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Timely diagnosis and surgical intervention are crucial in managing hydrocele of the canal of Nuck. A systematic approach, including thorough examination and appropriate imaging, followed by meticulous surgical technique, ensures successful treatment and favorable long‐term outcomes for patients. [ABSTRACT FROM AUTHOR]

Abstract Background Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. Case presentation 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. Conclusion According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery.

Background: Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. Case presentation: 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. Conclusion: According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery. [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]

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias. Key clinical message: This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.

Background The inguinal region is an area of complex anatomy that could contain diverse uncommon contents in routine clinical practice. Although inguinal hernia repair is one of the commonest surgeries done routinely, thorough preoperative imaging has a significant impact on the outcome of the surgery, by revealing the presence of unusual contents in the inguinal region. Aim The aim of this article is to review the differential diagnosis of the uncommon inguinal pathologies, which can simulate an inguinal hernia, to determine, and to simplify the treatment approach. Conclusions A profound understanding of the imaging characteristics of uncommon inguinal pathologies is crucial for both the radiologists (to prevent misdiagnosis) and the treating physicians (to avoid surgical complications) and ensure optimal management.

Introduction Liposarcoma is the most common retroperitoneal soft tissue tumor. Liposarcomas are often asymptomatic and are discovered after they become huge. Surgical resection is the first‐line treatment for retroperitoneal liposarcoma, but the surrounding organs are often resected with the liposarcoma. Case presentation A man saw a hospital with a complaint of left lower abdominal distention, and a left retroperitoneal mass was noted on imaging examination. The patient was referred to our hospital. The mass extended from the retroperitoneum through the inguinal canal to the thigh and involved the femoral nerve and psoas major muscle. A well‐differentiated liposarcoma was suspected, and an open surgical resection was performed. Complete resection of a retroperitoneal liposarcoma extending to the thigh was achieved without postoperative complications. Conclusion Treatment strategies for huge retroperitoneal liposarcomas are important to balance antitumor efficacy and postoperative quality of life.

The article presents a clinical case of a patient with a histologically confirmed cyst of the canal of Nuck, similar at the preoperative stage according to anamnestic, instrumental, objective data with an endometrioid cyst of the inguinal canal.

Background The inguinal region is an area of complex anatomy that could contain diverse uncommon contents in routine clinical practice. Although inguinal hernia repair is one of the commonest surgeries done routinely, thorough preoperative imaging has a significant impact on the outcome of the surgery, by revealing the presence of unusual contents in the inguinal region. Aim The aim of this article is to review the differential diagnosis of the uncommon inguinal pathologies, which can simulate an inguinal hernia, to determine, and to simplify the treatment approach. Conclusions A profound understanding of the imaging characteristics of uncommon inguinal pathologies is crucial for both the radiologists (to prevent misdiagnosis) and the treating physicians (to avoid surgical complications) and ensure optimal management. [ABSTRACT FROM AUTHOR]

Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes. [ABSTRACT FROM AUTHOR]

A 24-year-old healthy male with left sided groin pain and swelling extending into the left hemiscrotum. Computed tomography reported an encysted spermatic cord hydrocoele. Open exploration revealed a cystic structure arising from the spermatic cord. Histopathological analysis demonstrated sebaceous glands within the wall of the cyst, pathognomonic for a dermoid cyst. A literature review demonstrates just 12 cases of inguinal dermoid cysts to date. Our case demonstrates the importance of radiological imaging in cases of groin lumps to facilitate surgical planning as well as the importance of sending surgical specimens for histopathological analysis to aid in the event of recurrence.

Objective: Comparative evaluation of the results of laparoscopic (LHP) and conventional (CHP) hernioplasty in older patients (OP) and assessment of morphological changes in the tissues of the inguinal canal. Methods: The results of surgical treatment of 88 OP with inguinal hernias were studied. The main group consisted of 53 (60.2%) patients who underwent LHP, the control group included 35 (39.8%) patients after CHP; among them 77 (87.5%) patients had primary hernias, and 11 (12.5%) – recurrent hernias. The age of the patients varied from 60 to 84 years. In the main group patients underwent laparoscopic transabdominal preperitoneal (TAPP) hernioplasty. In the control group, various types of plasty of the posterior wall of the inguinal canal were applied: autoplasty using local tissues, Bassini and Postempsky repair. Muscle, aponeurotic and adipose tissues of the inguinal canal were sampled for morphological examination. Results: For all studied parameters (surgery duration, in-hospital duration, duration of complete rehabilitation), statistically significantly better results were obtained in in the LHP compared with CHP (p0.05), the higher number of complications and their later onset tended to be seen in the CHP group compared with LHP. In patients with small hernias, decreased density of muscle tissue with increased density of the connective tissue were noted, while in patients with large hernias, thinning of the muscle tissue prevail, with expansion of dystrophic adipose tissue observed in all cases. Conclusion: The immediate results of LHP in OP showed its higher effectiveness compared with CHP. Significant changes in the tissues of the inguinal canal found in OP indicate their decreased resilience and potentially delayed reparation processes.

Background: In traditional laparoscopic orchiopexy for inguinal undescended testis (UDT) surgery, the testicles are pulled back into the abdominal cavity by grasping and cephalad retracting the testicle and the cord. If this fails, a subsequent open inguinal incision is made to complete orchiopexy. To improve the orchiolysis and avoid extra open inguinal incision, we describe our early experience with and illustrate the surgical procedure of a novel anatomical laparoscopic orchiopexy (ALO) and hybrid transscrotal orchiopexy as required in high palpable UDT. Methods: From March 2018 to April 2020, ALO was performed in 140 consecutive patients (158 testes) with high inguinal UDT. After blunt and bloodless dissection of the inter-tunica vaginalis-cremasteric fascia plane, tunica vaginalis enveloping the testis was brought into the abdominal cavity as a whole. When the tunica vaginalis was unable to be brought into the abdominal cavity, given that the orchiolysis had already been partially carried out, the testis could be brought out of the external ring and descended when converting to transscrotal surgery. Results: The mean age in this study was 1.88 years (standard deviation ±1.95). The position of the testis assessed at surgery was peeping (58, 36.7%) and canalicular (100, 63.3%). In 128 testes (81.1%), ALO brought the UDT into the abdominal cavity; the remaining 30 testes (18.9%) required a hybrid transscrotal technique. All testes were descended without conversion to open inguinal procedure. The mean operative time was 43.9 ± 9.2 minutes. All patients had follow-up within a median of 17.8 months, with satisfactory results in relation to viability and location of the testis. Conclusions: ALO was shown to be not only safe, feasible, and effective for high inguinal UDT but also facilitated subsequent hybrid transscrotal orchiopexy; when the testis failed to be pulled into the abdominal cavity, the conversion to open inguinal orchiopexy could be obviated. [ABSTRACT FROM AUTHOR]

Sports hernia is a non-anatomic, non-diagnostic term that has been attributed to many different causes of groin pain.» Sports hernia is better described as pain localized anatomically to the inguinal region of an athlete without an actual hernia.» Nonoperative management including core stability while avoiding extreme hip range of motion should be attempted for at least 2 months prior to any operative intervention.» Associated pathology such as femoroacetabular impingement or adductor tear should be addressed.» If a sports hernia is not responsive to rehabilitation, referral to a general surgeon is appropriate.

Sports hernia is a non-anatomic, non-diagnostic term that has been attributed to many different causes of groin pain.» Sports hernia is better described as pain localized anatomically to the inguinal region of an athlete without an actual hernia.» Nonoperative management including core stability while avoiding extreme hip range of motion should be attempted for at least 2 months prior to any operative intervention.» Associated pathology such as femoroacetabular impingement or adductor tear should be addressed.» If a sports hernia is not responsive to rehabilitation, referral to a general surgeon is appropriate.

In children and adolescents, inguinal and scrotal diseases are relatively common, and imaging is very useful for the diagnosis and differential diagnosis of these diseases. Therefore, it is important to understand the imaging findings of these diseases. In this article, we classify these diseases into small testes, cryptorchidism, patent processus vaginalis, acute scrotum pain, trauma, testicular tumors, and others and describe their characteristic findings. [ABSTRACT FROM AUTHOR]

Purpose: Cloquet's node, located at the junction between the deep inguinal nodes and the external iliac chain, is easily accessible and commonly excised during pelvic lymph node dissection for prostate cancer. However, we hypothesize that Cloquet's node is not part of lymphatic metastatic spread of prostate cancer. Materials and Methods: Between September 2016 and June 2019, 105 consecutive patients with high-risk prostate cancer (cT3a or Grade Group 4/5, or prostate specific antigen >20 ng/ml) underwent a laparoscopic radical prostatectomy and pelvic lymph node dissection. First, Cloquet's node was identified, retrieved and submitted separately to pathology as right and left Cloquet's node. Next, a pelvic lymph node dissection was completed including the external iliac, obturator fossa and hypogastric nodal packets. Each lymph node was cut into 3 mm slices which were separately embedded in paraffin, stained with hematoxylin and eosin, and examined microscopically. Results: The final analysis included 95 patients. In this high-risk population, the median number of nodes removed was 22 (IQR 18e29); 39/95 patients (41%) had lymph node metastasis. The median number of Cloquet's nodes removed was 2 (IQR 2e3). Cloquet's node was negative in all but 1 patient (1.1%), who had very high-risk features and high metastatic burden in the lymph nodes. Conclusions: In high-risk prostate cancer, metastasis to the ilioinguinal node of Cloquet is rare. Given this low prevalence, Cloquet's node can be safely excluded from the pelvic lymph node dissection template. [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 tension-free 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, Department of General Surgery, Rabindra Nath Tagore Medical College, Udaipur Rajasthan, India, over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15×7.5 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.

Summary: Background: Inguinal hernias are among the most common abdominal wall hernias but rarely caused by penetrating trauma. Case presentation: We report a case of a 61-year-old patient with a traumatic inguinal hernia after penetrating injury through the inguinal canal. Local inspection of the intestines and abdominal cavity showed no fecal spill, blood clots or signs of contamination. Therefore, no laparoscopy or laparotomy was initiated. The abdominal wall was closed using a mesh patch. No infections or re-herniation occurred. Conclusion: Clinicians could consider local exploration in the treatment of traumatic inguinal hernias.

BACKGROUND AND OBJECTIVE: Hydatid disease is a common health problem in developing countries. The liver and lungs are the most common organs affected by this infection. Hydatid cyst is very rare in the inguinal area. The aim of this case report was to introduce a patient with multiple hydatid cysts in the right inguinal area who developed symptoms of inguinal hernia. CASE REPORT: The patient is a 92-year-old man who was referred to Imam Reza Hospital in Mashhad due to pain, swelling and redness in the right inguinal area. The patient s blood tests showed an increase in neutrophils, and a decrease in eosinophils, basophil and monocyte. Ultrasound examinations of the patient revealed right inguinal hernia and hydatid cysts in the liver, abdomen and pelvic cavity. Finally, the patient was operated with a diagnosis of incarcerated inguinal hernia. During the operation, multiple cysts were observed in the inguinal area; the cysts were removed and sent to pathology. Pathological findings confirmed the presence of hydatid cyst. After 2 days, the patient was discharged in relatively good general condition and with albendazole (400 mg) twice daily for 6 months. At the end of the treatment period, no signs of recurrence of hydatid cyst were observed in the patient. CONCLUSION: According to the cases reported in patients diagnosed with hydatid cyst with inguinal pain, the possibility of migration or hernia of hydatid cyst should be considered, because knowing its presence is useful for preoperative planning and reduction of complications.

PurposeAmong the few studies that have examined the development of the anterior abdominal wall, several are based on incomplete “series”, substituted in many cases by non-human specimens.Material and MethodsIn total, 19 human embryos corresponding to Carnegie stages 15–23, 36 fetuses with estimated gestational ages ranging from 9 weeks to term, and eight neonates were included in this study. All specimens belong to the collection of the Department of Anatomy and Embryology at the Complutense University of Madrid.ResultsThe muscles of the anterior abdominal wall appear in the dorsal region at stages 15 and 16 (33–37 days). At stages 17 and 18 (41–44 days), this muscular mass grows ventrally and splits into two sheets: the external abdominal oblique muscle and the common mass of the internal abdominal oblique, and the transversus abdominis muscles, all of which end ventrally in the primitive condensation of the rectus abdominis. In embryos at stages 19 and 20 (48 days), the anterior abdominal wall continues to show an umbilical hernia in the amniotic cavity. However, a narrow neck is apparent for the first time and there is a wider anterior abdominal wall below the hernia made up of dense mesenchyme tissue without layers and showing the primordia of the umbilical canal. In embryos at stages 21, 22, and 23 (51–57 days), the abdominal muscles and aponeuroses cross the midline (linea alba) covering the rectus abdominis and pyramidalis muscles while the umbilical hernia has shrunk. In fetuses during the 9th and 10th weeks, the umbilical hernia becomes encircled by the rectus abdominis muscle, its aponeurosis, and the three layers of lateral abdominal muscles, which are more developed and covered by Camper's and Scarpa's fasciae. The inguinal canal has a course and relationships like those described in adults, with Hesselbach's ligament.

Purpose: Open inguinal lymph node dissection (OILND) plays a crucial role in penile cancer management, but in order to improve patient outcomes, minimally-invasive (MILND) approaches were developed. Our "bottoms-up" MILND is a novel endoscopic technique, changing the way the sequence of dissection is performed. This study aims to compare our approach to the current standard of OILND in terms of oncologic and perioperative outcomes., Materials and Methods: In our database, from 2016 to 2023, 12 patients underwent OILND and 16 had a "bottoms-up" MILND, which is performed with a three port configuration, starting the dissection under the fascia lata, dissecting the femoral vessels in the most distal part of the femoral fossa, followed by dissection of the proximal and superficial lymph nodes at the top of thefemoral triangle., Results: For MILND, median operation time per groin was shorter (58 vs 64 minutes, p=0.34), patients presented shorter hospital stays (10 vs 18 days, p=0.32) and fewer days with drains (14 vs 24 days, p=0.01). Median lymph node yield per groin was higher for MILND (10 vs 9 nodes, p=0.7), but OILND had a higher median of positive lymph nodes (4 vs 3 nodes, p=0.63). MILND patients experienced a lower incidence of major complications (33% vs 58%, p=0.007)., Conclusions: We have proved that our technique of MILND is not inferior to the current standard and we believe that it can further improve patient outcomes with a safer, simplified and easily reproducible approach.

Aim: The primary aim of this study was to validate the reliability, sensitivity and safety profile of novel combination of ICG- methylene blue dye as an SN tracer for PeCa., Methods: This is a validation and non-randomised prospective observational study involving 25 patients (50 inguinal basins) who underwent SLNB where in ICG and methylene blue were used for localisation. The patients with clinically node negative groins were recruited in the study. SNs were identified intraoperatively using near infrared fluorescence imaging (NIRF Imaging system, SPY-PHI, Stryker, Sweden) and blue dye. The numbers of SNs identified by each tracer and the rates of complications and nodal recurrence during the followup., Results: Overall 137 SNs were identified intraoperatively. Among the 137 SNs excised fluorescence, blue dye and Combined (blue + green) identified 57(41.6%), 27 (19.7%), and 51 (37.2%), respectively. The average number of SLNs removed per patient was 5 (range, 1-11) with sentinel lymph nodes detection rate at 94% (47/50). Seven patients had malignancy on SLNB and underwent ipsilateral radical inguinal lymphadenectomy. One patient had false negative SN and positive node in modified inguinal lymphadenectomy specimen. No adverse events were observed in all cases., Conclusion: The Novel combination of ICG fluorescence-Methylene blue dye technique is simple, reliable and safe. Moreover, it demonstrates a high SLN detection rate with a low false-negative rate, and it avoids radiation exposure., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction Inguinal hernioplasty (IH) is one of the most frequently performed surgical procedures globally. Today, a variety of surgical techniques and prosthesis types are available for this procedure. Methods At our center, we performed 200 inguinal hernioplasties using the dynamic self-adjusting prosthesis (protesi autoregolantesi dinamica , PAD) from May 1, 2022, to May 31, 2023. Our objective was to retrospectively analyze the outcomes and compare them with the current scientific literature on this surgical technique. Results Our results align with those reported by other authors using the same surgical technique. With the PAD technique, we assessed the type and frequency of adverse events up to 12 months following IH. All patients were male, with an average BMI of 26.6. Among the 200 hernias, 99 were right-sided, 101 were left-sided, 63 were direct, and 137 were indirect. The average length of hospitalization was one day. The most common postoperative complication was hematoma near the surgical site, but no prosthesis displacement was observed. In 71% of patients, analgesics were discontinued within 24 hours. The outcomes of our study are comparable to those reported by the inventor of this surgical technique. Conclusion The procedure has demonstrated safety and effectiveness and could serve as a viable alternative to traditional IH techniques., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fernicola et al.)

Penile cancer with bulky inguinal metastasis has a high probability of harboring pathologically involved lymph nodes best managed in a multidisciplinary care setting. Appropriate staging with cross-sectional imaging and fine-needle aspirate cytology of suspicious nodes guide decision-making for the use of platinum-based neoadjuvant chemotherapy followed by inguinal lymph node dissection. Surgical resection plays an important diagnostic, therapeutic, and guiding role in disease management. Patients with adverse pathologic features, especially those with extranodal disease extension, may derive additional benefit from adjuvant radiotherapy., Competing Interests: Disclosure The authors have no pertinent conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To assess clinical outcomes of inguinal lymph node surgical resection compared to primary groin radiotherapy for locally advanced, surgically unresectable vulvar cancer., Methods: All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/- chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size., Results: Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4-2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05-0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1-100) in patients with surgical groin resection compared to 79.2% (69.1-90.9) in patients treated with primary radiation (p = 0.02)., Conclusions: In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone., Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.

UnlabelledMucosal immunity is central to sexual transmission and overall pathogenesis of HIV-1 infection, but the ability of vaccines to induce immune responses in mucosal tissue compartments is poorly defined. Because macaque vaccine studies suggest that inguinal (versus limb) vaccination may better target sexually-exposed mucosa, we performed a randomized, double-blinded, placebo-controlled Phase I trial in HIV-1-uninfected volunteers, using the recombinant Canarypox (CP) vaccine vCP205 delivered by different routes. 12 persons received vaccine and 6 received placebo, divided evenly between deltoid-intramuscular (deltoid-IM) or inguinal-subcutaneous (inguinal-SC) injection routes. The most significant safety events were injection site reactions (Grade 3) in one inguinal vaccinee. CP-specific antibodies were detected in the blood of all 12 vaccinees by Day 24, while HIV-1-specific antibodies were observed in the blood and gut mucosa of 1/9 and 4/9 evaluated vaccinees respectively, with gut antibodies appearing earlier in inguinal vaccinees (24-180 versus 180-365 days). HIV-1-specific CD8(+) T lymphocytes (CTLs) were observed in 7/12 vaccinees, and blood and gut targeting were distinct. Within blood, both deltoid and inguinal responders had detectable CTL responses by 17-24 days; inguinal responders had early responses (within 10 days) while deltoid responders had later responses (24-180 days) in gut mucosa. Our results demonstrate relative safety of inguinal vaccination and qualitative or quantitative compartmentalization of immune responses between blood and gut mucosa, and highlight the importance of not only evaluating early blood responses to HIV-1 vaccines but also mucosal responses over time.Trial registrationClinicalTrials.gov NCT00076817.

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]

Context: There are several procedures for surgical nodal staging in clinically node-negative (cN0) penile carcinoma., Objective: To evaluate the diagnostic accuracy, perioperative outcomes, and complications of minimally invasive surgical procedures for nodal staging in penile carcinoma., Evidence Acquisition: A systematic review of the Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov was conducted. Published and ongoing studies reporting on the management of cN0 penile cancer were included without any design restriction. Outcomes included the false negative (FN) rate, the number of nodes removed, surgical time, and postoperative complications., Evidence Synthesis: Forty-one studies were eligible for inclusion. Four studies comparing robot-assisted (RA-VEIL) and video-endoscopic inguinal lymphadenectomy (VEIL) to open inguinal lymph node dissection (ILND) were suitable for meta-analysis. A descriptive synthesis was performed for single-arm studies on modified open ILND, dynamic sentinel node biopsy (DSNB) with and without preoperative inguinal ultrasound (US), and fine-needle aspiration cytology (FNAC). DSNB with US + FNAC had lower FN rates (3.5-22% vs 0-42.9%) and complication rates (Clavien Dindo grade I-II: 1.1-20% vs 2.9-11.9%; grade III-V: 0-6.8% vs 0-9.4%) in comparison to DSNB alone. Favourable results were observed for VEIL/RA-VEIL over open ILND in terms of major complications (2-10.6% vs 6.9-40.6%; odds ratio [OR] 0.18; p < 0.01). Overall, VEIL/RA-VEIL had lower wound-related complication rates (OR 0.14; p < 0.01), including wound infections (OR 0.229; p < 0.01) and skin necrosis (OR 0.16; p < 0.01). The incidence of lymphatic complications varied between 20.6% and 49%., Conclusions: Of all the surgical staging options, DSNB with inguinal US + FNAC had the lowest complication rates and high diagnostic accuracy, especially when performed in high-volume centres. If DSNB is not available, favourable results were also found for VEIL/RA-VEIL over open ILND. Lymphatic-related complications were comparable across open and video-endoscopic ILND., Patient Summary: We reviewed studies on different surgical approaches for assessing lymph node involvement in cases with penile cancer. The results show that a technique called dynamic sentinel node biopsy with ultrasound guidance and fine-needle sampling has high diagnostic accuracy and low complication rates. For lymph node dissection in penile cancer cases, a minimally invasive approach may offer favourable postoperative outcomes., (Copyright © 2023. Published by Elsevier B.V.)

Aim: The significance of lymphadenectomy and its indications in patients with inguinal lymph node metastasis (ILNM) of anorectal adenocarcinoma is unclear. This study aimed to clarify the surgical outcomes and prognostic factors of inguinal lymphadenectomy for ILNM., Method: This study included patients who underwent surgical resection for ILNM of rectal or anal canal adenocarcinoma with pathologically positive metastases between 1997 and 2011 at 20 participating centres in the Study Group for Inguinal Lymph Node Metastasis from Colorectal Cancer organized by the Japanese Society for Cancer of the Colon and Rectum. Clinicopathological characteristics and short- and long-term postoperative outcomes were retrospectively analysed., Results: In total, 107 patients were included. The primary tumour was in the rectum in 57 patients (53.3%) and in the anal canal in 50 (46.7%). The median number of ILNMs was 2.34. Postoperative complications of Clavien-Dindo Grade III or higher were observed in five patients. The 5-year overall survival rate was 38.8%. Multivariate analysis identified undifferentiated histological type (P < 0.001), pathological venous invasion (P = 0.01) and pathological primary tumour depth T0-2 (P = 0.01) as independent prognostic factors for poor overall survival., Conclusion: The 5-year overall survival after inguinal lymph node dissection was acceptable, and it warrants consideration in more patients. Further larger-scale studies are needed in order to clarify the surgical indications., (© 2024 Association of Coloproctology of Great Britain and Ireland.)