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Purpose: This study aimed to develop, validate, and evaluate machine learning (ML) algorithms for predicting Surgical site infections (SSI) and surgical site occurrences (SSO) after elective open inguinal hernia surgery. Methods: A cohort of 491 patients who underwent elective open inguinal hernia surgery at Fudan University Affiliated Huadong Hospital between December 2019 and December 2020 was enrolled. To create a strong prediction model, we employed five ML methods: generalized linear model, random forest (RF), support vector machines, neural network, and gradient boosting machine. Based on the best performing model, we devised online calculators to facilitate clinicians' access to a linear predictor for patients. The receiver operating characteristic curve was utilized to evaluate the model's discriminatory capability and predictive accuracy. Results: The incidence rates of SSI and SSO were 4.68% and 13.44%, respectively. Four variables (diabetes, recurrence, antibiotic prophylaxis, and duration of surgery) were identified for SSI prediction, while four variables (diabetes, size of hernias, albumin levels, and antibiotic prophylaxis) were included for SSO prediction. In the test set, the RF model showed the best predictive ability (SSI: area under the curve (AUC) = 0.849, sensitivity = 0.769, specificity = 0.769, and accuracy = 0.769; SSO: AUC = 0.740, sensitivity = 0.513, specificity = 0.821, and accuracy = 0.667). Online calculators have been developed to assess patients' risk of SSI (https://wuqian17.shinyapps.io/predictionSSI/) and SSO (https://wuqian17.shinyapps.io/predictionSSO/) after surgery. Conclusions: This study developed a prediction model for SSI/SSO using ML methods. It holds the potential to facilitate the selection of appropriate treatment options following elective open inguinal hernia surgery. [ABSTRACT FROM AUTHOR]

Background and Aims: Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well. Material and Methods: Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery. Results: A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl (P < 0.001), with better pain scores (P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block. Conclusion: The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients.

The Inguinal Hernia Application (IHAPP) is designed to overcome current limitations of regular follow-up after inguinal hernia surgery. It has two goals: Minimizing unnecessary healthcare consumption by supplying patient information and facilitating registration of patient-reported outcome measures (PROMs) by offering simple questionnaires. In this study we evaluated the usability and validity of the app. Patients (≥18 years) scheduled for elective hernia repair were assessed for eligibility. Feasibility of the app was evaluated by measuring patient satisfaction about utilization. Validity (internal consistency and convergent validity) was tested by comparing answers in the app to the scores of the standardized EuraHS-Quality of Life instrument. Furthermore, test-retest reliability was analyzed correlating scores obtained at 6 weeks to outcomes after 44 days (6 weeks and 2 days). During a 3-month period, a total of 100 patients were included. Median age was 56 years and 98% were male. Most respondents (68%) valued the application as a supplementary tool to their treatment. The pre-operative information was reported as useful by 77% and the app was regarded user-friendly by 71%. Patient adherence was mediocre, 47% completed all questionnaires during follow-up. Reliability of the app was considered excellent (α > 0.90) and convergent validity was significant (p = 0.01). The same applies to test-retest reliability (p = 0.01). Our results demonstrate the IHAPP is a useful tool for reliable data registration and serves as patient information platform. However, further improvements are necessary to increase patient compliance in recording PROMs. [ABSTRACT FROM AUTHOR]

Objective Pain is one of the most common problems after surgery. Various strategies have been used to alleviate it. To achieve the optimal pain management, various analgesics and narcotics are used, despite of having side effects. Numerous sources of Iranian Traditional Medicine have indicated the analgesic effects of lettuce. This study aims to evaluate the effects of lettuce syrup as an adjunctive therapy on pain relief after inguinal hernia surgery. Methods This is a triple-blind clinical trial. Seventy patients candidates for inguinal hernia surgery referred to Valiasr Hospital in Arak, Iran were randomly divided into two groups of intervention and placebo. From 3 days before surgery to after surgery, lettuce and placebo syrup were prescribed separately as well as morphine, if needed. Pain was measured using visual analogue scale (VAS) during recovery and 1, 2, 4, 6, 12 and 24 hours after surgery. The data were analyzed by independent t-test, chi-square test, and repeated measure ANOVA. Results The acute pain level during recovery after surgery significantly decreased in the intervention group compared to the control group. The mean VAS score 24 hours after surgery was 0.68±1.94 in the intervention group and 2.75±8.13 in the control group (P

This study aimed to examine possible associations between Attention-Deficit/Hyperactivity Disorder (ADHD) and pregnancy-related, birth-related, developmental, medical, and surgical history characteristics. The sample was derived from a non-referred community sample aged 6 to 14. 91 cases with ADHD and 264 without any psychopathology were compared in terms of psychological and physical problems in pregnancy, mode of delivery, birth complications, developmental stages, injuries, medical and surgical diseases. A semi-structured clinical interview was applied to diagnose the children. ADHD Rating Scale-IV (ADHD-RS-IV) was completed by the parents. Male gender, delay in talking time, and physical injury history predicted increased risks for ADHD. Although having any surgery, and in particular, tonsillectomy did not predict ADHD, inguinal hernia surgery alone predicted an increased risk for ADHD even when controlled for gender. Psychological problems during pregnancy were associated with elevated inattention (IN) and hyperactivity-impulsivity (HI) scores, but not associated with ADHD as a diagnosis. Elevated IN scores but not HI scores were associated with a physical injury history. Although the mode of delivery and physical disease history were not associated with ADHD, asthma increased the likelihood for higher HI scores. The findings have crucial clinical implications that address several points. The findings suggest ADHD may have associations with some negative neurodevelopmental, medical, and surgical history characteristics. The predictivity of inguinal hernia surgery for ADHD might depend on the exposure to general anesthesia at younger ages. Hence, children who had these features should carefully be screened for ADHD. [ABSTRACT FROM AUTHOR]

Faiz SHR, Nader ND, Niknejadi S, Davari-Farid S, Hobika GG, Rahimzadeh P. J Pain Res. 2019;12:201–207. There were concerns over the potential inaccurate representation of data in the original Figure 3 on page 205 of the published article. The spline approach used in the original figure illustrated scores that do not exist through the interpolation of missing parameters between concrete assessment time points. Therefore, we, the authors, replaced the image with a time-to-event analysis (Kaplan-Meier) where the event was set for the request for an analgesic within the first 24 hours. The new figure presents cumulative hazards (probability) of requesting an analgesic medication over the first 24 hours after ilioinguinal nerve block versus transverse abdomens plane block. The time-to-event analysis by the Kaplan-Meier Log-Rank test revealed no difference in analgesic requirement between the two types of blocks (P=0.912). The correct Figure 3 is as follows. Figure 3 The probability of request for additional parenteral analgesic drugs is shown at any given time.Abbreviation: TAP, transversus abdominis plane.

Background: Inguinal hernia has a lifetime incidence of 27% in men and 3% in women. Surgery is the recommended treatment, but there is no consensus on the best method. Open repair is most popular, but there are concerns about the risk of chronic groin pain. Laparoscopic repair is increasingly accepted due to the lower risk of chronic pain, although its recurrence rate is still unclear. The aim of this overview is to compare the risk of recurrence and chronic groin pain in laparoscopic versus open repair for inguinal hernia. Methods: We searched Ovid MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses. Only reviews of randomised controlled trials (RCTs) in adults published in English were included. Conference proceedings and editorials were excluded. The quality of the systematic reviews was assessed using the AMSTAR 2 checklist. Two outcomes were considered: hernia recurrence and chronic pain. Results: Twenty-one systematic reviews and meta-analyses were included. Laparoscopic repair was associated with a lower risk of chronic groin pain compared with open repair. In the four systematic reviews assessing any laparoscopic versus any open repairs, laparoscopic repair was associated with a statistically significant (range: 26–46%) reduction in the odds or risk of chronic pain. Most reviews showed no difference in recurrence rates between laparoscopic and open repairs, regardless of the types of repair considered or the types of hernia that were studied, but most reviews had wide confidence intervals and we cannot rule out clinically important effects favouring either type of repair. Conclusion: Meta-analyses suggest that laparoscopic repairs have a lower incidence of chronic groin pain than open repair, but there is no evidence of differences in recurrence rates between laparoscopic and open repairs. [ABSTRACT FROM AUTHOR]

To explore the value of transverse abdominal plane block and intravenous analgesia in hernia surgery. From January 2019 to December 2020, 120 patients undergoing inguinal hernia surgery in our hospital were selected as research subjects. According to the difference of anesthesia methods, they were divided into two groups. The control group was given intravenous analgesia, while the observation group was given transverse abdominal plane block. The intraoperative doses of propofol, ephedrine and fentanyl in the two groups of patients, as well as the VAS score and the number of fentanyl supplements at different times after the operation were recorded; the incidence of postoperative nausea and vomiting between the two groups was compared, and Compare eating time, intestinal function recovery time, and time to get out of bed. The dosages of propofol, ephedrine and fentanyl in the observation group were significantly less than those in the control group (P<0.05). The VAS scores of 1 h (T0), 5 h (T1), 10 h (T2), 1 d (T3), 2 d (T4) in the observation group were significantly lower than those in the control group (P<0.05). The number of additional fentanyl in the observation group was 4 times per person(P<0.05). The incidence of nausea and vomiting (6.67%), eating time, intestinal function recovery time, and time to get out of bed in the observation group after hernia surgery were significantly lower than those in the control group (P<0.05). Transverse abdominis plane block is significantly better than intravenous analgesia for patients with inguinal hernia after surgery, and it is more helpful to promote postoperative recovery. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground: Patients with chronic liver disease and liver cirrhosis have many anesthetic considerations with general anesthesia and limitation of ability to receive regional anesthesia due to coagulopathy and low platelets count.Our study aims to compare the combination of the Ilioinguinal-iliohypogastric (ILIH) nerve block with the Transverse Abdominis Plane block (TAB) versus the Ilioinguinal-iliohypogastric (ILIH) nerve block alone as a sole anesthetic technique in hepatic patients with liver cirrhosis for surgical repair of inguinal hernia.Methods: Sixty patients known to have chronic liver disease and liver cirrhosis undergoing unilateral repair of inguinal hernia were randomly assigned to two equal groups:Group (T) received ipsilateral transverse abdominis plane block (TAB) ultrasound-guided (US) in combination with Ilioinguinal-iliohypogastric (ILIH) nerve block intraoperatively.Group (I) received US-guided ipsilateral Ilioinguinal-iliohypogastric nerve block only intraoperatively.The degree of pain was evaluated using the VAS score for pain hourly for the first 6 h and at 12, 18, and 24 h postoperatively. Need for LA infiltration into surgical field or the conversion to GA was assessed. Onset of sensory block, duration of analgesia, the use of rescue analgesia and its total dose in 24 hours, the patient’s and surgeon’s satisfaction and any adverse events were recorded. Liver functions were measured 24 h postoperatively.Results: The duration of analgesia was significantly longer in group (T) (14.27 ± 2.5 hours) than in group (I) (11.81 ± 2.9 hours; p = 0.039). The total required dose of acetaminophen in first 24 hours was higher in group (I) (1.1 ± 0.81 gm) than in group (T) (0.6 ± 0.94 gm; p = 0.021).There was no significant difference between groups in onset of sensory block, need for LA infiltration, need for GA, or incidence of postoperative side effects. Patients’ satisfaction was statistically better in group T compared to group I whereas there was no statistical significant difference between both groups regarding surgeon’s satisfaction.Conclusion: Combined Transverse Abdominis plane block (TAB) with Ilioinguinal-iliohypogastric (ILIH) nerve block has longer duration of analgesia and less dose of rescue analgesia with more patient satisfaction than the use of Ilioinguinal-iliohypogastric (ILIH) nerve block in surgical repair of inguinal hernia in chronic hepatic patients with liver cirrhosis.

Calprotectin is one of the most abundant proteins of neutrophil granulocytes. It is released upon neutrophil activation and is considered a sensitive and clinically useful marker for neutrophil-mediated inflammation, including bacterial infections. However, early kinetics of calprotectin activation following inflammatory activation has hitherto been unknown. The aim of the present study was to determine the early phase of the kinetics of calprotectin, in comparison with the inflammatory markers CRP, IL-6, TNF-α, and procalcitonin, in plasma following a standardized temporary mild inflammatory response, using uncomplicated inguinal hernia surgery as a model. The study cohort consisted of 17 adult patients (15 male and 2 female) undergoing elective surgery for hernia. Values of calprotectin increased significantly at 2 h following surgery, and continued to increase to reach the highest level at 24–36 h after surgery, values still not exceeding upper normal reference level. This contrasts to IL-6 and CRP, for which an elevation was found first later, 4 h and 24–36 h post-surgery, respectively, for IL-6, and CRP. No significant increase was seen for TNF-α, or procalcitonin. The data demonstrate a very rapid and significant but modest increase in calprotectin following induction of mild inflammation, supporting that calprotectin can be useful for early detection of inflammatory response. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic liver disease and liver cirrhosis have many anesthetic considerations with general anesthesia and limitation of ability to receive regional anesthesia due to coagulopathy and low platelets count. Our study aims to compare the combination of the Ilioinguinal-iliohypogastric (ILIH) nerve block with the Transverse Abdominis Plane block (TAB) versus the Ilioinguinal-iliohypogastric (ILIH) nerve block alone as a sole anesthetic technique in hepatic patients with liver cirrhosis for surgical repair of inguinal hernia.Methods: Sixty patients known to have chronic liver disease and liver cirrhosis undergoing unilateral repair of inguinal hernia were randomly assigned to two equal groups: Group (T) received ipsilateral transverse abdominis plane block (TAB) ultrasound-guided (US) in combination with Ilioinguinal-iliohypogastric (ILIH) nerve block intraoperatively. Group (I) received US-guided ipsilateral Ilioinguinal-iliohypogastric nerve block only intraoperatively. The degree of pain was evaluated using the VAS score for pain hourly for the first 6 h and at 12, 18, and 24 h postoperatively. Need for LA infiltration into surgical field or the conversion to GA was assessed. Onset of sensory block, duration of analgesia, the use of rescue analgesia and its total dose in 24 hours, the patient's and surgeon's satisfaction and any adverse events were recorded. Liver functions were measured 24 h postoperatively.Results: The duration of analgesia was significantly longer in group (T) (14.27 ± 2.5 hours) than in group (I) (11.81 ± 2.9 hours; p = 0.039). The total required dose of acetaminophen in first 24 hours was higher in group (I) (1.1 ± 0.81 gm) than in group (T) (0.6 ± 0.94 gm; p = 0.021).There was no significant difference between groups in onset of sensory block, need for LA infiltration, need for GA, or incidence of postoperative side effects. Patients' satisfaction was statistically better in group T compared to group I whereas there was no statistical significant difference between both groups regarding surgeon's satisfaction.Conclusion: Combined Transverse Abdominis plane block (TAB) with Ilioinguinal-iliohypogastric (ILIH) nerve block has longer duration of analgesia and less dose of rescue analgesia with more patient satisfaction than the use of Ilioinguinal-iliohypogastric (ILIH) nerve block in surgical repair of inguinal hernia in chronic hepatic patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background and Aims: Inguinal hernia surgeries can pose significant postoperative pain, leading to chronic pain syndromes when not managed well., Material and Methods: Sixty American Society of Anesthesiologists (ASA) I/II adult patients scheduled to undergo unilateral inguinal hernia surgeries were enrolled in this trial. The patients were randomly allocated into three groups according to the various approaches of ultrasound-guided quadratus lumborum (QL) block: group transmuscular (TM): TM or anterior approach, group L: lateral approach, and group P: posterior approach. All the patients underwent surgery under subarachnoid blockade. A QL block was administered at the end of the surgery., Results: A total of 19 patients in each group were analyzed. Patients in the TM group had the least 24-hour requirement of fentanyl ( P < 0.001), with better pain scores ( P < 0.001) and prolonged duration of analgesia. No significant difference was found in the patient satisfaction scores (PSSs) in the three approaches. None of the patients reported any adverse effects related to the block., Conclusion: The TM approach of QL block is an effective analgesic strategy in patients undergoing unilateral hernia surgeries. It could form a part of the multimodal analgesic regimen for such patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Anaesthesiology Clinical Pharmacology.)

Introduction: Mesh-related complications following pelvic prolapse surgery has potentiated societal fear and led to increased investigation into mesh use in inguinal hernia repair (IHR) surgery online. However concern exists regarding the quality of Internet health informatics. The DISCERN Instrument and HONcode tool can be used to assess the quality and reliability of online health information. The aim of this study is to investigate the reliability and quality of online information pertaining to mesh use in IHR surgery using the DISCERN instrument and HONcode tool. Methods: An Internet search using the keywords: 'mesh', 'inguinal hernia' and 'surgery' was carried out via Google, Yahoo, Bing, Facebook and Twitter. The HONcode and DISCERN scores were generated for each of the first ten search engine result pages (SERPs). Results: Google provided the most reliable [Median HONcode score 77% (IQR 25.5%)] and highest quality information [Median DISCERN score; 61.5 (IQR 18.25)]. Social media yielded both the most unreliable and lowest quality information. Facebook was the most unreliable [Median HONcode score 21% (IQR 14.25%)], while Twitter imparted the lowest quality information [Median DISCERN score of 18.5 (IQR 25.25)]. Discussion: A 2018 Cochrane review concluded the use of mesh in IHR to be safe and associated with superior outcomes. However, numerous SERPs present results contradicting this, based solely upon Level 5 evidence. Commercialisation of the Internet has resulted in search engine optimisation, which can permit lesser quality sites to obtain higher SERP ranking. Alarmingly if only a limited search is carried out by patients [4], lower quality, sensationalist evidence may be the only information they are exposed to. As such this may negatively influence the patient decision-making process detrimentally. However utilisation of social media by healthcare professionals may offer a solution to bridge the gap between the public and high quality medical information. Conclusions: Online information regarding mesh repair of inguinal herniae is of variable quality and reliability. Enhanced quality assurance of online health information is necessary. However, increased presence by hernia societies on social media may help to disseminate high quality information to patients, thus enabling pre-hospital education to set the scene prior to formal hospital consultation. [ABSTRACT FROM AUTHOR]

Background: Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery.In this randomized clinical trial, we have compared the analgesic efficacy of transverses abdominis plane (TAP) block with that of ilioinguinal/ iliohypogastric (II-IH) nerve block and quadrates lamborum(QL) block in patients undergoing unilateral open inguinal hernia repair. Objectives: comparison of the efficacy of either of the three types of regional anesthetic blocks , the ultrasound –guided TAP block , ultrasound-guided Quadratus Lamborum block and ultrasound- guided ilioinguinal and iliohypogastric nerve block in quality and duration of postoperative pain control. Patients and methods:This is a cross-sectional, hospital based study carried out on 90 cases undergoing inguinal hernia repair under general anesthesia using either of the three types of block in each group; the ultrasound–guided TAP block , ultrasound- guided ilioinguinal and iliohypogastric nerve block and ultrasound-guided Quadratus Lamborum block nerve All cases enrolled fromgeneralsurgerydepartment and seen at the pre operative holding area before going to the operative theatre of Qena university hospital between August 2018 to August 2019 . Result(s):VAS were lower in the IINB group and QLB group compared to the TAP block group both at rest and during cough. The difference in VS score was statistically significant various times postoperative. Time to first analgesic request was delayed in IIIH nerve block Group(7.3±1.3 ) hours than TAP block group (5.9±1.3)hours (P value .008)and time to first analgesic request was delayed in QL block Group < br />(10.3±3.9) hours than TAP block group (5.9±1.3)hours (P value 0.001) .15 patients (50%) in TAP block group,10 patient (33.3%) in IINB group and 4 patients (13.3%)required morphine 24 hours postoperative . Conclusion:This study demonstrated that compared to TAP block II-IH nerve block and QL block provides better pain control after open repair of inguinal hernia when all blocks were administered under US guidance.

Seyed Hamid Reza Faiz,1 Nader D Nader,2 Soraya Niknejadi,1 Sina Davari-Farid,2 Geoffrey G Hobika,2 Poupak Rahimzadeh3 1Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran; 2Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA; 3Pain Research Center, Iran University of Medical Sciences, Tehran, Iran Objective: To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair. Patients and methods: This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire. Results: NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups. Conclusion: This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB. Keywords: US-guided nerve block, transversus abdominis plane, ilioinguinal, iliohypogastric nerve, inguinal hernia surgery

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]

Abstract Background To assess the construct validity and responsiveness of the PROMIS Physical Function v1.2 short form 8b (PROMIS-PF), and the PROMIS Ability to Participate in Social Roles and Activities v2.0 short form 8a (PROMIS-APS) in postoperative recovery. Methods An observational pilot study was conducted in which 30 patients participated, undergoing various forms of abdominal surgery. Patients completed the PROMIS-PF and PROMIS-APS, the Short Form 36 Health Survey (SF-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) at several time points before and after surgery. The construct validity and responsiveness of the two PROMIS short forms were evaluated by testing pre-defined hypotheses and were considered adequate when at least 75% of the data was consistent with the hypotheses. Construct validity was evaluated by calculating Spearman correlations and the responsiveness by calculating effect sizes. Results 6/7 (85.7%) of the results were consistent with the hypotheses supporting the construct validity of the PROMIS-PF. For the PROMIS-APS this was the case in 7/15 (46.7%) of the results. For the PROMIS-PF, 6/7 (85.7%) of the results were consistent with the hypotheses, supporting responsiveness. Regarding the responsiveness of the PROMIS-APS, only 7 out of 13 (53.8%) of these results were consistent with the hypotheses. Conclusions This study supported the construct validity and the responsiveness of the PROMIS-PF v1.2 short form 8b for measuring recovery in abdominal surgery. Considering the major advantages of PROMIS, we recommend the use of the PROMIS-PF in abdominal surgery.

Abstract Background Postoperative recovery after abdominal surgery is measured mostly based on subjective or self-reported data. In this article we aim to evaluate whether recovery of daily physical activity levels can be measured postoperatively with the use of an accelerometer. Methods In this multicenter, observational pilot study, 30 patients undergoing laparoscopic abdominal surgery (hysterectomy, adnexal surgery, cholecystectomy and hernia inguinal surgery) were included. Patients were instructed to wear an Actigraph wGT3X-BT accelerometer during one week before surgery (baseline) and during the first, third and fifth week after surgery. Wear time, steps taken and physical activity intensity levels (sedentary, light, moderate and vigorous) were measured. Patients were blinded for the accelerometer outcomes. Additionally, an activity diary comprising patients’ self-reported time of being recovered and a list of 18 activities, in which the dates of resumption of these 18 activities were recorded after surgery, was completed by the patient. Results Five patients were excluded from analyses because of technical problems with the accelerometer (n = 1) and protocol non-adherence (n = 4). Light, moderate, vigorous, combined moderate and vigorous intensity physical activity (MVPA), and step counts showed a clear recovery curve after surgery. Patients who underwent minor surgery reached their baseline step count and MVPA three weeks after surgery. Patients who underwent intermediate surgery had not yet reached their baseline step count during the last measuring week (five weeks after surgery). The results of the activity diaries showed a fair agreement with the accelerometer results (Cohens Kappa range: 0.273-0.391). Wearing the accelerometer was well tolerated and not regarded as being burdensome by the patients. Conclusions The accelerometer appeared to be a feasible way to measure recovery of postoperative physical activity levels in this study and was well tolerated by the patients. The agreement with self-reported physical recovery times was fair.

The current literature suggests that perioperative complications occur in 8%–10% of all inguinal hernia repairs. However, the clinical relevance of these complications is currently unknown. In our review, based on 571,445 hernia repairs reported in 39 publications, we identified the following potential risk factors: patient age, ASA score, diabetes, smoking, mode of admission (emergency vs. elective surgery), surgery in low resource settings, type of anesthesia, and (in men) bilateral and sliding hernias. The most commonly reported complications are bleeding (0.9%), wound infection (0.5%), and pulmonary and cardiovascular complications (0.2%). In 3.9% of the included publications, a reliable grading of the reported complications according to Clavien-Dindo classification was possible. Using this classification retrospectively, we could show that, in patients with complications, these are clinically relevant for about 22% of these patients (Clavien-Dindo grade ≥IIIa). About 78% of all patients suffered from complications needing only minor (meaning mostly medical) intervention (Clavien-Dindo grade

Various surgical approaches for inguinal hernia repair have been outlined in medical literature. In most cases, these lesions are repaired by general surgeons. A variety of surgical techniques for the treatment of inguinal hernias have been documented in the medical literature. In 2018, the European Hernia Society (EHS) recommended laparo-endoscopic repair as a preferred approach for adults. This method involves a combination of laparoscopic and endoscopic techniques for hernia repair. The goal of this systematic review is to conduct a thorough examination of the total extraperitoneal vs. transabdominal preperitoneal comparison in inguinal hernia repair, with an emphasis on randomized controlled trials (RCTs). It also intends to conduct a trial sequential analysis (TSA) in order to determine whether more trials and investigations are required or whether there is sufficient evidence to draw a firm conclusion. The study's systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used the PubMed and Google Scholar databases to conduct a thorough web search for articles published between January 2019 and December 2023. The meta-analysis was carried out using Resource Manager Revman version 5.4.1 (Revman International, Inc., New York City, New York). After a review of the studies was done, ten studies were selected to be used in conducting the systematic review and meta-analysis. The recurrence rate of TEP treatment was found to be slightly lower than transabdominal preperitoneal (TAPP). The two techniques did not differ in terms of postoperative complications; however, TEP had a marginally lower rate of postoperative pain. Further, the study revealed that there was a decreased risk of wound infections, seromas, and hematomas with total extraperitoneal (TEP) as opposed to transabdominal preperitoneal (TAPP). TEP also reduced the amount of recovery time needed. After conducting successful hernia treatments, total extraperitoneal and transabdominal preperitoneal both had low rates of complications and recurrence. Based on the information obtained from the study analysis, this meta-analysis provides evidence for the efficacy of TAPP and TEP techniques in the management of inguinal hernias. Though there was a statistically significant difference while applying both methods in the treatment of hernia (p=0.001), TEPs have been shown to have a lower recurrence rate than TAPPs. Similarly, the TEP method has been revealed to have a slight reduction in postoperative pain compared to transabdominal preperitoneal. However, the two techniques have been shown to have no significant difference in postoperative complications. Further, laparoscopic procedures have proved to be a little bit safer and more effective than open procedures. This has been shown by reduced risk of wound infection, hematoma, seroma, and decreased sensibility while using this method. It accelerated the healing process as well. Thus, depending on the needs of the patients and the experience level of the surgeons responsible for the treatments, inguinal hernias can be repaired using either transabdominal preperitoneal or total extraperitoneal techniques since both treatment techniques have generally minimal chance of complications or recurrence as both have proved to safer method., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Almutairi et al.)

Mesh repair has significantly reduced recurrence rate after groin hernia surgery. Recently, attention has shifted to issues such as chronic pain and discomfort, leading to development of lightweight and partially re-absorbable meshes. The aim of the study was to evaluate the effect of lightweight mesh vs heavyweight mesh on post-operative pain, discomfort and quality of life in short and medium term after inguinal hernia surgery. Eight hundred and eight patients with primary inguinal hernia were allocated to anterior repair (Lichtenstein technique) using a lightweight mesh (Ultrapro®) or a heavyweight mesh (Prolene®). Primary outcomes were incidence of chronic pain and discomfort at 6-month follow-up. Secondary endpoints were quality of life (QoL), pain and complication at 1 week, 1 and 6 months. At 6 months, 25% of patients reported pain of some intensity; severe pain was reported by 1% of patients in both groups. A statistically significant difference in favour of lightweight mesh was found at multivariable analysis for pain (1 week and 6 months after surgery: p = 0.02 and p = 0.04, respectively) and QoL at 1 month and 6 months (p = 0.05 and p = 0.02, respectively). There was no difference in complication rate and no hernia recurrences were detected. The use of lightweight mesh in anterior Lichtenstein inguinal hernia repair significantly reduced the incidence of pain and favourably affected the perceived quality of life at 6 months after surgery compared to heavyweight mesh. [ABSTRACT FROM AUTHOR]