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Background: The best repair of a recurrent inguinal hernia after primary laparoendoscopic repair is debatable. The aim was to assess chronic pain after two laparoendoscopic repairs in the same groin compared with Lichtenstein reoperation preceded by a laparoendoscopic repair.Methods: This cohort study included adult patients who had received two laparoendoscopic repairs (Lap-Lap) or a laparoendoscopic repair followed by the Lichtenstein repair (Lap-Lich). Eligible patients were identified in the Danish and the Swedish hernia databases. Lap-Lap was matched 1:3 with Lap-Lich, and patients were sent validated questionnaires. The primary outcome was the proportion with chronic pain-related functional impairment, compared between the two groups. Secondary outcomes included chronic pain during various activities.Results: In total, 74% (546 patients) responded to the questionnaires with a median follow-up since the second repair of 4.9 years (0.9-21.9 years). Regarding the primary outcome, 21% in Lap-Lap and Lap-Lich had chronic pain-related functional impairment of daily activities (p = 0.94). More patients in Lap-Lap compared with Lap-Lich reported pain ≥ 20 mm measured by the visual analog scale, 11% versus 5%, p = 0.04. However, there was no difference in the median VAS score or in the vast majority of the remaining secondary outcomes.Conclusions: There was no overall difference in chronic pain between patients who had received Lap-Lap compared with Lap-Lich. Choice of operative strategy for the second repair should, therefore, not be based on risk of chronic pain. [ABSTRACT FROM AUTHOR]

Summary: Background: Scrubbing of the skin during Hammam, a Turkish spa treatment, removes cells from the ultraviolet radiation absorbing stratum corneum. Aim: The aim of this study was to assess if skin is more susceptible to sunburn after a Hammam treatment. Methods: In this randomized controlled trial with a paired design, healthy adult participants with skin types 1‐3 were randomized to receive Hammam treatment on one side of the back while the other side was used as control. Participants had 30 minutes of sun exposure on their backs. Erythema and pain were assessed before and 1, 4, 8, and 24 hours after sun exposure. Erythema was assessed by a visual scale and by using chromatography on high‐resolution photos. Pain was assessed with the Visual Analogue Scale (VAS). The primary outcome was the difference in chromatography‐assessed erythema from baseline to the 24‐hour assessment, compared between the Hammam‐ and the control side. Secondary outcomes were differences in pain and visually assessed erythema. Results: Twelve participants were included with complete follow‐up. Eight participants had type‐3 skin and four had type‐2 skin. There was no difference between the Hammam and the control side for any of the outcomes. Even though erythema assessed by chromatography was slightly higher for the Hammam side, the difference was insignificant. Conclusion: Hammam treatment did not increase sunburn, measured by UV‐induced skin erythema and pain, compared with untreated skin following 30 minutes of sun exposure. [ABSTRACT FROM AUTHOR]

Introduction: The most common laparo-endoscopic groin hernia repair techniques are TEP (total extraperitoneal) and TAPP (transabdominal preperitoneal) repair. Despite geographic proximity, Swedish surgeons distinctively favour TEP, whereas Danish surgeons prefer TAPP. The aim of this study is to analyse the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair using data from two nationwide registers. We also aim to discuss advantages of international collaboration between nationwide registers., Methods: All groin hernia operations registered as TEP, TAPP or Lichtenstein repair in the Swedish Hernia Register and the Danish Hernia Database between January 2004 and December 2020 will be included. Cumulative hazard rate of reoperation for recurrence will be estimated using Cox-regression analyses adjusted for age and anatomy., Conclusion: Approximately 400,000 operations are estimated to have been registered prospectively in the inclusion period in the registers. The merging of two nationwide registers was made possible owing to close cooperation between the register steering committees and by obtaining the necessary approvals. This unique collaboration between nationwide registers will make it possible to compare the risk of reoperation for recurrence after TAPP, TEP and Lichtenstein repair on an international level. In future, similar collaboration may be established to explore other outcomes such as complication rates and chronic pain., Funding: This study protocol is financed by grants generated from Sahlgrenska University Hospital (ALF grant ALFGBG-733561, an agreement concerning research and education of doctors) and the Swedish Society of Medicine (SLS-784551)., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

A rapid review is a synthesis of available evidence in which some components of the review process are modified slightly to shorten the process. This will require tight control as well as day-to-day scientific mentoring. The typical rapid review has a focused research question covering a narrow and well-defined clinical problem. With a continuous focus on some elements in the planning and production phases, it is realistic to produce a rapid scoping or systematic review with or without meta-analysis within three months without compromising on scientific quality., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

The main symptom of a groin hernia is a bulge in the groin. The clinical examination is often sufficient for the diagnosis. Imaging is only necessary when the diagnosis is uncertain, where ultrasound is the first choice, but one must also consider differential diagnoses in these cases. Children, women, and men with symptoms should be referred for elective surgery while watchful waiting can be used in asymptomatic men. However, if a hernia is incarcerated and the clinical examination suggests possible strangulation, the patient should immediately be referred to a hospital, as argued in this review.

Background: The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called "sports groin," which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin., Methods: This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998-2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction., Results: Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment., Conclusions: Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.

Introduction: Due to disagreement on optimal timing of inguinal hernia repair in children, we explored how Danish surgeons plan repair in children at different ages and with different symptoms., Methods: A validated questionnaire on timing of inguinal hernia repair in children was sent to all surgeons performing paediatric hernia repair in Denmark. The surgeons were asked how they plan repair of asymptomatic reducible, symptomatic reducible, incarcerated, and strangulated hernias in children aged less than 2, 2-12 and 13-18 years., Results: Forty-eight surgeons (81%) completed the questionnaire. Answers concerning the timing of repair of reducible and incarcerated hernias varied greatly for all age groups. For reducible hernias, the answers ranged from repairing within one week to considering watchful waiting. For incarcerated hernias, the answers ranged from repair within 12 hours to three months. There was broad agreement on the need for acute repair of strangulated hernias., Conclusions: Timing of paediatric inguinal hernia repair was inconsistent for children of all age groups and in particular for those with reducible hernias. The results call for a new guideline to ensure consistent and optimal treatment as well as an educational effort about the pros and cons of early and delayed repair., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

This case report presents a 34-year-old surgeon, who had a six-hour faecal digital smell after 96 minutes of manual disimpaction. The surgeon used a double layer of sterile latex gloves and an additional layer of gynaecological gloves. He noted a distinct faecal digital smell on several occasions, and a colleague also confirmed the odour two hours after the disimpaction. Currently, surgeons tend to use the same pair of gloves during surgery, as long as they are visibly intact. This case report emphasises the need for glove change during long contaminated procedures in order to maintain glove integrity.

Background: The aim was to assess chronic pain after two Lichtenstein repairs for inguinal hernias (Lichtenstein-Lichtenstein) compared with Lichtenstein followed by a laparoscopic reoperation (Lichtenstein-Laparoscopy)., Methods: In this cohort study, adults having an inguinal hernia reoperation were identified in a nationwide database. Lichtenstein-Lichtenstein was matched 1:3 with Lichtenstein-Laparoscopy and sent validated pain questionnaires. The primary outcome was difference in proportion of patients with chronic pain-related functional impairment. Secondary outcomes were differences in chronic pain prevalence and severity., Results: In total, 196 patients having Lichtenstein-Lichtenstein and 777 patients having Lichtenstein-Laparoscopy were included. There was no difference in the primary outcome, 26% with pain in Lichtenstein-Lichtenstein versus 19% in Lichtenstein-Laparoscopy (p = 0.051). However, a few of the secondary outcomes favored Lichtenstein-Laparoscopy., Conclusions: A high proportion of patients in both groups had pain several years after the second repair. None of the analyses favored Lichtenstein-Lichtenstein, but a few of the secondary outcomes favored Lichtenstein-Laparoscopy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: No recent guidelines exist for surgical treatment of paediatric inguinal hernias. Internationally, there is disagreement about both the preferred approach and the details of the surgical procedure. The aim of this nationwide survey study was to assess variations in Danish surgeons' technique when repairing inguinal hernias in children., Methods: A questionnaire was sent to all surgeons in Denmark performing paediatric inguinal hernia repair, including questions about demographic details, choice of open or laparoscopic repair, and technical details of the chosen surgical approach. In the questionnaire, each item was repeated for children aged les than 2, 2-12, and 13-18 years of age., Results: In total, 48 of 59 surgeons responded (81%). For children 12 years of age, the majority of surgeons only performed open repair, whereas none performed laparoscopic repair only. For children aged 13-18 years of age, two thirds of the surgeons performed open repair only, 6% performed laparoscopic repair only and the rest used both methods. We found considerable variations in the execution of both open and laparoscopic repair. The variations regarded incision of the external fascia, nerve identification, division of the cremaster muscle, and exploration of the contralateral groin and repair of an asymptomatic hernia., Conclusions: This study found considerable variation in the execution of both open and laparoscopic repair of inguinal hernias in children of different age groups. Research into inguinal hernia repair in children is needed to rationalise and update guidelines in order to improve quality and facilitate research., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

This review summarises aetiology, diagnostic approach, and treatment of longstanding groin pain, which can be divided in adductor-related, pubis-related, iliopsoas-related, and inguinal-related pain. Among the diagnoses included in the inguinal-related entity is the so-called sports hernia. However, the terminology is a misnomer since sports hernia is characterised by not being a hernia. Both athletes and non-athletes are affected, and the condition may cause long sick leaves. The treatment is primarily exercise treatment. If this treatment is unsuccessful after 2-6 months, surgery is an option.

Groin hernia is a common condition in children. However, in Denmark, no national guideline for treatment exists, and the evidence is sparse regarding optimal timing and preferred surgical technique. Almost all Danish children are treated with open surgery, even though the complication rate is similar for laparoscopy. Correct timing of repair of an asymptomatic reducible groin hernia is controversial, and the benefits of waiting versus the risk of incarceration should be considered. In this review, we summarise the evidence and give our proposal for a treatment flow chart.

Flights longer than four hours pose a risk of venous thromboembolism in the general population, and the risk increases when additional risk factors are present. Compression stockings have proven beneficial on deep as well as superficial vein thrombosis and oedema during long-haul flights, without causing side effects or discomfort. However, no data exist for flights shorter than four hours. Passengers can use compression stockings as general prophylaxis, and this should be recommended based on an assessment of endogenous risk factors and the duration of the travel.