Asymptomatic Hernia Research Articles

Understanding patient experiences to improve care for females groin hernia.

Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed. Prior to conducting such trials, it is essential to obtain preliminary data from female participants to ensure that the studies are designed appropriately to address their priorities and improve sex disparities in outcomes. Semi-structured qualitative interviews were conducted between July 7 and December 31, 2023, with 34 females evaluated for groin hernia. Interviews were conducted via Zoom at an academic medical center. The discussions aimed to explore the challenges in diagnosing hernias, the considerations for selecting treatment options, and the priorities for future research. The transcripts were analyzed using descriptive content analysis, facilitated by MAXQDA software. Diagnostic challenges included delayed recognition due to underappreciation of female hernias. Participants desired greater familiarity with hernias and treatment options from providers. For surgical decisions, fear of complications drove some towards surgery, while others prioritized avoiding recovery time for asymptomatic hernias. Participants called for research on female-specific risk factors, pain experiences, recovery impacts, and non-operative approaches. The majority of participants agreed or considered participating and serving as an advisor in a future study. Females with hernia face sex-based disparities in diagnosis and treatment. Improving provider awareness and developing guidelines are needed. This qualitative study identifies key areas for future research to optimize person-centered hernia care for females based directly on personal perspectives and priorities, laying the groundwork for prospective trials aimed at improving outcomes.

Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.

There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability. A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively. Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory. This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.

565. LAPAROSCOPIC TREATMENT OF HIATAL HERNIAS COMBINED WITH MODIFIED TOUPET FUNDOPLICATION. SURGICAL TECHNIQUE

Abstract Introduction Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias. Aim This study aims to describe our surgical technique of laparoscopic repair in hiatal hernias, including sliding, paraesophageal and mixed types. Material and Methods A total of 65 consecutive patients underwent laparoscopic hiatal hernia repair by the same surgical team within 4 years. Results Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac en bloc, 3 cm of intra-abdominal esophageal length, crural closure and an effective anti-reflux procedure as our modified Toupet fundoplication. Conclusions Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have significant reflux disease, an operative repair is required. A minimally invasive approach is safe and can provide excellent outcomes in the hand of experts. https://we.tl/t-KgcOuSyEMt

Watchful waiting to surgery in men with mildly symptomatic or asymptomatic inguinal hernia: an individual participant data meta-analysis of long-term follow-up of randomized controlled trials.

Individual studies on men with mildly symptomatic or asymptomatic inguinal hernia who have opted for watchful waiting (WW) vary considerably. Furthermore, long-term data on such patients who cross over to herniorrhaphy is scarce. PubMed, EMBASE, and Cochrane databases were searched systematically from inception to 3rd April 2024 for long-term follow-up of randomized controlled trials (RCTs) on men with mildly symptomatic or asymptomatic inguinal hernia. Individual participant survival data of cross over rates from WW to herniorrhaphy were extracted, reconstructed and combined. Secondary outcome was reason for cross over to herniorrhaphy. Long-term follow-up of three RCTs with 592 participants was included. A total of 344/592 participants crossed over to herniorrhaphy during a median follow up period that ranged from 3.2 to 12.0 years. The median cumulative cross over rate was 54.2% (95% CI 45.5% - 66.3%). The cumulative 1-year, 5-year, and 10- year cross over rates were 28.7% (95% CI 25.2% - 32.5%), 51.5% (95% CI 47.4% - 55.6%), and 70.6% (95% CI 66.2% - 74.9%) respectively. During follow-up, the most frequent reasons for cross over to herniorrhaphy were increased pain 198/344 (57.6%) and incarceration 15/344 (4.4%). This study provides valuable long-term data for patient counselling, indicating that while WW is a safe strategy for men with mildly symptomatic or asymptomatic inguinal hernia, symptoms would likely progress eventually, necessitating operative repair.

Incidentally found obturator hernias during totally extraperitoneal (TEP) inguinal hernia repair: a single-center experience.

This study aimed to determine the occurrence of incidental obturator hernia and clinical risk factors of their appearance in patients undergoing totally extraperitoneal (TEP) inguinal hernioplasty. Data were collected retrospectively from patients who underwent TEP inguinal hernioplasty between June 2020 and December 2022. A total of 251 patients were included in the study. Obturator hernias were found in 21 patients (8.4%). At admission, no patient presented clinical signs of an obturator hernia. There was a significant predominance of women in the obturator hernia compared to the non-obturator hernia group (28.6% vs. 10.9%, respectively, p=0.018). There was no correlation between age (p=0.479) and BMI (p=0.771) and the occurrence of obturator hernia. Additional obturator hernia repair within the TEP inguinal hernioplasty procedure did not influence the overall length of the surgery (60.86 minutes) compared to the standard TEP inguinal hernioplasty (61.09 minutes, p=0.876). The TEP inguinal hernioplasty allows the detection and repair of incidental obturator hernia. Through thorough inspection of the obturator canal, an asymptomatic obturator hernia can be detected and adequately treated within the same procedure, without the impact on the surgery duration, when performed by an experienced hernia surgeon.

Updated Markov Model to Determine Optimal Management Strategy for Patients with Paraesophageal Hernia and Symptoms, Cameron Ulcer, or Comorbid Conditions.

The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year-old Markov analysis. Recently, we have shown that elective laparoscopic hernia repair (ELHR) provides an increase in life-years (L-Ys) compared with WW in most healthy patients aged 40 to 90 years. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients. A Markov model with updated variables was used to compare L-Ys gained with ELHR vs WW in hypothetical people with any type of PEH and symptoms, Cameron lesions, and/or comorbid conditions. In men and women aged 40 to 90 years with PEH-related symptoms and/or Cameron lesions, ELHR led to an increase in L-Ys over WW. The presence of comorbid conditions impacted life expectancy overall, but ELHR remained the preferred approach in all but 90-year-old patients with symptoms but no Cameron lesions. Using a Markov model with updated values for key variables associated with management options for patients with a PEH, we showed that life expectancy was improved with ELHR in most men and women aged 40 to 90 years, particularly in the presence of symptoms and/or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH.

No Reason to Use Mesh in Groin Hernia Repair in Adolescents.

Groin hernias are common and hernia repair is one of the most frequent surgical procedures performed worldwide. Despite this, there is no international guideline on the management of groin hernias in adolescents. Mesh reinforcement is used for repair in adults but not in young children. Adolescents, positioned between these age groups, pose unique challenges for surgeons due to their varying growth patterns. Placing a synthetic mesh in growing patients is a concern, particularly in relation to chronic pain. Traditionally, the hernia literature has defined adults as individuals aged 18years and above. Considering that growth can continue until age 19, this review proposes a revised definition of adolescence for patients with groin hernias encompassing ages 10 to 19. Symptomatic groin hernias in adolescents should be repaired with an open non-mesh technique because of acceptable recurrence rates and the desire to avoid introducing synthetic foreign materials into young patients with ongoing growth potential. Watchful waiting is suggested for asymptomatic groin hernias, postponing repair until the adolescent has become a fully grown adult and symptoms from the hernia develop. Most groin hernias in adolescents are lateral hernias, but before pursuing a watchful waiting strategy in females, an ultrasound or magnetic resonance imaging scan is suggested to rule out the presence of a femoral hernia that may need repair.

Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy

Postoperative hiatal hernia is a rare and specific complication after esophagectomy. This complication leads to emergency and affects mortality. Incidence of this complication has increased due to the great number of minimally invasive procedures over the past decades. In addition, chronic cough, preoperative hiatal hernia and transhiatal approach also increase the risk of recurrent hernias. Most post-esophagectomy hiatal hernias do not require emergency surgery. About 70% of patients have symptoms reducing the quality of life. About 25% of cases are asymptomatic and discovered incidentally during follow-up examinations. The role of surgery for asymptomatic post-esophagectomy hernias is a matter of debate because the risk of symptoms or complications is poorly predictable. Surgical treatment is the only radical method for symptomatic or complicated hernias. However, there is still no consensus regarding surgical approach and technique. Most surgeons prefer open surgery fearing severe adhesive process and other technical difficulties. Laparoscopic approach is widely accepted as the "gold standard" for primary hiatal hernia. However, minimally invasive access for post-esophagectomy hiatal hernias is not sufficiently studied and described in several case reports. Currently, it is very important to study the risk factors of hiatal hernias after esophagectomy. We present successful laparoscopic repair of hiatal hernia after hybrid McKeown esophagectomy.

Elective Laparoscopic Paraesophageal Hernia Repair Leads to an Increase in Life Expectancy Over Watchful Waiting in Asymptomatic Patients: An Updated Markov Analysis.

The aim of this study was to perform an updated Markov analysis to determine the optimal management strategy for patients with an asymptomatic paraesophageal hernia (PEH): elective laparoscopic hernia repair (ELHR) versus watchful waiting (WW). Currently, it is recommended that patients with an asymptomatic PEH not undergo repair based on a 20-year-old Markov analysis. The current recommendation might lead to preventable hospitalizations for acute PEH-related complications and compromised survival. A Markov model with updated variables was used to compare life-years (L-Ys) gained with ELHR versus WW in patients with a PEH. One-way sensitivity analyses evaluated the robustness of the analysis to alternative data inputs, while probabilistic sensitivity analysis quantified the level of confidence in the results in relation to the uncertainty across all model inputs. At age 40 to 90, ELHR led to greater life expectancy than WW, particularly in women. The gain in L-Ys (2.6) was greatest in a 40-year-old woman and diminished with increasing age. Sensitivity analysis showed that alternative values resulted in modest changes in the difference in L-Ys, but ELHR remained the preferred strategy. Probabilistic analysis showed that ELHR was the preferred strategy in 100% of 10,000 simulations for age 65, 98% for age 80, 90% for age 85, and 59% of simulations in 90-year-old women. This updated analysis showed that ELHR leads to an increase in L-Ys over WW in healthy patients aged 40 to 90 years with an asymptomatic PEH. In this new paradigm, all patients with a PEH, regardless of symptoms, should be referred for the consideration of elective repair to maximize their life expectancy.

Twelve-year outcomes of watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomised controlled trial

Inguinal hernia belongs to the most common surgical pathology worldwide. Approximately, one third is asymptomatic. The value of watchful waiting (WW) in patients with asymptomatic or mildly symptomatic inguinal hernia has been established in a few randomised controlled trials (RCTs). The aim of this study was to assess long-term outcomes of a RCT comparing WW and elective surgery. In the original study, men aged ≥50 years with an asymptomatic or mildly symptomatic inguinal hernia were randomly assigned to WW or elective repair. In the present study, the primary outcome was the 12-year crossover rate to surgery, secondary outcomes were time-to-crossover, patient regret, pain, quality of life and incarceration. Dutch Trial Registry: NTR629. Out of 496 originally analysed patients, 488 (98.4%) were evaluable for chart review (WW: n=258, surgery: n=230), and 200 (41.0%) for telephone contact (WW: n=106, surgery: n=94) between November 2021 and March 2022 with a median 12 years follow-up (IQR 9-14). After 12 years, the estimated cumulative crossover rate to surgery was 64.2%, which was higher in mildly symptomatic than in asymptomatic patients (71.7% versus 60.4%, HR 1.451, 95% CI: 1.064-1.979). Time-to-crossover was longer in asymptomatic patients (50% after 6.0 years versus 2.0 years, p=0.019). Patient regret was higher in the WW group (37.7 versus 18.0%, p=0.002), as well as pain/discomfort (p=0.031). Quality of life did not differ (p=0.737). In the WW group, incarceration occurred in 10/255 patients (3.9%). During 12-year follow-up, most WW patients crossed over to surgery, significantly earlier with mildly symptomatic hernia. Considering the relatively low incarceration rate, WW might still be an option in asymptomatic patients with a clear preference and being well-informed about pros and cons. The initial trial was funded by the Netherlands Organisation for Health Research and Development (ZonMW). This long-term study did not receive funding.

Paraconduit hernia following esophagectomy: Is it safe to watch and wait?

ObjectivesWe hypothesized that emergency complications related to asymptomatic paraconduit hernias may occur less often than generally believed. Therefore, we assessed the occurrence and timing of paraconduit hernia diagnosis after esophagectomy, as well as outcomes of these asymptomatic patients managed with a watch-and-wait approach. MethodsFrom 2006 to 2021, 1214 patients underwent esophagectomy with reconstruction at the Cleveland Clinic. Among these patients, computed tomography scans were reviewed to identify paraconduit hernias. Medical records were reviewed for timing of hernia diagnosis, hernia characteristics, and patient symptoms, complications, and management. During this period, patients with asymptomatic paraconduit hernias were typically managed nonoperatively. ResultsParaconduit hernias were identified in 37 patients. Of these, 31 (84%) had a pre-esophagectomy hiatal hernia. Twenty-one hernias (57%) contained colon, 7 hernias (19%) contained pancreas, and 9 hernias (24%) contained multiple organs. Estimated prevalence of paraconduit hernia was 3.3% at 3 years and 7.7% at 10 years. Seven patients (19%) had symptoms, 4 of whom were repaired electively, with 2 currently awaiting repairs. No patient with a paraconduit hernia experienced an acute complication that required emergency intervention. ConclusionsThe risk of paraconduit hernia increases with time, suggesting that long-term symptom surveillance is reasonable. Emergency complications as a result of asymptomatic paraconduit hernias are rare. A small number of patients will experience hernia-related symptoms, sometimes years after hernia diagnosis. Our findings suggest that observation of asymptomatic paraconduit hernias (watch and wait) may be considered, with repair considered electively in patients with persistent symptoms.

Current Surgical Management of the Inguinal Hernias

Definition: Inguinal hernias are characterized by the protrusion of tissues through a weakness in the abdominal wall in the inguinal region. They are divided into direct and indirect hernias, with anatomical differences influencing the choice of surgical technique. Types of Hernias and Surgical Management: The surgical approach is based on individual and symptomatic considerations. Asymptomatic hernias may be observed, while symptomatic ones usually require intervention. Mesh repair is a common technique, with both open and laparoscopic repair options. The choice is based on the patient's anatomy and the surgeon's experience. Complications: Despite progress, recurrences remain a concern. Careful selection of technique and attention to mesh placement can reduce this rate. Postoperative complications, such as infections and chronic pain, are also concerns to consider. Discussion: The discussion focuses on the choice between open and laparoscopic repair techniques. Adaptation to the patient's individual conditions, such as age and comorbidities, is essential. Research and innovation continue to play a crucial role in improving outcomes and preventing complications. Conclusions: The surgical management of inguinal hernias is a balance between tradition and innovation. Collaboration between surgeons and constant research are critical to advancing the field. The individualized approach and continuous improvement of techniques and materials will continue to provide patients with a better quality of life and more positive outcomes in the future.

Impact of consensus guideline publication on the timing of elective pediatric umbilical hernia repair

BackgroundThe American Academy of Pediatrics published consensus guidelines advising observation of asymptomatic umbilical hernias until age 4 or 5, given unnecessary risks of early intervention and substantial practice variation. Yet, the impact of guidelines on early repair (age <4) or if certain groups remain at risk for avoidable intervention is unclear. MethodsThis retrospective study used data from children’s hospitals participating in the Pediatric Health Information System database. Children aged 17 years and younger who underwent umbilical hernia repair from July 2017 to August 2022 were eligible for inclusion. Children with recurrent hernias, an emergency, or urgent presentation were excluded. An interrupted time series using segmented multivariable logistic regression estimated the association of guideline publication in November 2019 with the odds of guideline-adherent repair (age ≥4) after adjusting for sociodemographic characteristics and hospital-level random effects. Results16,544 children underwent repair, of which 3,115 (18.8%) were children <4 years old. After adjustment, guideline publication was associated with an immediate increase in guideline-adherent repairs (odds ratio = 1.25 95% confidence interval = 1.05–1.49). The interrupted time series found that each month after publication was associated with a 2% increase in the odds of guideline-adherent repair (odds ratio = 1.02, 95% confidence interval = 1.01–1.03). Children with public insurance were nearly 20% less likely to receive guideline-adherent repair than privately insured children (odds ratio = 0.82, 95% confidence interval = 0.74–0.91). Children in the Midwest had lower odds of guideline-adherent repair (Midwest versus Northeast: odds ratio = 0.45. 95% confidence interval = 0.24–0.84). ConclusionGuideline publication was associated with greater odds of guideline-adherent repair, yet public insurance coverage and Midwest location remain significant predictors of early repair against recommendations.

V-016 TAPP APPROACH FOR A GIANT INGUINOSCROTAL HERNIA

Abstract Aim We present the case of a patient with giant inguinoscrotal hernia and the laparoscopic approach performed. Material &amp; Methods 54yo Male, no medical history except for BMI41. He is evaluated in outpatient clinic for asymptomatic left inguinoscrotal hernia of ten years of evolution. He denies digestive symptoms. Difficulty in urination without symptoms of obstruction. On examination, 20×15cm left not reducible inguinoscrotal hernia extending to the mid-thigh. Minimally invasive approach, TransAbdominal PrePeritoneal, was performed. The content of the hernia is a long portion of sigma and a large amount of fat from the greater omentum. After returning them to the abdominal cavity with the help of pressure from the outside, the TAPP technique was performed without incident, with localization of elements of the spermatic cord. Polypropylene mesh 12×15cm fixed with tackers and cyanoacrylate is placed. Results the patient was discharged on the 4thPO day with no incidents. Subsequently he developed a large seroma that required percutaneous drainage and heart failure that caused large scrotal edema, resolved with diuretic treatment. Ten months later there is no recurrence. Conclusions Giant inguinoscrotal hernia is a surgical challenge. Anterior or posterior approach, open or minimally invasive, can be performed. Sometimes intestinal resection and/or orchiectomy is required. The need for preoperative conditioning with botulinum toxin and even pneumoperitoneum can be considered. We presume that, when possible, the minimally invasive posterior approach is the best technique for these large defects since it provides the best surgical field in the most resistant plane for inguinal hernia repair.

Diagnostic Accuracy of Imaging Modalities on Occult Groin Hernias According to Hernia type and a Surgeon-centered Individualized Groin Hernia Management Algorithm

The purpose of this study is to evaluate the diagnostic performance of imaging techniques for the identification of groin hernias based on the type of hernia and to demonstrate the efficacy of an algorithm based on the surgeon and surgical technique. Medical records of 561 patients who were operated on for groin hernia were retrospectively analyzed. A total of 102 patients who had both pelvic computed tomography (CT) and ultrasonography (USG) recordings preoperatively and underwent transabdominal preperitoneal repair were included in the study. A contralateral asymptomatic occult groin hernia was detected in 25.5% of all patients. The overall sensitivity of USG and CT on contralateral asymptomatic occult hernia was 42.3% and 65.4%, respectively. The sensitivity of USG according to the contralateral occult hernia type was 66.7%, 35.7%, 33.3%, and 50% for direct, indirect, femoral, and pantaloon hernias, respectively. The sensitivity of CT according to the contralateral occult hernia type was 0%, 57.1%, 100%, and 100% for direct, indirect, femoral, and pantaloon hernias, respectively. The handicap created by the variability in the diagnostic sensitivity of imaging modalities can be overcome with the choice of transabdominal preperitoneal repair in the surgical technique.

Paraesophageal hernia: the state of the problem and controversial issues. Review

The literature review focuses on the controversial issues regarding the treatment of paraesophageal hernia. The limitations of the current classification of hiatal hernias are highlighted. It is irrelevant and does not meet clinical needs. Objective criteria for its improvement are proposed. Data on the prevalence and course of hiatal hernias are given. Their pathogenetic factors and diagnostic methods are underlined. Considerable emphasis is placed on the paraesophageal hernia treatment strategies in patients with an asymptomatic and mildly symptomatic clinical course of the disease. Arguments are presented in favour of both wait‑and‑see tactics and planned hernioplasty. The choice of hernioplasty technique, especially in the case of giant hernias, the feasibility and indications for the use of mesh implants depending on their shape and composition, and the potential complications of allogenioplasty are the main topics for discussion. The problem of selecting a fundoplication method is addressed while weighing the advantages and potential side effects of employing various fundoplication modifications. The effects of correcting a short esophagus and eliminating the axial pressure on the esophageal hiatus are thoroughly evaluated, as these conditions increase the risk of hernia recurrence.&#x0D; The authors concluded that there are many controversial issues in the treatment of paraesophageal hernia. A consensus is needed on the classification of paraesophageal hernias, which would meet the urgent needs of choosing the method of operative delivery, and, in particular, the definition of the concepts of «large hernia» and «giant hernia.» Further research is required on issues such as the indications for operative treatment of paraesophageal hernias, especially in the case of asymptomatic large hernias and incarcerated hernias; the feasibility of using implants for plastic surgery of the esophageal hiatus; the choice of a fundoplication method; the diagnosis and correction of a short esophagus; and methodology for evaluating long‑term treatment outcomes.&#x0D;

Asymptomatic contralateral inguinal and ventral hernias among people with a workers' compensation claim for hernia.

There is a gap in evidence that demonstrates an increased risk of hernia formation in laborers. A notable incidence of a second asymptomatic hernia among people making a workers' compensation claim for a hernia would suggest that the pathology is not acute and probably not related to work, or the performance of a single strenuous event. We performed a retrospective database study of a consecutive sample of 106 adults who claimed a work-related abdominal hernia between September 2016 and December 2018 and had a Computed Tomography (CT) scan as part of a diagnostic workup. Hernias were classified as incidental if patients had a contralateral inguinal hernia with unilateral groin symptoms, or if patients had a ventral hernia with only groin symptoms or vice versa. Thirty-three percent of patients had an incidental hernia. No patient factors were associated with having an incidental hernia. Higher BMI and having a concurrent incidental hernia were associated with lower odds of surgical treatment under the injury claim. Abdominal symptoms after a work event might lead to a diagnosis of hernia, and there is a notable likelihood that the hernia is incidental and unrelated to work. New symptoms at or near the site of an abdominal hernia may or may not be from the hernia, and very often are more consistent with an abdominal muscle strain. The clinical or imaging finding of an abdominal wall defect or the presence of a hernia may be incidental, unrelated to the physical activity.

P-048 DOES BILATERAL REPAIR INCREASE COMPLICATION RATES COMPARED TO UNILATERAL REPAIR IN PATIENTS UNDERGOING LAPAROSCOPIC TOTALLY EXTRAPERITONEAL INGUINAL HERNIA SURGERY?

Abstract Introduction There is ongoing debate over whether to fix asymptomatic contralateral inguinal hernias during repair of the presenting hernia. This study reviewed the practice of one high-volume hernia surgeon, comparing unilateral and bilateral laparoscopic repairs, to establish if bilateral repair is associated with an increased risk of post-operative complications compared to unilateral repair. Material &amp; Methods All patients operated on within a 5-year period were audited and subcategorised depending on whether they underwent unilateral or bilateral repair. Data was collected on complication rates, rates of recurrence, readmission within 30 days and duration of operation. Results 186 patients underwent repair of 265 hernias. 79 patients underwent bilateral repair. 25 patients suffered a complication (13.4%). Complication rates were 11.2% and 16.5% in the unilateral group and bilateral group respectively (p=0.50). These included superficial infection (1.9% vs 1.3%, p=0.75), haematoma (5.6% vs 7.6%, p=0.59), seroma (2.8 vs 7.6%, p=0.13), and chronic pain (0% vs 2.5%, p=0.01). There were no mesh infections, persisting numbness or explantation in either arm. In both groups, median nights stayed was 0. At median length of follow-up of 1.8 years, recurrence rates were 1.9% vs 0% in the unilateral and bilateral arms respectively (p=0.22). Conclusions There was no significant difference in rates of complications between the bilateral and unilateral arms. Opportunistic repair may reduce risk of future surgeries and morbidity and does not appear to be associated with increased complications. Surgeons may wish to consider this when consenting patients.

How Often Occult Inguinal or Spigelian Hernias Detected During Laparoscopy of Other Reasons Are Later Operated?

The incidence of occult inguinal or Spigelian hernias found in other laparoscopies is seldom studied and their development to symptomatic hernias is unknown. The orifices of all inguinal and Spigelian hernias at linea semilunaris were carefully recorded prospectively in the laparoscopic surgery during the years 2003-2004 (104 cholecystectomies, 55 fundoplications, 36 diagnostic, and 6 miscellaneous). The patients were followed up over 15 years to find out how often the detected occult hernias at index laparoscopy become later symptomatic and were repaired. The index laparoscopic operation was performed to 201 patients with a mean age of 53±14 years. The overall frequency of unexpected hernias was 21% including 36 (18%) inguinal hernias, 5 (2.5%) Spigelian hernias, and 2 (1.0%) ventral hernias. At the index laparoscopy, only 5/201 inguinal and 2 Spigelian hernioplasties were concomitantly undertaken. After 15 years, data of 169 patients were available and new hernia repairs were performed only in 8 (4.7%) patients (2 inguinal, 4 umbilical, and 2 ventral hernias). Asymptomatic occult hernias detected during laparoscopic surgery of other reason evolve very seldom (<5%) to symptomatic and need to be repaired.

Frequency of Potentially Avoidable Surgical Referrals for Asymptomatic Umbilical Hernias in Children.

The American Association of Pediatrics released guidelines in 2019 recommending delay of surgical referral in children with asymptomatic umbilical hernias until 4-5y of age. The purpose of this study was to assess contemporary rates of potentially avoidable referrals in this cohort of children, and to assess whether rates have decreased following guideline release. Retrospective analysis of umbilical hernias referrals evaluated at a single pediatric surgery clinic from October 2014 to August 2021. Potentially avoidable referrals (PAR) were defined as asymptomatic, non-enlarging umbilical hernia referrals in a child 3y of age or younger without a history of incarceration. Referral indication, disposition following clinic visit, and rates of PAR were compared before and after guideline release. A total of 803 umbilical hernia referrals were evaluated, of which 48% were in children 3y of age or younger at time of evaluation ("early" referrals). 33% of all referrals and 68% of early referrals were categorized as a PAR, and rates were similar before and after guideline release (all referrals: 32% versus 33%, P=0.94; early referrals: 68% versus 67%, P=0.94). Of the 333 early referrals who were managed expectantly per guideline recommendations, 2 (0.6%) developed incarceration which was managed with successful reduction and interval repair. One-third of all referrals for umbilical hernia evaluation are potentially avoidable, and this rate did not change following release of American Academy of Pediatrics guidelines. Aligning expectations between surgeons and referring providers through improved education and guideline dissemination may reduce avoidable visits, lost caregiver productivity, and exposure to potentially avoidable surgery.