study interrogated long-term mortality and its predictors following elective IHR in veteran octogenarians. Materials and methods: This is a retrospective analysis of 109 veterans (≥ 80 years of age), ten of which were nonagenarians who had an elective IHR. Data were dichotomized between deceased vs. non-deceased patients for univariable and multivariable analyses. Patient characteristics were also assessed in patients undergoing general (GA) vs. local (LA) anesthesia and corrected for unilateral repair and age. Kaplan–Meier curves were generated in corrected and uncorrected cohorts receiving GA vs. LA. Results: At the time of analysis, 46 (45.0%) octogenarians were deceased. The average time to death following IHR was 3.7 ± 2.9 years [range (37 days–12.4 years)]. Univariable analysis showed renal disease (19.9% vs. 5.3%), operative time (67.9 ± 29.0 vs. 56.1 ± 14.4 min) and use of GA (73.0% vs. 34.8%) associated with long-term mortality (all p < 0.01). Renal disease [odds ratio (95% confidence intervals) 4.1 (1.2–13.8)] and use of GA [5.0 (2.0–10.0)] were independent predictors of mortality. Patients undergoing LA (n = 62) were older, were more likely to have cardiac disease, and had a higher ASA compared to patients receiving GA (n = 47). After correcting for age, cardiac disease and higher ASA remained more common in patients submitting to LA. Long-term mortality was significantly higher in both matched and unmatched octogenarians undergoing GA. Conclusion: Octogenarian veterans with a high burden of comorbid conditions are unlikely to experience short-term mortality because of their pre-existing conditions. Inguinal hernia repair should be offered to octogenarian veterans, but GA should be avoided whenever possible. [ABSTRACT FROM AUTHOR]

Purpose: To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to make a pragmatic evaluation of the rates of potentially surgery-related CPIP vs. postoperative continuation of preexisting preoperative pain. Methods: Groin pain of patients operated from 01/11/2011 to 01/04/2014 was assessed preoperatively, postoperatively and at 2-year follow-up using a VRS-4 in 5670 consecutive groin hernia repairs. A PROM (Patient Related Outcomes Measurement) questionnaire studied the impact of CPIP on the patients' daily life. Results: Relevant (moderate or severe VRS) pain was registered preoperatively in 1639 of 5670 (29%) cases vs. 197 of 4704 (4.2%) cases at the 2-year follow-up. Among the latter, 125 (3.7%) cases were found in 3353 cases with no-relevant preoperative pain and 72 (5.3%) in 1351 cases with relevant preoperative pain. Relevant CPIP consisted of 179 (3.8%) cases of moderate pain and 18 (0.4%) cases of severe pain. The rate of severe CPIP was independent of the preoperative VRS-pain category while the rate of moderate CPIP (3.1%, 3.4%, 4.1%, 6.8%) increased in line with the preoperative (none, mild, moderate, and severe) VRS-pain categories. The VRS probably overestimated pain since 71.6% of the relevant CPIP patients assessed their pain as less bothersome than the hernia. Conclusion: At the 2-year follow-up, relevant CPIP was registered in 4.2% cases, of which 63.5% were potentially surgery-related (no-relevant preoperative pain) and 36.5% possibly due to the postoperative persistence of preoperative pain. The rate of severe CPIP was constant around 0.4%. [ABSTRACT FROM AUTHOR]

Introduction Inguinal hernioplasty is one of the most frequently performed surgical procedures. Laparoscopic hernia repair popularized the preperitoneal mesh position due to promising results in alleviating chronic pain. However, considerable proportions of severe adverse events, learning curves, or added costs have to be taken into account. Therefore, open preperitoneal mesh techniques may have more advantages. The trans-rectus sheath extraperitoneal procedure (TREPP) is a novel technique that was developed in 2006 combining the advantages of both the Lichtenstein technique and totally extraperitoneal (TEP). It differs from other preperitoneal techniques due to its medial approach avoiding the interference with the course of all three inguinal nerves through the lateral abdominal wall. Patients and methods This study recruited 100 patients, 50 were operated upon by the TREPP technique and another 50 patients were operated upon by TEP techniques. The items of comparison were conversion to another technique, postoperative pain, bleeding (intraoperative or postoperative hematoma) and surgical site infection. The late items of comparison were chronic postoperative inguinal pain and early recurrence. Results The mean operative time was significantly shorter for the TREPP group. Two patients among the TEP group were converted into TREPP techniques while all the patients among the TREPP group were completed successfully. There were no differences between the two groups as regards postoperative pain, hematoma, or surgical site infection. Also, chronic postoperative inguinal pain occurred in one patient out of 48 patients among the TEP group but occurred in two patients out of the 52 patients among the TREPP group. There was no single recurrence among the TREPP group (52 patients), while there were two hernia recurrences among the TEP group (two out of 48 patients, 4%). Conclusion There were significant advantages of TREPP over TEP: shorter operative time and significantly reduced postoperative pain with less recurrence rate. The main advantage is the ease of learning of the TREPP technique. So, we obtain better results using a simple inexpensive open technique in comparison with the laparoscopic TEP technique. The main criticism, in my mind, was the small sample size of patients and the short follow-up period. [ABSTRACT FROM AUTHOR]

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

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

Background: This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. Methods: Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. Results: A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P<0.001) and used less analgesics after TEP repair, compared to those who had modified Lichtenstein repair. Two patients in the TEP group and five in the Lichtenstein group developed superficial wound infection (P=0·446). Only one reoperation was performed in the Lichtenstein group due to haematoma. Conclusion: TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. [ABSTRACT FROM AUTHOR]

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein's tensionfree mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race, and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15x7.5 cm2) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student's t-test, respectively. Results: Areas of mesh actually applied in the study-mean (85.26±11.04 cm2), mean+2SD (107.34 cm2), most common (75-97.4 cm2) and maximum (102.75 cm2)- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background: Surgery for a groin hernia is the most common operation in general surgery. The recurrence rate in non-specialized centres is high, and postoperative pain and discomfort are common. The inguinal hernia repair has been a controversial area in surgical practice ever since it was associated with recurrence rates which have decreased because of the use of prosthetic mesh. Objective: This study was aimed to evaluate the benefits and harms of the total extra-peritoneal technique compared with the Lichtenstein technique for inguinal hernia repair. Patients and Material: This randomized controlled trial study included a total of 40 male patients aged between 14 and 60 years with unilateral or bilateral inguinal hernia, attending at Outpatient Clinic, Aswan University Hospital and followed up there. This study was conducted period from August 2017 to August 2018. They were randomly divided into two groups; Group A Open Lichtenstein hernioplasty and Group B; laparoscopic total extraperitoneal hernioplasty (TEP). Results: There was a statistically significant difference between Groups A and B cases as regard operative time and hospital stay. There was no statistically significant difference between Group A and B cases as regard intraoperative/postoperative complications. Also, there was no s statistically significant difference as regard VAS, recurrence in either group during the follow- up period of 6 months. Conclusions: It could be concluded that laparoscopic total extraperitoneal hernioplasty yielded better results regarding operative time and hospital stay. Yet, better results were found regarding complications, but the study could not detect statistical differences. [ABSTRACT FROM AUTHOR]

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

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

Purpose: There are cases where surgeons repair a recurrent inguinal hernia using a second Lichtenstein repair (Lichtenstein-Lichtenstein) or a second laparoscopic repair (Laparoscopy-Laparoscopy) in the same groin even though this contradicts current guideline recommendations. The aim of this study was to provide an overview of surgical modifications and findings during these reoperations.Methods: Patients in this observational study were identified in the nationwide Danish Hernia Database during a 6-year period. Outcomes were identified in medical records. The primary outcome was the prevalence of tailored reoperations and standard reoperations for Lichtenstein-Lichtenstein and Laparoscopy-Laparoscopy, respectively. The secondary outcomes were findings during the reoperation such as inguinal hernia type and size, fibrosis, and difficulty to identify anatomical landmarks.Results: Of the 102 Lichtenstein reoperations, 43 (42%) were tailored repairs and 59 (58%) were standard repairs. The most common modifications were posterior wall reinforcement with permanent sutures, dividing a structure to enable sufficient hernioplasty, and a modification of the new mesh size and/or shape. There were no differences in the findings during tailored- and standard Lichtenstein reoperations. Of the 58 laparoscopic reoperations, 35 (60%) were tailored repairs and 23 (40%) were standard repairs. The most common modifications were necessitation of a coated mesh due to insufficient peritoneal coverage and use of unusual mesh sizes and/or shapes. Fibrosis was more commonly described during the tailored laparoscopic reoperations.Conclusions: A substantial part of the Lichtenstein- and the laparoscopic reoperations was tailored approaches, and various modifications were used. Fibrosis was more commonly described during tailored laparoscopic reoperations. [ABSTRACT FROM AUTHOR]

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