Echoscopic quality control of performed hernioplasty of inguinal hernia

A Simple Procedure to Prevent Postoperative Inguinal Hernia after Robot-Assisted Laparoscopic Radical Prostatectomy: A Plugging Method of the Internal Inguinal Floor for Patients with Patent Processus Vaginalis

Introduction: Inguinal and femoral hernias may occur in the groin region in case of protrusion of the contents of the abdominal cavity through the transverse fascia above the inguinal ligament, or below, through the femoral canal. Reparation of groin hernias is one of the most frequently operation performed at general surgery. Objective: To show the frequency of groin hernias subtypes and frequency of different surgical techniques used in reparation during a three-year period. Patients and methods: Retrospective analysis included data obtained from surgical operating protocols and medical histories of patients operated elective or urgent, at the surgical ward of the General Hospital Kikinda, because of groin hernias in the period 1st January 2013 - 31st December 2015. For statistical analysis we used Pearson's χ2-test. Results: 377 patients were operated (340 men vs. 37 women; χ2=243.52; p<0.001), mean age 57.18±17.27 years (4-89); 358 (94.96%) patients had inguinal and 19 (5.04%) patients had femoral hernia (χ2=304.84; p<0.001). An inguinal hernia was more frequent in men (333 men vs. 25 women; χ2=264.98; p<0.001), while in femoral hernia there was no statistical significance between the genders (7 men vs. 12 women; χ2=1.32; p>0.05). 333(97.94%) men had inguinal hernia surgery; 7 (2.06%) men had femoral hernia surgery (χ2=312.58; p<0.001). 25 (67.57%) women had inguinal hernia surgery; 12 (32.43%) women had femoral hernia surgery (χ2=4.56; p<0.05). 388 hernioplasties were done - 369 (95.10%) inguinal and 19 (4.90%) femoral (χ2=315.72; p<0.001). 347 (96.93%) patients had unilateral inguinal hernioplasty (203 right and 144 left) and 11 (3.07%) patients had bilateral inguinal hernioplasty (χ2=162.11; p<0.001). 347(94.04%) inguinal hernias were primary and 22 (5.26%) inguinal hernias were recurrent. 13(3.52%) inguinal hernias were incarcerated. Of all inguinal hernias 127 (34.42%) were direct, 201 (54.47%) were indirect and 41 (11.11%) were direct and indirect (χ2=104.26; p<0.001). 15 (78.95%) patients had femoral hernia surgery on the right side and 4 (21.05%) patients had femoral hernia surgery on the left side (χ2=6.36; p<0.05). All femoral hernias were primary. 6 (31.58%) patients had incarcerated femoral hernias. Incarcerated femoral hernias were more frequent than incarcerated inguinal hernias (χ2=254.31; p<0.001). 347(92.05%) patients were operated in general anaesthesia (χ2=587.85; p<0.001). 371 tension-free hernioplasties and 17 tension hernioplasties (95.62% vs. 4.38%; χ2=322.98; p<0.001) were done. The mesh sized 6x11cm was most frequently used (χ2=175.26; p<0.001). 352 (95.39%) inguinal hernioplasties were done by Lichtenstein technique. 16 (84.21%) femoral hernioplasties were done by Rives technique. Bowel resection in incarcerated hernias was performed in1 of 13(7.69%) patients with inguinal hernias, and in 3 of 6 (50.0%) patients with femoral hernias (χ2=19.43; p<0.001). Conclusion: Groin hernias are more common in men. Inguinal hernias are more frequent than femoral in both genders. Inguinal and femoral hernias are more common on the right side. The most common is an indirect inguinal hernia. The operation is usually performed in general anaesthesia. The tension-free techniques with synthetic 6x11cm mesh are predominantly used. Lichtenstein hernioplasty is predominantly used for inguinal hernias. Rives hernioplasty is predominantly used for femoral hernias. Incarcerated inguinal hernias are rare. Incarcerated femoral hernias are more common and often need bowel resection.

Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

Incidence and Risk Factors for Inguinal and Incisional Hernia After Laparoscopic Radical Prostatectomy

In their well-designed presentation, Henriksen et al. [1] use a massive sample of over 92,000 patients from the Danish Hernia Database to explore the association between inguinal and ventral hernias. The authors find that on multivariate analysis direct and recurrent inguinal hernias are associated with ventral hernias. The odds ratios are statistically significant, but the effect sizes are modest and range from 1.28 to 1.76. In other words, even if the risk for a ventral hernia increases in the presence of an inguinal hernia, the increase is small, as shown by the fact that less than 1 % of inguinal hernia patients were found to have ventral hernias too. Readers should note that the Danish Hernia Database includes only hernias that were treated surgically. Therefore, this study reports on the association between inguinal and ventral hernias, requiring repair; the true association for all hernias in not known. Another puzzling piece of information is the timing of hernia repair as reported in this study. Only 8.7 % of ventral hernias were repaired before the inguinal hernia was repaired. It almost seems that there is a biologic clock by which the inguinal floor gives up first; then the abdominal wall follows. One could assume that an inguinal hernia is a forewarning of future anatomical defects. In any case, it only makes good common sense to assume that a disease of collagen structure, as is hernia, will not be localized only to a certain area of the body. Using the scientific lenses of this study, investigators should look into other possible associations between inguinal hernia and collagen abnormalities. Preventive methods could then be developed and additional surgical interventions could be planned. Until then, the conclusions of this study are interesting, but I would not know how to use them. The authors have provided us with great food for thought. Any plans for the next step?

Post-Radical Prostatectomy Inguinal Hernia: A Simple Surgical Intervention can Substantially Reduce the Incidence—Results From a Prospective Randomized Trial

Грыжи брюшной стенки остаются самым распространенным заболеванием, требующим планового хирургического лечения,встречаясь у каждого 3–5-го жителя планеты. Ежегодно в мире выполняют более 20 млн. хирургических операций, из кото-рых 10-15% составляют грыжесечения, занимающие третье место в структуре хирургических операций после аппендэкто-мии и холецистэктомии.Паховые грыжи диагностируются у 80% от общего числа больных с вентральными грыжами, с количеством рецидивов по-сле пластики косой паховой грыжи от 5 до 30% наблюдений, при прямой – до 10%. Вероятность повторного рецидива припластике паховых грыж достигает до 40%.Операцией выбора при паховых грыжах в настоящий момент является ненатяжная герниопластика задней стенки паховогоканала с использованием различных сетчатых имплантов, которая может быть выполнена как традиционным (открытым),так и лапароскопическим способами. И только при отсутствии возможности осуществить ненатяжную гернипластиткупо каким либо причинам, прибегают к натяжным методам.Целью работы явился выбор наиболее эффективного и рационального с экономической точки зрения способа герниопластикипри паховых грыжах у пациентов, среди наиболее часто применяемых современных хирургических методик.Материалы и методы. Ретроспективному медико-экономическому анализу были подвергнуты 100 медицинских карт ста-ционарных больных, оперированных по поводу паховых грыж в хирургическом отделении ФНКЦ за период 2013-2015 гг.Средний возраст пациентов составил 51,4 ± 3,7 лет, из них 83 было мужчин и 17 – женщин. У 53 больных выявлена право-сторонняя паховая грыжа, из них у 39 грыжа была косой и у 14 - прямой. У 40 пациентов наблюдалась левосторонняяпаховая грыжа: у 28 – косая и у 12 – прямая. 7 больных имели двухстороннюю паховую грыжу. Анализируемым пациентамбыли выполнены в плановом порядке следующие операции: 1) герниопластика по методу Lichtenstein с использованиемполипропиленового сетчатого имплантата фирмы «Еticon» (США), 53 больных; 2) герниопластика по методу Onstep с ис-пользованием полипропиленового сетчатого имплантата «Polysoft» фирмы «C.R. Bardinc.» (США), 21 пациент и лапаро-скопическая интраперитонеальная герниопластика с использованием полипропиленового сетчатого имплантата фирмы«Еticon» (США), 26 больных.Результаты и их обсуждение. Длительность оперативных вмешательств при односторонних паховых грыжах была прак-тически одинаковой в группах больных оперированных лапароскопическим способом и по методу по методу Lichtenstein,соответственно 42,8 ± 12,4 мин. и 39,7 ± 8,9 мин. (р ˃ 0,05). Общее время, затраченное на выполнение операций по методуOnstep, было существенно меньше, чем при использовании других 2 методик, а именно: 25,3 ± 4,7 мин. (р ˂ 0,05).С финансовой точки зрения, себестоимость анестезиологического пособия была значительно больше у пациентов с лапа-роскопической интраперитонеальной герниопластикой - 3,5 тысячи рублей, тогда как у больных, оперированных по методуLichtenstein или Onstep – 2 тысячи рублей. Наибольшая общая стоимость расходных материалов, как и ожидалось, оказаласьпри выполнении лапароскопической интраперитонеальной герниопластики, за счет использования инструмента для фик-сации сетчатого имплантата (герниостеплер). Послеоперационное ведение пациентов было одинаковым и не зависело отспособа хирургического лечения грыжи. К основным осложнениям герниопластики в послеоперационном периоде относятся:серома или гематома в области послеоперационной раны, невралгия, отек мошонки, чувство инородного тела, водянка илиатрофия яичка, орхит, орхоэпидидимит, раневая инфекция и образование свища. В нашем наблюдении встретились следую-щие осложнения: при лапароскопической интраперитонеальной герниопластике – 1 острая задержка мочи, потребовавшаякатетеризации мочевого пузыря; при герниопластике по методу Lichtenstein – в 1 случае длительная невралгия и в 2 случаях– жалобы пациентов на чувство инородного тела в области послеоперационного рубца. Осложнений при герниопластикепо методу Onstep не наблюдали. В исследуемой группе из 100 больных сроки наблюдения составили от 6 месяцев до 2-х лет.Рецидив грыжи выявлен у двух пациентов через 1 и 1,5 года соответственно, после лапароскопической интраперитонеальнойгерниопластике и гернипластике по методу Lichtenstein.Выводы. 1. Высокая эффективность лечения, простота в применении, а также надежность в отношении риска возникно-вения рецидивов заболевания позволяет рекомендовать грыжесечение по методике Onstep для пластики практически у всехпациентов с паховыми грыжами. 2. Герниопластика по методу Onstep особенно показана у лиц пожилого и старческоговозраста, имеющим сопутствующие заболевания, которая может быть выполнена под местной анестезией. 3. Для гер-ниопластики по методу Onstep необходимо использовать полипропиленовый сетчатый имплантат «Polysoft» фирмы «C.R.Bardinc.» (США), размером 14 х 7,5 см или 16 х 9,5 см. 4. При выделении грыжевого мешка необходимо добиться полной егомобилизации и отделения от семенного канатика. В случае косых паховых грыж целесообразно иссечение грыжевого мешка,при прямых грыжах допустимо погружение его в брюшную полость. 5. Не позднее чем через 2 часа после операции, больныхнеобходимо активизировать, что способствует их ранней реабилитации и благоприятному послеоперационному течению.Ключевые слова Паховая грыжа, медико-экономический стандарт лечения, метод «ONSTEP», паховый имплантат, стра-ховая медицина.

The aim of this systematic review was to determine the exact volume and growth pattern of articles on abdominal wall hernias, in particular the effect of the journal Hernia on publications about hernias. A PubMed search was performed for every year between 1965 and 2010, using the title words "inguinal hernia," "incisional hernia," and "umbilical hernia." Then, two consecutive 10-year periods were chosen for a systematic PubMed search, before and after 2001--the year in which Hernia began to be indexed in PubMed. The main keywords used were as follows: "inguinal hernia" "incisional hernia" "umbilical hernia" "mesh" "laparoscopic" and "experimental." The number of all articles indexed in PubMed increased 1.6-fold between the periods 1991-2000 and 2001-2010. The number of articles with the title word "inguinal hernia" increased 1.7-fold, whereas the rises for incisional and umbilical hernias were more prominent: 3.9- and 2.6-fold. Article titles with the combined keywords "hernia and mesh" and "hernia and laparoscopic" increased 2.8- and 2.4-fold. The most striking combined search was for "umbilical hernia and mesh" with a 20.5-fold rise. The percentage of articles published in the journal Hernia among all articles in all 25 selected journals, including Hernia was 30% on average. Hernia, Surgical Endoscopy and the British Journal of Surgery were the leading journals for publications for inguinal hernia in the last decade. Growth in hernia papers is greater than the overall growth in PubMed. Articles on incisional hernia increased faster than did those on inguinal and umbilical hernias. The establishment and indexing of Hernia decreased the proportion of hernia publications in other journals. The core journals for herniology are Hernia, Surgical Endoscopy, and the British Journal of Surgery.

INGUINAL HERNIA AFTER RADICAL RETROPUBIC PROSTATECTOMY FOR PROSTATE CANCER: A STUDY OF INCIDENCE AND RISK FACTORS IN COMPARISON TO NO OPERATION AND LYMPHADENECTOMY

Inguinal and incisional hernias are the two most common types of hernias caused by abdominal wall weakness and defects in connective tissue. The structure of the extracellular matrix, mainly collagen and metalloproteinases (MMPs), and their regulators have been studied extensively and found to play a significant role in the pathophysiology of hernias. One of the regulators of MMPs, tissue inhibitor metalloproteinases (TIMPs), bind to MMPs and inhibit its activity significantly shifting the balance towards collagen synthesis rather than degradation. Due to their importance in collagen metabolism, their metabolism might be significant in the aetiology of hernias. Our study used immunohistochemical techniques to investigate the possible effects of TIMP 1 and 2 on the samples taken from the abdominal walls of patients with inguinal and incisional hernias, compared them with control patients, and reviewed the literature. In this study, samples of 90 patients (30 patients from control, inguinal hernia, and incisional hernia groups) were taken and analysed. These samples were stained with TIMP‐1 Ab‐2 and TIMP2 Ab‐5 (Clone 3A4) antibodies and evaluated under ×100 magnification. The degree of staining was classified as (a): No staining (0), (b): Staining less than 10% (I), (c): Staining between 10% and 50% (II), (d): Staining more than 50% (III). Statistical analyses were done. No significant difference was found between groups in terms of patient demographics. Smoking and family history of hernia was not found to be associated with TIMP expression. TIMP1 expression was significantly higher in the incisional and inguinal hernia group than in the control group (P < .05), while the level of TIMP2 was higher in the control group. (P < .05). TIMP1 and TIMP2 levels did not significantly differ between incisional and inguinal hernia groups. We found significantly increased TIMP‐1 levels in tissue samples from patients with hernia supporting its suggested role in hernia pathophysiology. Local alterations in MMP and TIMP levels might play a role in the pathogenesis of hernias. Thus detection of TIMP in tissues can be important for clinical use after further validation studies. In the era of molecular medicine, detecting TIMP levels in hernia patients can impact clinical practice.

Abstract. Among the complex and unresolved issues of Urology and Herniology, simultaneous operations for benign prostatic hyperplasia and inguinal hernia occupy a significant place. The aim of the study: from the standpoint of the anatomical structure of the inguinal space and the posterior wall of the inguinal canal, to substantiate the feasibility of using a single-stage inguinal prostatectomy and simultaneous preperitoneal inguinal hernioplasty. Materials and methods. To substantiate the feasibility of retropubic and simultaneous preperitoneal hernioplasty, the distance from the middle of the vesico-prostatic junction to the middle of the opening of the direct and oblique inguinal hernias was determined during the operation after removal of the hernial sac from the right and left sides. All one-stages retropubic prostatectomies and simultaneous hernioplasty were performed through a transverse suprapubic approach, the length of which ranged from 15 to 20 cm, depending on the patient’s constitution. 58 simultaneous hernioplasty were performed in 50 patients (8 patients underwent hernioplasty on both sides): inguinal hernias were found on the right side in 38 cases, on the left side in 20. In 34 patients, the hernias were oblique, in 24 – direct. Anatomical measurements were performed in 32 patients, who underwent 36 preperitoneal hernioplasty (20 on the right side, 16 on the left). The results. The average distance from the middle of the vesico-prostatic junction to the middle of the direct hernia opening was (7.7±1.2) cm on the right side and (7.9±1.1) cm on the left; the average distance from the middle of the vesico-prostatic junction to the middle of the oblique hernia opening was (11.8±1.4) cm on the right side and (11.6±1.6) cm on the left. It has been established that the operating areas of retropubic prostatectomy and simultaneous preperitoneal inguinal hernioplasty are located side by side, and the maximum distance between them does not exceed 12 cm. A transverse suprapubic incision of up to 20 cm is sufficient to perform bilateral inguinal preperitoneal hernioplasty. Conclusions. The close location of the intraoperative prostatectomy zone to the hernioplasty zone requires simultaneous preperitoneal hernioplasty of not only obvious but also hidden (occult) inguinal hernias, as well as inguinal hernias in the initial stages of their formation when performing prostatectomy in patients with benign prostatic hyperplasia and inguinal hernia.

Hernias in patients with ascites are common, however we know very little about the surgical repair of hernias within this population. The study of these repairs has largely remained limited to single center and case studies, lacking a population-based study on the topic. The Michigan Surgical Quality Collaborative and its corresponding Core Optimization Hernia Registry (MSQC-COHR) which captures specific patient, hernia, and operative characteristics at a population level within the state was used to conduct a retrospective review of patients with ascites undergoing ventral or inguinal hernia repair between January 1, 2020 and May 3, 2022. The primary outcome observed was incidence and surgical approach for both ventral and inguinal hernia cohorts. Secondary outcomes included 30-day adverse clinical outcomes as listed here: (ED visits, readmission, reoperation and complications) and surgical priority (urgent/emergent vs elective). In a cohort of 176 patients with ascites, surgical repair of hernias in patients with ascites is a rare event (1.4% in ventral hernia cohort, 0.2% in inguinal hernia cohort). The post-operative 30-day adverse clinical outcomes in both cohorts were greatly increased compared to those without ascites (ventral: 32% inguinal: 30%). Readmission was the most common complication in both inguinal (n = 14, 15.9%) and ventral hernia (n = 17, 19.3%) groups. Although open repair was most common for both cohorts (ventral: 86%, open: 77%), minimally invasive (MIS) approaches were utilized. Ventral hernias presented most commonly urgently/emergently (60%), and in contrast many inguinal hernias presented electively (72%). A population-level, ventral and incisional hernia database capturing operative details for 176 patients with ascites. There was variation in the surgical approaches performed for this rare event and opportunities for optimization in patient selection and timing of repair.

PurposeIn addition to incisional hernia, inguinal hernia is a recognized complication to radical retropubic prostatectomy. To compare the risk of developing inguinal and incisional hernias after open radical prostatectomy compared to robot-assisted laparoscopic prostatectomy.MethodPatients planned for prostatectomy were enrolled in the prospective, controlled LAPPRO trial between September 2008 and November 2011 at 14 hospitals in Sweden. Information regarding patient characteristics, operative techniques and occurrence of postoperative inguinal and incisional hernia were retrieved using six clinical record forms and four validated questionnaires.Results3447 patients operated with radical prostatectomy were analyzed. Within 24 months, 262 patients developed an inguinal hernia, 189 (7.3%) after robot-assisted laparoscopic prostatectomy and 73 (8.4%) after open radical prostatectomy. The relative risk of having an inguinal hernia after robot-assisted laparoscopic prostatectomy was 18% lower compared to open radical retropubic prostatectomy, a non-significant difference. Risk factors for developing an inguinal hernia after prostatectomy were increased age, low BMI and previous hernia repair. The incidence of incisional hernia was low regardless of surgical technique. Limitations are the non-randomised setting.ConclusionsWe found no difference in incidence of inguinal hernia after open retropubic and robot-assisted laparoscopic radical prostatectomy. The low incidence of incisional hernia after both procedures did not allow for statistical analysis. Risk factors for developing an inguinal hernia after prostatectomy were increased age and BMI.

Incidence of Inguinal Hernia after Radical Prostatectomy: A Systematic Review and Meta-Analysis.

The minimally invasive surgical repair of combined inguinal and ventral hernias often requires shifting from one approach or plane to another. The traditional enhanced-view totally extraperitoneal Rives-Stoppa repair consists of a large retro muscular dissection that is unjustified for small ventral hernias. Here we describe a modification to the minimally invasive Rives-Stoppa repair using a limited retro muscular dissection based on the ventral defect size for small/medium-sized hernias, with or without combined inguinal hernias. From a single surgical team, a retrospective study was performed over a 1-year period. Demographics, hernia characteristics, surgical techniques, intraoperative/postoperative complications, and outcomes were all analyzed and reported. We also included detailed surgical steps, landmarks, pitfalls, and personal tips for this technique. Twenty-four patients underwent a laparoscopic limited retromuscular dissection ventral hernia repair utilizing the eTEP access technique. Eighteen were primary umbilical hernias and six postoperative incisional hernias, and nine were combined ventral and inguinal hernia repairs. Eight of the primary umbilical hernias were EHS classified as medium size, 11 small, and for the incisional hernias, three were classified as M3W1 and two as M3W2. One procedure was converted to TAPP. There were no intraoperative complications. The mean length of stay was 1.25days (range 1-3). There was one postoperative retromuscular hematoma and no recurrence during the follow-up period. eTEP with limited dissection offers a good and safe solution for small to medium size hernias; it provides an efficient solution when an inguinal hernia is to be addressed as well.