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Obturator hernia (OH) is a rare form of pelvic hernia that constitutes less than 1% of all abdominal hernias. Due to the rarity of obturator hernia, there is no standardized recommendation for treatment, and preoperative and surgical approaches differ for each institution. Herein, we describe an elective laparoscopic repair technique for incarcerated obturator hernia using a mesh plug after ultrasound-guided noninvasive reduction. We retrospectively reviewed seven patients who underwent our procedure for obturator hernia at our hospital from April 2019 to May 2022. All obturator hernias were diagnosed using computed tomography. The surgical and perioperative data was assessed. All the patients were women, and their median age was 90 years. The operation time among all seven patients ranged from 34 to 122 min, including two cases involving the repair of other occult hernias. The postoperative hospital stay ranged from 4 to 62 days (median, 10.5 days). One patient developed cerebral infarction as a postoperative complication; however, there was no postoperative mortality or recurrence. Obturator hernia without strangulation can be electively and safely repaired with a mesh plug via the laparoscopic approach following ultrasound-guided manual reduction. This is a simple, safe, effective, and minimally invasive surgery for incarcerated obturator hernia. [ABSTRACT FROM AUTHOR]

Background: Over 20 million people have inguinal hernia repairs every year, making it one of the most frequent operations performed worldwide. The goal of a successful hernia repair is to minimize the rate of recurrence while enabling the patient to quickly and comfortably resume normal activities. Aim: To evaluate an improved and simple technique in inguinal hernia patients between mesh plug with patch repair and Lichtenstein repair techniques and to identify which technique is superior. Materials and Methods: A prospective study was conducted on 96 patients (48 Group A, 48 Group B) who underwent inguinal hernia surgery in the Department of General Surgery at a tertiary care teaching hospital for a year (October 2018–September 2019). Before surgery, the two groups were assessed for study parameters, operated, and complications were compared between patients. Patients were monitored for 2 years. Observation: No statistically significant differences were found between the study parameters and complications (P > 0.05). This difference between the two groups with respect to the duration of surgery, mean duration of hospital stay in patients, and day 1 pain in both the groups was statistically significant (P < 0.05) with a positive inclination toward the mesh plug system. Conclusion: Mesh plug repair was observed to be safe and easier. It shortens the duration of operation and hospitalization and is superior to Lichtenstein's technique regarding postoperative pain and quality of life. [ABSTRACT FROM AUTHOR]

Background and Objective: Inguinal hernioplasty is an ordinary operation all over the world. Many types of repair are present. Aim of the surgeon is to improve the outcome and decrease the recurrence. We evaluated the addition of a mesh plug with the usual repair as a synergistic way to reduce the recurrence.Patients and Methods: A clinical trial involved 200 inguinal hernia patients and was conducted in the General Surgery Department of the Faculty of medicine, Al-Azhar University, New Damietta. Patients were randomly divided into two equal groups; Group A: patients performed Onlay mesh hernioplasty surgery, whereas Group B patients performed combined Onlay-Plug mesh hernioplasty surgery. For six months, post-operative results in both groups were evaluated.Results: Group [B] patients who had undergone combination Onlay-Plug mesh hernioplasty surgery have increased incidences of after-surgery pain, scrotal swelling, cord sensitivity, and infected wounds, revealing a significant difference in the two groups.Conclusion: Adding mesh plug has no value. Onlay mesh is sufficient for the repair of inguinal hernioplasty.

Abstract The optimal method of anesthesia for inguinal hernia repair is still controversial. We have developed “three‐step tumescent local anesthesia (TLA) technique” for inguinal hernia repair, and recently showed that this technique is acceptable in view of short‐ and long‐term clinical outcomes. Our study included 273 consecutive cases (290 sides) of elective inguinal hernia repair performed under the newly developed technique between September 2003 and May 2019, and overall clinical outcomes were considered to be safe and feasible. Herein, we report the surgical procedure of “three‐step TLA technique.” Briefly, we rapidly inject the diluted solution of local anesthetic and epinephrine step‐by‐step into the three following closed tissue space. Initially, 80 mL injection into the subcutaneous tissue before skin incision (Step 1). After the external oblique fascia is exposed, injection of 20 mL into the inguinal canal before the external oblique fascia is incised and opened (Step 2). The hernia sac and spermatic cord are then dissected, and the blunt dissection of the preperitoneal space is made by injecting 20 mL under the internal inguinal ring (Step 3), followed by placing a gauze into the preperitoneal space, creating the space for mesh placement. We consider that the most important point of this technique is achieved through the rapid injection of TLA solution into each closed tissue space, which makes for easier dissection, hemostasis, and good pain control.

Background: Femoral hernia is peculiar due to its high propensity towards strangulation, high rates of diagnostic pitfalls and occurrence in older patients with multiple comorbidities. Therefore, an updated record of the clinical characteristics and burden of the disease in our locality should be established. Aims and Objectives: This study aimed to document the challenges of diagnosis and outcome of repair of femoral hernia in southeast Nigeria. Materials and Methods: This was a multi-centre retrospective study of adult patients with femoral hernias repaired surgically over twelveyears period. Tests of statistical significances were done. Results: A total of 128 patients were studied and they represented 3.4% and 2.6% of all patients with groin and abdominal wall hernias respectively. There were 116 females and 12 males. The overall rate of missed diagnosis was 14.8%; majority (84.2%) were in the emergency arm. Eighty-one (63.4%) patients presented emergently while 47 (36.7%) were managed electively. In the emergency group, the vast majority (72, 88.9%) presented beyond 24hours from onset of complications. Still on the emergency group, 72 (88.9%) were strangulated, seven (8.6%) were obstructed and 2 (2.5%) were incarcerated at presentation. Overall resection rate was 39.8%, but in the emergency group, it was 63.0%. Prosthetic meshes were used in only 4 (8.5%) of the 47 elective cases. Recurrence rate was Overall morbidity and mortality rates were 43.0% and 10.9% respectively. Late presentation was an independent predictor of mortality (p=0.000). Conclusion: Though femoral hernias are relatively uncommon, the rate of missed diagnosis is high, majority of which occur in the emergency group. Majority presented in emergency and have high propensity towards strangulation with attendant high morbidity and mortality.

The present study systematically evaluated the clinical effects of mesh-plug and Lichtenstein herniorrhaphy in the treatment of primary inguinal hernia. PubMed, Embase, and the Cochrane Library (cut-off: May 25, 2020) databases were searched to select randomized controlled trials (RCTs) on mesh-plug and Lichtenstein herniorrhaphy for the treatment of primary inguinal hernia. Articles that met the inclusion criteria were screened and evaluated for quality. RevMan 5.3 software was used to perform a meta-analysis of operation time, discomfort in the inguinal region, haematoma, seroma, infection, time to return to normal activities, incidence of postoperative chronic pain, and recurrence rate. Eleven RCTs with 1457 patients in the mesh-plug group and 1472 in the Lichtenstein group were included. Meta-analysis showed that the mesh-plug herniorrhaphy group had a shorter operation time than the Lichtenstein herniorrhaphy group [P < 0.0001] but a longer time to return to normal activities after surgery [MD = 1.48, 95% CI (0.58, 2.38), P = 0.001]. There were no significant differences in postoperative discomfort in the inguinal region [P = 0.90], seroma [P = 0.10], haematoma [P = 0.27], infection [P = 0.40], incidence of postoperative chronic pain [P = 0.90], or recurrence rate [P = 0.77] between groups. Mesh-plug herniorrhaphy requires a shorter operation time than Lichtenstein herniorrhaphy, and there is no significant difference in postoperative complications or recurrence rate between the two methods. Clinical trial registration: INPLASY202070088. Meta-analysis of mesh -plug repair and Lichtenstein repair in the treatment of primary inguinal hernia [ABSTRACT FROM AUTHOR]

Purpose: Inguinal hernias are a long-term complication of radical prostatectomy (RP). We investigated the clinical features and surgical outcomes of patients with inguinal hernias developing after RP. Methods: We retrospectively investigated 80 patients (86 hernias) who underwent inguinal hernia repair after RP. We repaired all RP-associated inguinal hernias by the tension-free method with a mesh plug. We also retrospectively investigated 729 adult male patients (779 hernias) who underwent inguinal hernia repair as a control group. Results: A higher proportion of the 80 post-RP patients developed right-sided hernias (53 [66%]) than the controls, which was significant. A higher proportion of the 86 post-RP hernias were indirect (76 [89%]) than the controls, which was also significant. The mean times to hernia development after robot-assisted RP, laparoscopic RP, and radical retropubic prostatectomy were 20.3, 48.9, and 73.2 months, respectively. The total complication rates did not differ significantly between the post-RP group and control group. Conclusion: The proportion of post-RP patients with right-sided hernia was significantly higher than controls. Indirect inguinal hernias were predominant among the post-RP hernias. The mesh plug method is safe and effective for inguinal hernia repair after RP. The time from robot-assisted RP to the development of inguinal hernia was shorter than those from laparoscopic RP, and radical retropubic prostatectomy. [ABSTRACT FROM AUTHOR]

The optimal method of anesthesia for inguinal hernia repair is still controversial. We have developed "three‐step tumescent local anesthesia (TLA) technique" for inguinal hernia repair, and recently showed that this technique is acceptable in view of short‐ and long‐term clinical outcomes. Our study included 273 consecutive cases (290 sides) of elective inguinal hernia repair performed under the newly developed technique between September 2003 and May 2019, and overall clinical outcomes were considered to be safe and feasible. Herein, we report the surgical procedure of "three‐step TLA technique." Briefly, we rapidly inject the diluted solution of local anesthetic and epinephrine step‐by‐step into the three following closed tissue space. Initially, 80 mL injection into the subcutaneous tissue before skin incision (Step 1). After the external oblique fascia is exposed, injection of 20 mL into the inguinal canal before the external oblique fascia is incised and opened (Step 2). The hernia sac and spermatic cord are then dissected, and the blunt dissection of the preperitoneal space is made by injecting 20 mL under the internal inguinal ring (Step 3), followed by placing a gauze into the preperitoneal space, creating the space for mesh placement. We consider that the most important point of this technique is achieved through the rapid injection of TLA solution into each closed tissue space, which makes for easier dissection, hemostasis, and good pain control. [ABSTRACT FROM AUTHOR]

Background: Femoral hernia is peculiar due to its high propensity towards strangulation, high rates of diagnostic pitfalls and occurrence in older patients with multiple comorbidities. Therefore, an updated record of the clinical characteristics and burden of the disease in our locality should be established. Aims and Objectives: This study aimed to document the challenges of diagnosis and outcome of repair of femoral hernia in southeast Nigeria. Materials and Methods: This was a multi-centre retrospective study of adult patients with femoral hernias repaired surgically over twelveyears period. Tests of statistical significances were done. Results: A total of 128 patients were studied and they represented 3.4% and 2.6% of all patients with groin and abdominal wall hernias respectively. There were 116 females and 12 males. The overall rate of missed diagnosis was 14.8%; majority (84.2%) were in the emergency arm. Eighty-one (63.4%) patients presented emergently while 47 (36.7%) were managed electively. In the emergency group, the vast majority (72, 88.9%) presented beyond 24hours from onset of complications. Still on the emergency group, 72 (88.9%) were strangulated, seven (8.6%) were obstructed and 2 (2.5%) were incarcerated at presentation. Overall resection rate was 39.8%, but in the emergency group, it was 63.0%. Prosthetic meshes were used in only 4 (8.5%) of the 47 elective cases. Recurrence rate was Overall morbidity and mortality rates were 43.0% and 10.9% respectively. Late presentation was an independent predictor of mortality (p=0.000). Conclusion: Thoughfemoral hernias are relatively uncommon, the rate of missed diagnosis is high, majority of which occur in the emergency group. Majority presented in emergency and have high propensity towards strangulation with attendant high morbidity and mortality. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair by mesh-plug (MP) is one of the most common general surgeries, and even residents can perform it. The aim of this study was to investigate the postoperative outcome of MP repair by residents and risk factors related to the recurrence. This study included 658 patients underwent MP repair for inguinal hernia. We compared short- and long-term outcomes of the MP repair by residents who were postgraduate year two with those by non-residents. Late complications were investigated via questionnaire. Among the patients, 206 patients (31%) underwent MP repair by residents, and the other 452 patients (69%) by non-residents. Operative time was significantly longer in the resident group (63 vs. 58 min, P = 0.004). Incidence of short- and long-term complications was not significantly different. The 3-year recurrence rate was significantly higher in the resident group (4.1 vs. 0.9%, P = 0.003). By multivariate analysis, independent perioperative risk factors related to recurrence were surgery by residents (Odds ratio 3.42, 95% CI 1.34–8.76, p = 0.010) and direct hernia (Odds ratio 7.69, 95% CI 2.83–20.83, p < 0.001). The MP repair by residents and direct hernia were risk factors related to recurrence. Surgeons should provide very careful guidance to residents especially for direct hernia. [ABSTRACT FROM AUTHOR]

We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer. The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis. This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections. This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries. • Initially thought to be appendiceal cancer post-hernia surgery, presenting with a right inguinal lump. • No apparent signs of infection despite the presence of a lump. • Pus-filled abscess found during surgery, revealing a mesh infection in the inguinal region. • Mesh infections mimicking appendiceal cancer pose challenges when typical indicators are absent. • Early recognition and differentiation crucial; mesh infections may be mistaken for conditions like appendiceal cancer post-hernia surgery when typical signs are lacking. [ABSTRACT FROM AUTHOR]

• An anterior approach to inguinal hernia repair using laparoscopy is demonstrated. • This approach provides added advantage to recurrent inguinal hernia repair. • This approach can prevent nerve damage by reducing surgical dissection. • Laparoscopic confirmation assures complete coverage of all hernia defects. The HerniaSurge Group and the European Hernia Society guidelines recommend an anterior approach to treat recurrent inguinal hernias after a failed posterior approach. The hybrid method combining explorative laparoscopy and anterior open approach can provide the benefits of both approaches. A 79-year-old man presented with a recurrent inguinal hernia after primary repair for an indirect hernia using the laparoscopic transabdominal preperitoneal approach (TAPP) 5 years ago. The indirect hernia formed inferior to the lower edge of the previous mesh was diagnosed under laparoscopy. The hernia defect (2 cm) was fixed using a mesh plug via the anterior approach. Appropriate mesh overlap was confirmed using laparoscopy. This minimally invasive method enabled us to choose the best treatment for recurrent hernia and prevent chronic pain due to possible nerve damage caused by extended dissection of the scar tissue. Furthermore, the final confirmation step using laparoscopy assures complete coverage of all defects within the myopectineal orifice. This hybrid method facilitates the choice of an optimal approach for the treatment of recurrent hernia and may reduce surgical complications and re-recurrence rate. [ABSTRACT FROM AUTHOR]

Tension-free hernia repair with a mesh plug causes relatively low postoperative pain and allows an earlier return to work, as well as a low recurrence rate. Occasionally, however, hernioplasty can result in complications including mesh migration and invasion of intra-abdominal organs. This report describes the case of a 57-year-old man who had undergone a right inguinal hernioplasty 13 years previously. Recovery was uneventful until he experienced inflammation of the groin, and required open drainage three times for a refractory abscess in his right groin. Additional colonoscopy and x-ray examinations with contrast medium clearly demonstrated a mesh plug that had migrated and penetrated the cecum, forming a colocutaneous fistula. The mesh was successfully removed under general anesthesia, and the inflammation in the groin resolved. [ABSTRACT FROM AUTHOR]

Purpose: Tension-free mesh repair of adult inguinal hernias has become a standard procedure, but there have been few comparisons of the postoperative outcome after hernia repair using the Prolene Hernia System (PHS) vs. the Mesh Plug (MP) method in a large number of patients from a single institution. Methods: We reviewed the medical records of patients to investigate the short- and long-term outcomes of the different types of hernia repair. Late symptoms were evaluated by questionnaire. A total of 1,141 repairs performed from 1999 to 2008 (PHS in 957 and MP in 184 repairs) were evaluated. Results: There were 93 early postoperative complications (8.2 %). A subcutaneous hematoma was found more frequently after MP repair compared with after PHS repair (3.8 vs. 1.3 %, P = 0.013). Seven hundred and ten patients (62.2 %) could be followed up for more than 2 years. Recurrence was detected in 14 patients with PHS repair and two patients with MP repair (1.5 vs. 1.1 %, P = 0.956). Wound infections occurred in three patients (0.3 %) with PHS repair vs. none with MP repair ( P > 0.999). Patients with PHS and MP repair showed no significant differences in the long-term wound pain. Conclusions: The recurrence and wound infection rates were similar after hernia repair using the PHS and MP methods. Patients undergoing PHS repair developed fewer subcutaneous hematomas. An older age (≥65 years) was a significant independent risk factor for recurrence. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair. Methods: Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group). Results: All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups. Conclusion: Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair. [ABSTRACT FROM AUTHOR]

Purpose: The biological responses to mesh in vivo have been evaluated in some papers, but the in vivo condition of mesh and plugs have not been sufficiently evaluated. This study evaluated the endoscopic observations and histological assessments of mesh plugs using swine models. Methods: An artificial abdominal hernia was established in the porcine abdomen, and repaired using three different sizes of two types of plug, Proloop (ATRIUM Medical Corporation, Hudson, NH, USA) or Perfix (BARD Medical Division, Covington, GA, USA). The in vivo conditions of each plug were periodically observed using a laparoscope. Moreover, a histological evaluation of the plugs was performed 3 months after implantation. Results: The laparoscopic observation revealed that inversion of the plugs occurred in 10 out of 18 cases repaired with Perfix, while no case repaired with Proloop inverted. The large and medium sizes of Perfix plugs were inclined by an average of more than 30°. In addition, the triangular shape of Perfix plugs was broken and the vertical/horizontal ratio was enlarged during the observation period, while Proloop plugs shrank both vertically and horizontally. The inflammatory cell count was significantly lower within the Proloop plugs than within Perfix plugs. Conclusion: Proloop plugs are apparently superior because they are stable even 3 months after implantation. [ABSTRACT FROM AUTHOR]

Purpose: The two most common procedures for open tension-free groin hernia repair with prosthetic mesh are the Lichtenstein operation and the mesh plug (Rutkow-Robbins) technique. Our study evaluated these two techniques on testicular blood flow and volume, and sperm function in young adults. Methods: We randomized operation types with a systematic sampling method, and handled consecutive patients of age 20-30 years having unilateral inguinal hernia repair at our institution from March to August 2008. The study subjects were divided into the Lichtenstein group (LG) and the mesh plug group (MPG). All subjects received color Doppler ultrasonography to determine testicular volume and resistive index (RI) the day before surgery and 3 months postoperatively by a physician blinded for the type of planned or performed operation. Spermiograms done preoperatively and at 3 months postoperatively measured sperm concentration and the rate of progressive motility. Results: Sixty-four patients met the study criteria, with 32 patients each in the LG and MPG. RI levels were elevated postoperatively in both the LG ( P = 0.027) and MPG ( P = 0.012); there was no significant alteration in terms of testicular volume and spermiogram in the LG and MPG. Conclusion: The Lichtenstein and mesh plug techniques in unilateral inguinal hernia increase the RI level significantly in the early postoperative period, but do not have a significant effect on sperm concentration and the rate of progressive motility. [ABSTRACT FROM AUTHOR]

Although the mesh plug procedure is an effective operation, sutureless implantation of a single onlay mesh, if successful, would avoid the risks of plug-related complications. One hundred patients with primary inguinal hernias were randomized to undergo PerFix Plug or Hertra 1 implantation. Mean duration of the operation was similar, 38 versus 35 min for plug and onlay mesh implantation, respectively (nonsignificant, NS). The level of postoperative pain and early complication rate was similarly low in both groups (NS). Recurrence rate was the same-2 patients in each group (4%)-all following large hernia repair. The level of long-term discomfort was low after each type of operation (NS). Implantation of the onlay mesh-Hertra 1 as compared to the use of PerFix Plug is simple, safe, and equally effective in small and medium inguinal hernia repair, suggesting that a plug device is not necessary for successful hernia surgery. [ABSTRACT FROM AUTHOR]

Adult umbilical and paraumbilical hernia repair is associated with a high recurrence rate of 10-30%. Mesh repair has been reported to be associated with low recurrence rates. This study aims to compare sutured repair with prosthetic mesh repair to evaluate recurrence and infection rates. A retrospective study was conducted over an 8-year period including all the umbilical and paraumbilical hernia repairs performed by one consultant surgeon. The hernias were repaired using interrupted suture, Mayo overlap, flat mesh and mesh plug techniques. The study was based on case-note review, telephone and postal questionnaire survey. A total of 100 patients were studied, of which 70 had paraumbilical hernias, 28 had umbilical hernias and 2 had both types of hernia. Median age was 56 years (range 19-90 years). A total of 61 patients had suture repair (50 interrupted suture repair, 11 Mayo) and 39 had prosthetic mesh repair (33 mesh plug, 6 flat mesh). The median body mass index (BMI) was 31.2 (range 23.4 44.5) in the suture repair group and 33.3 (range 24. 1-59.1) in the mesh group, with no significant statistical difference in BMI between the two groups (P > 0.05). Median follow-up was 4.5 years (range 1-8 years). Recurrence rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P = 0.007). Infection rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P = 0.007). Our data suggest that prosthetic mesh repair is ideal for managing primary and recurrent umbilical hernias in both obese and non-obese patients. [ABSTRACT FROM AUTHOR]

A 30-year-old male with 1 1/2-year history of an asymptomatic, large, reducible right indirect scrotal hernia presented to the emergency department complaining of a 2-week history of increasing abdominal distension and daily emesis. He had recently undergone an emergent exploratory laparotomy in which his asymptomatic hernia was repaired with a mesh plug from an intra-abdominal approach. The mesh plug subsequently migrated into the patient's scrotum resulting in a strangulating bowel obstruction. This paper discusses a serious complication that may result from inappropriate use and placement of a mesh plug and our approach to correct the situation utilizing a bioabsorbable mesh prosthesis. [ABSTRACT FROM AUTHOR]

Background: The standard method of repair of paraumbilical hernia (PUH) is by the Mayo technique, using a double-breasted flap of the rectus sheath. The reproducibility of this technique in the hands of others is highly variable. The present study describes and evaluates the application of a Prolene mesh plug in the repair of PUH. The use of a mesh plug in hernia repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal Hernias. Methods: The study is a retrospective analysis of hospital records and telephone interviews of 34 patients having undergone PUH repair using the mesh plug technique in the period March 1998 May 2002. There were 20 males and 14 females with a median age of 53 years (range 34-86 years) Seventy-six percent (26) of the patient sample was obese (median BMI 33). Whenever possible local anaesthetic was used. Principal outcome measures studied were post-operative complications, recurrences, length of stay in hospital, post-operative analgesia, duration of drain, return to normal activities and patient satisfaction. Results: Post-operative complications encountered included one case of seroma and a single wound infection with recurrence. Ninety-seven percent (32) of patients were satisfied with the procedure. Conclusion: Mesh plug repair can be performed with minimal postoperative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standard treatment for PUH in adults. [ABSTRACT FROM AUTHOR]

Background: Mesh plug (MP) erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair (IHR), and may lead to aggravation of symptoms if not treated promptly. It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations, and surgery is often needed for confirmation. In recent years, with the increased understanding of postoperative complications, MP eroding into the intra-abdominal organs has been a cause for concern among surgeons., Case Summary: A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d. He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago, respectively. Computed tomography revealed a circinate high-density image with short segmental thickening of the ileum stuck to the abdominal wall, and no evidence of recurrent inguinal hernia. Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall; the rest of the small intestine was normal. Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug, which eroded the ileum. Partial resection of the ileum, including the MP and end-to-side anastomosis with an anastomat, was performed., Conclusion: Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

The aim of this prospective study was to evaluate the results of the Perfix® plug in inguinal hernia. A series of 228 consecutive patients operated on for 242 hernias was prospectively evaluated. The operation was performed under local anesthesia in 154 cases (63.6%), spinal anesthesia in 84 cases (34.7%) and general in 4 cases (1.7%). A plug was used in 202 cases (83.5%). Another procedure was preferred in 40 cases (16.5%) for some type I and II hernias in young people, or for large hernias with a wide deficiency of the posterior wall. Thirteen (5.4%) benign postoperative complications occurred, one plug was removed for sepsis. The mean duration (days, (SD, extremes)) of analgesics consumption, postoperative hospital stay, cessation of normal activities and time off work were 3 (4.07, 0–60), 1.2 (0.89, 0–11), 4.7 (4.45, 0–51) and 16.4 (10, 0–60) respectively. The mean follow-up was 22.3 months (SD: 9.93, extremes: 12–48). Only one patient was lost to follow-up. There was one recurrence in the plug series (0.5%) and 2 in other procedures (5%) (ns). Seventeen patients (8.6%) felt some degree of pain in the groin, but not one had to be reoperated on. In conclusion the plug technique provides uneventful postoperative outcome with early recovery and a low recurrence rate, but in some cases some degree of secondary pain may be present. [ABSTRACT FROM AUTHOR]

The authors report their experience with open mesh-plug repair in the treatment of adult primary inguinal hernias from 1992 to 1998. Eight hundred and twenty-six cases, i.e.: 71% of all repairs for primary hernias, were operated using this procedure. 65.3% of all this operations were performed under local anesthesia (LA). The following complications were observed: wound infection 1.7%, haematoma 1.6%; orchitis 0.9%, recurrence 0.8%. The results were consistent with those of large series in the literature. Complications increased when anesthesia other than LA was used, in obese and in elderly patients. No patients required prosthesis removal due to pain or infection. We also discuss the various prostheses and our results favour polypropylene as opposed to Dacron. Several types of polypropylene mesh are discussed, comparing thickness, thread and pore size and their physical properties. The results suggest that a single thread close knit with controlled memory stiffness for the mesh and a looser and thinner version for the plug give the best results. [ABSTRACT FROM AUTHOR]

The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor and creation of a new internal ring made of prosthesis. The preliminary report of this operation was published in 1989, with no recurrence at that point in time. Shortly after the submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991 [Amid 1993]. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias. [ABSTRACT FROM AUTHOR]

Two hundred consecutive adult patients receiving Perfix mesh plugs and onlay mesh grafts for inguinal hernia repairs in an ambulatory surgery unit were studied between January 1996 and October 1997. Xylocaine and Marcaine were used for local anesthesia. Deep sedation was maintained with intravenous Propofol after induction with Versed and Fentanyl. Some patients received Brevital and most were given Toradol to prolong analgesia. Total operating room time averaged 45 minutes. Narcotic use for pain relief averaged 2 days, and the majority were driving their cars in 6 days. Local anesthesia plus intravenous deep sedation has excellent patient acceptance and enables rapid patient recovery from inguinal herniorrhaphy. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to evaluate the postoperative pain and disability after treatment of inguinal hernia by the plug technique. Postoperative pain, main organic functions, mobility, return to normal activities and absence from work were prospectively assessed in 118 consecutive patients. Only 3 benign postoperative complications (2.5%) occurred. The mean postoperative pain as assessed by visual analogue scale was 20.3 ± 15.1 mm/100. The mean duration of analgesic consumption was 2.7 ± 1.6 days and the mean total number of capsules was 7.1 ± 4.7. The percentages of patients capable of eating lunch the day of operation, passing urine, walking and bending forward without difficulty 6 hours after operation were 97.5,97.4, 97.5 and 85.6 respectively. The mean postoperative hospital stay was 1.2 ± 0.6 days. The mean times of first outdoor walking, return to normal activities and return to work were 1.5 ± 1, 3.6 ± 2.2 and 15.2 ± 8.9 days respectively. These results show that the plug technique provides a low complication rate, a low level of pain, and allows early resumption of full activity. [ABSTRACT FROM AUTHOR]

The value of the use of biomaterials for the repair of abdominal wall hernias is gaining increasing recognition. The use of synthetic mesh to achieve a tension-free repair has resulted in a significant reduction in postoperative pain, in length of the recovery period, and in the number of recurrences. However, certain physical properties of biomaterials can lead to undesirable consequences. These include increased risk of infection, seroma formation, biomaterial-related intestinal obstruction, and fistula formation and failure of repair due to shrinkage of the mesh. The purpose of this paper is to discuss the mechanism of these problems with special emphasis on pore size, molecular permeation and shrinkage of biomaterials and their effects on infection, seroma formation, and recurrence of mesh repair of abdominal wall hernias. [ABSTRACT FROM AUTHOR]