One-Stage Totally Extraperitoneal Mesh Repair for Incarcerated Groin Hernias With Separated Operative Fields.

Background Tension free mesh repair is considered as gold standard technique for elective groin hernia repair. However, use of synthetic mesh remains controversial in the presence of gangrenous bowel, contaminated or infected surgical field. Aims/ Objective This study aimed to evaluate the outcome of emergency groin hernia repair, to assess the safety of mesh repair and explore risk factors of postoperative complications for adult patients with incarcerated groin hernia. Methods From April 2019 to August 2022, consecutive adult patients who underwent emergency repair for incarcerated groin hernia in our trust were retrospectively reviewed. Data was collected from electronic patient record, which includes patient demographics, type of hernia, repair (mesh/ non mesh), and the outcome in terms of early and late postoperative complications. Results 153 patients underwent emergency groin hernia repair, of these 137 were primary and 15 recurrent. Median age was 75.5 (range 23 to 96), with male to female ratio 3:1. 80 percent cases were inguinal hernia and 20 percent femoral. 75 percent patients had mesh repair and remaining had suture repair done. Bowel resection was performed in 11 cases. Early complications were reported in 7 cases (hematoma 2, seroma 2, chronic pain 2 , recurrence 1 and infection 1) and late complications within 90 days were seen in 5 cases (recurrence, groin pain, adhesions). Conclusions Polypropylene mesh could be safely used in incarcerated groin hernia repair. However, suture repair is recommended when bowel resection is required. Delay in surgical repair, obesity and co-morbidities are risk factor of post-operative complications.

Purpose: Management strategies for acutely incarcerated/strangulated groin and obturator hernias may differ from institution to institution, although, conventionally, the open approach has been used. Recently, laparoscopic transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair have become commonly used operative procedures for the repair of groin hernias. It is unclear whether laparoscopic reduction and herniorrhaphy can be successfully accomplished in all cases. This study was aimed at assessing the effectiveness of laparoscopic treatment. Methods: We conducted a prospective clinical trial of the laparoscopic approach from December 2011 and comparatively analyzed the surgical outcomes between the open and laparoscopic approaches for incarcerated/strangulated hernias seen from December 2000 to March 2017. Results: The open approach for repair was used in 54 patients (50.9%) and the laparoscopic approach in 52 patients (49.1%). There was 1 case in which from the laparoscopic approach to laparotomy (1.9%) was required. The operation time treated by the laparoscopic approach was significantly longer than the open approach (126.4 minutes versus 104.6 minutes; P = .0079); however, the incidence of postoperative complications and the postoperative length of hospitalization were also less in the former group than in the latter group (3.9% versus 18.5%; P = .0172 and 5.6 days versus 14.7 days; P = .0096). Second-stage TAPP herniorrhaphy was performed in 7 patients (15.2%) after bowel resection or closure of bowel perforation, and first-stage TEP herniorrhaphy was performed in 1 patient after bowel resection. There was no case of mesh infection in the group treated by the laparoscopic approach, and there was 1 case of mesh infection in the group treated by the open approach. The mortality rate was 0% in the group treated by the laparoscopic approach. Conclusions: Laparoscopic reduction and herniorrhaphy for acutely incarcerated/strangulated groin and obturator hernias is effective, safe, and feasible.

Obturator hernias are a rare groin hernia. They are most commonly found incidentally during laparoscopic inguinal hernia repair. We investigated our experience with obturator hernias in the elective and emergency setting. Cases of obturator hernia were identified from a hospital database and reviewed retrospectively over the last 10 years. There were no exclusions. There were a number of surgeons involved with an interest in groin hernia surgery. Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery. Computed tomography would be recommended in cases of diagnostic uncertainty. It may avoid unnecessary surgery in the elective setting and allow a focused procedure in the emergency setting. Laparoscopic repair is feasible in the emergency and elective setting with excellent results.

Therapeutic Strategy for Incarcerated Obturator Hernia Using Preoperative Manual Reduction and Laparoscopic Repair

The purpose of this study was to evaluate the mesh repair for an incarcerated groin hernia. A total of 110 patients who underwent emergency surgery for incarcerated hernias were retrospectively analyzed using a multivariate analysis. The postoperative complications were associated with bowel resection, odds ratio (OR) 2.984, and 95 % confidence interval (CI) 1.273 to 6.994. The risk factors for bowel resection were femoral hernia, (OR 5.621, 95 % CI 2.243 to 14.082), and late hospitalization (24 h<), (OR 2.935, 95 % CI 1.163-7.406). The hernias were repaired with mesh in ten of the 39 (25.6 %) patients with bowel resection and sixty-four of the 71 (90.1 %) patients without bowel resection. The complication rate of the patients with bowel resection was 53.8 % and was 26.8 % in those without. The ratios of wound infection were 23.1 and 0.0 %, respectively. Wound infections were detected in two (20 %) of the ten patients who underwent bowel resection with mesh repair; however, there were no patients in whom the mesh was withdrawn due to infection. No wound infections in patients without bowel resection were detected, and mesh repair could be safely performed. Mesh repair for the patients with bowel resection is not contraindicated, as long as the clean-contamination of the wound was maintained during surgery.

Background:Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH.Methods:We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients.Results:Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705–6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873–5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH.Conclusion:In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.

BackgroundThe incarceration of a segment of bowel within a groin hernia can result in intestinal strangulation if hernia treatment is delayed. Once intestinal strangulation occurs, a bowel resection may be required, and there is an overall increased risk for postoperative complications. The aim of this study was to identify biomarkers to predict the severity of an incarcerated groin hernia.Material/MethodsWe retrospectively evaluated the records of 95 patients with incarcerated groin hernias who underwent emergency surgical correction of the hernias. The need for a bowel resection was regarded as an indicator of severity in incarcerated groin hernia patients. The patients were divided into 2 groups: patients with bowel resection surgery and patients without bowel resection surgery.ResultsWe discovered that leukocyte count (leukocyte count ≥10×103/mm3), neutrophil-to-lymphocyte ratio (NLR, NLR ≥11.5), presentation of bowel obstruction, and duration of incarceration (duration of incarceration ≥26 h) were significantly associated with bowel resection in incarcerated groin hernia patients by using the chi-square test. Factors such as leukocyte count, NLR, presentation of bowel obstruction, and duration of incarceration were analyzed using multivariate logistic regression analysis. We found that NLR, presentation of bowel obstruction, and duration of incarceration were independently and significantly related to bowel resection in incarcerated groin hernia patients.ConclusionsAn elevated NLR can serve as a biomarker for the prediction of severity of incarcerated groin hernias. Additionally, incarcerated groin hernia patients who present with bowel obstruction or with duration of intestinal incarceration longer than 26 h have an increased risk for bowel resection.

To compare the feasibilities and efficacies of the total extraperitoneal (TEP) technique and laparotomy for incarcerated obturator hernia repair. All study subjects were diagnosed with incarcerated obturator hernia, preoperatively and TEP was performed as for TEP groin hernia repair. The incarcerated intestine was retracted into the peritoneal cavity with the hernia sac. The obturator foramen was then covered with a rectangular mesh (9× 13cm), which also covered the internal inguinal ring, Hesselbach's triangle, and the femoral ring. Non-ischemia of the incarcerated bowel was confirmed laparoscopically. In patients undergoing laparotomy, the obturator foramen was closed by continuous sutures, and no prosthesis was used. We recorded the length of hospital stay, operative time, amount of intraoperative bleeding, and postoperative complications. Twenty-two patients underwent obturator hernia repair in our hospital between January 2000 and December 2012, of whom 10 were treated with laparotomy and the remaining 12 via TEP. Three patients undergoing TEP were converted to laparotomy. The operation time was significantly longer in the conversion group compared with either the laparotomy or the TEP groups. There was no difference between the laparotomy and TEP groups regarding intraoperative bleeding. Patients who underwent TEP without conversion had a significantly shorter hospital stay than those who underwent laparotomy or required conversion. TEP provides a suitable approach for incarcerated obturator hernia repair, with favorable results regarding hospital stay. TEP is a feasible, minimally invasive technique for the repair of incarcerated obturator hernias.

BackgroundIt is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work.MethodsPatients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed.ResultsA total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254–23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436–51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021–1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836–0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901–0.974) and had a good clinical benefit.ConclusionClinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.

About 30% of all female 'groin' hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias. This study included all female patients ≥ 18 years operated for a groin hernia between 2005 and 2009. A total of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively, femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia. Femoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes.

Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR -1.02; 95% CI -1.87, -0.17; P = 0.02; I2 = 94%) and operative time (OR -9.21; 95% CI -16.82, -1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.

Backgraund Early recognition of the risk of bowel resection of patients with incarcerated groin hernia(IGH) will facilitate the clinical decision making of surgeons and improve the outcomes of patients. This study aimed to reveal the risk factors of bowel resection in patients with incarcerated inguinal hernia. Materyal methods We retrospectively collected 312 patients who underwent emergency hernia repair surgery for IGH between January 2017 and October 2022. The patients were categorized into those who received bowel resection and those who did not require bowel resection Data analysis was approved by the local ethics committee. Patient characteristics, laboratory and radiological examinations, surgery data, and postoperative outcomes were compared between patients with and without bowel resection. Risk factors for bowel resection were assessed with univariate and multivariate analysis. Results Univariate analysis identified 7 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, Charlson comorbidity index (CCI) odds ratio [OR] = 0.751, 95% confidence interval [CI] 0.592 0.953, P = .018), Gender (OR = 4.071, 95% CI 1.749/9.475, P = 0.001) and C-reactive protein(CRP) (OR = 0.321, 95% CI 0.145–0.708, P = 0.005) were identified as independent risk factors for bowel resection among patients with IGH. Conclusion In this study, an elavated CRP, gender and high CCI in patients with bowel obstruction due to IGH are associated with an increased risk of bowel resection. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated CRP and high CCI concurrent with IGH.

Background: Inguinal hernia is one of the diseases that has haunted humanity from its very beginning to the modern times. Groin hernias are the most common conditions referred to surgeons all over the world and over five lakh hernia repairs are performed annually. The lifetime risk for men is 27.0% and for women is 3.0%. Approximately 75.0% of all abdominal wall hernias occur in the groin. Inguinal hernias are more common on the right than on the left and are seven times more likely in males than in females. Aims and Objectives: Aim and objective of the study is to compare extended total extra peritoneal (e-TEP) and total extra peritoneal (TEP) repair in terms of complications and recurrence. To evaluate ease of operability of e-TEP and TEP for inguinal hernia repair. Materials and Methods: Patients with inguinal hernia who were hospitalized to the Department of General Surgery at GSVM Medical College, Kanpur, and who were over the age of 18 years of both sexes were studied from December 2019 to October 2021 after signing a consent form. The research procedure followed was in accordance with the approved ethical standards of GSVM Medical College, Kanpur, UP, India Ethics Committee (Human). Data were analyzed and evaluated using Statistical Package for Social Sciences, version 23 (SPSS Inc., Chicago, IL). Results for continuous variables are shown as mean ± standard deviation, whereas results for categorical variables are shown as number (percentage). For comparison of nominal data, Chi-square (χ2) test was used. The level P&lt;0.05 was considered as the cut-off value of significance. Results: Majority of the patients of Group TEP (25 patients) had complications as Conversion to trans abdominal pre-peritoneal (TAPP) 4 (16.0%) and proceed surgery without veress needle decompression 2 (8.0%). In Group eTEP (25 patients) majority of patients had complications as proceed surgery without veress needle decompression 8 (32%) followed by Seroma 2 (8.0%). No recurrences seen in either groups. Mean operative time of eTEP was less as compared to TEP. Conclusion: With TEP, complications such as SSI, hematoma, and conversion to TAPP are more common; however with eTEP, proceed surgery without veress needle decompression and seroma. Considering the average operative time of eTEP and TEP, as well as the bigger defect size that eTEP can readily handle. For new surgeons, eTEP is a more straightforward procedure. Moreover, our study findings showed that e-TEP mesh repair of inguinal hernia showed more firm and efficacious results than TEP repair. We suggest that long-term randomized control trials with enhanced sample size and reduced confounding factors are still required to establish the absolute superiority of e-TEP over TEP.

Despite their rarity, obturator hernias pose significant clinical challenges due to their high complication rate and frequent emergency presentation. While minimally invasive surgery has proven effective and safe for elective groin hernia repair, its application in emergency settings, particularly for obturator hernias, lacks robust evidence, highlighting a critical knowledge gap in this area. This systematic review aims to evaluate the feasibility of a minimally invasive approach for the repair of obturator hernias in emergency settings. A systematic review was conducted searching PubMed, OVID, MEDLINE, Embase, and Cochrane reviews for ((obturator hernia) AND (laparoscop* OR minimal access OR robotic)) AND (strangulat* OR obstruct* OR incarcerat*). The time of the literature is from the establishment of each database to 1 September 2023. Critical appraisal used the Joanna Briggs Institute (JBI) appraisal checklist. A systematic review of 337 manuscripts identified 47 relevant studies, including 39 case reports, 4 case series, and 4 retrospective studies. Minimally invasive approaches, particularly totally extraperitoneal (TEP), transabdominal preperitoneal (TAPP), and the Kugel procedure, demonstrated favourable outcomes for obturator hernias, including shorter operative times, reduced hospital stays, low recurrence rates, effective management of complications, and improved diagnostics, with success dependent on timely intervention, bowel viability, and patient selection. The findings suggest that minimal access surgery can effectively avoid unnecessary laparotomy for hernial content assessment, particularly when employing the TAPP approach. While emergency repair of obturator hernias using minimal access techniques appears feasible and safe, achieving outcomes comparable to open surgery requires further high-quality evidence. PROSPERO: CRD42024503724.

Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair. PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups. Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient's clinical status, comorbidities, and degree of intraoperative contamination.