Bilateral Groin Hernia Research Articles

Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience.

Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repairperformed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.

Low incidence of recurrence and chronic pain after groin hernia repair in adolescents: a systematic review and meta-analysis

PurposeThe best operative management of groin hernia in adolescents is uncertain. The aim of this systematic review was to assess recurrence and chronic pain after mesh versus non-mesh repair for groin hernia in adolescents.MethodsA systematic search was done in PubMed, EMBASE, and Cochrane CENTRAL in May 2022 for studies reporting postoperative chronic pain (≥6 months) or recurrence after groin hernia repair in adolescents aged 10–17 years. We included randomized controlled trials and observational studies on primary unilateral or bilateral groin hernia repair. Risk of bias was assessed with the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Meta-analysis of the incidence of recurrence was conducted. This review is reported according to PRISMA guideline.ResultsA total of 21 studies including 3,816 adolescents with groin hernias were included comprising two randomized controlled trials, six prospective, and 13 retrospective cohort studies. For non-mesh repairs, the weighted mean incidence proportion of recurrence was 1.6% (95% CI 0.6–2.5) after 2,167 open repairs and 1.9% (95% CI 1.1–2.8) after 1,033 laparoscopic repairs. For mesh repairs, it was 0.6% (95% CI 0.0–1.4) after 406 open repairs while there were no recurrences after 347 laparoscopic repairs (95% CI 0.0–0.6). Across all surgical techniques, the rate of chronic pain after 1,153 repairs ranged from 0 to 11%. Follow-up time varied and was reported in various ways.ConclusionThe incidences of recurrence after groin hernia repair in adolescents were low for both open and laparoscopic mesh and non-mesh repairs. Rates of postoperative chronic pain were low.Trial registrationPROSPERO: CRD42022130554.

V-007 Robotic repair of a bilateral recurrent groin hernia in a kidney transplant patient

Abstract Aim Due to the increased frequency of kidney transplantations and the high incidence of inguinal hernia in men, the coincidence of both features is not uncommon. Material & Methods A 58-year-old male patient with a history of a kidney transplantation in the right fossa due to bilateral shrivel kidneys, presented with a bilateral recurrent incisional hernia. Two years before he had an anterior bilateral groin hernia repair; a Liechtenstein repair on the left side and a partial preperitoneal repair with mesh reinforcement on the right side. Results The case was approached via a robot assisted TAPP (transabdominal preperitoneal) procedure to perform the preperitoneal dissection of the myopectineal orifices. At the region of the right inguinal hernia, the normal anatomy was distorted, due to the extraperitoneal course of the donor ureter which was freed accordingly. A partial mesh excision of the previous mesh was performed. The preperitoneal dissection area was covered with a self-gripping mesh. The postoperative course was uneventful. Conclusions The extraperitoneal course of the ureter in a kidney transplant patient challenges the surgical repair of an inguinal hernia. In primary groin hernias an anterior approach seems best suited, but in case of a recurrence after a previous anterior approach, a laparoscopic approach is a possible though challenging surgical option.

Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital.

Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited. A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates. Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min±17.2 vs. 71.9 min±19.9, P<0.001) and lower total costs (€ 974.51±266.67 vs. € 1165.32±285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8±13.4 min vs. 34.5±16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9±16.6 min vs. 41.7±18.7 min, P<0.001) and higher total costs in the unilateral open procedure (€ 1007.47±238.58 vs. € 909.35±305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons. Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.

Perioperative outcome in groin hernia repair: what are the most important influencing factors?

Using registry analyses, a large number of influencing factors on the perioperative outcome of groin hernia repair has been identified. The interactions between several influencing factors and differences in the influencing value have to date been inadequately investigated. This retrospective analysis of prospectively collected data from the Herniamed Registry included all fully documented cases with minimum age of 16years and groin hernia repair. Patients were assigned to the risk groups unilateral, bilateral, recurrent and emergency groin hernia repair. Multivariable analysis was performed to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the outcome parameters intraoperative, postoperative general and postoperative surgical complications, complication-related reoperation and total perioperative complications. A highly significantly unfavorable association with the total perioperative complication rate was identified for emergency groin hernia repair, scrotal hernia, anticoagulant medication and coagulopathy. A significantly unfavorable relation with the total perioperative complication rate was found for recurrence procedure, bilateral repair, high age, ASA score III/IV, femoral hernia, antithrombotic medication, smoking, COPD and corticosteroid medication. A significantly favorable correlation with the total perioperative complication rate was observed for the laparo-endoscopic techniques, smaller defects, female gender, normal weight and medial hernia. Both the number of potential influencing factors and their influencing value on the perioperative outcome should be considered when estimating the individual risk of a patient with groin hernia repair.

Comparison of open and laparoscopic inguinal hernia repair

Inguinal hernia repair is one of the most commonly performed general surgery operations. Throughout the years there have been many variations and advancements, including open and laparoscopic techniques, to accomplish the same task of reducing herniated contents and preventing groin hernia recurrence. An array of factors contributes to deciding which operative technique is the best approach to managing a patient presenting with an inguinal hernia. Published data vary due to the heterogeneity of techniques compared, patient presentations, and surgeon expertise. In experienced hands, laparoscopic repair results in a quicker return to work and reduced postoperative pain. Patients with bilateral groin hernias, female patients with groin hernias, and patients with recurrent hernias after prior anterior mesh repair should be offered a laparoscopic preperitoneal mesh approach, when surgeons have the appropriate skill set and experience. We find that open and laparoscopic techniques of inguinal hernias can both achieve exceptional outcomes when applied to the right patient population. To know one’s own capabilities, it is beneficial for surgeons to have baseline familiarity of the multitude of methods of repair, become proficient in both mesh and mesh-free techniques as well as open and laparoscopic techniques to best tailor the surgery to the patient and the clinical circumstances, and follow personal outcomes to evaluate individual results.

Bilateral femoral hernias in a male child as the initial presentation of Ehlers-Danlos syndrome

Abstract In this article, we present an unusual case of a young boy who presented with bilateral groin hernias. Surgical exploration ruled out inguinal or direct hernia and subsequent workup including a repeat ultrasound revealed bilateral femoral hernias. Given the patients previous history of joint hypermobility and the rarity of bilateral femoral hernias, the patient was subsequently evaluated for a connective tissue disorder and was ultimately diagnosed with Ehlers-Danlos syndrome (EDS). There are no other such reported cases in the literature. This case highlights the potential association between connective tissue disorders and bilateral femoral hernias in young children.

Robotic-assisted single site (RASS) TAPP: an advantageous choice? : Outcomes of single site robotic groin hernia repair.

Laparoscopic transabdominal preperitoneal (TAPP) is a valid option for bilateral primary groin hernia and recurrent cases. Robotic approach for inguinal hernia is still debated. The aim of this study is to investigate the potential role of robotic-assisted single site-TAPP (RASS-TAPP) reporting our experience. We performed 44 RASS TAPP in 32 patients from February 2016 to July 2018. Data on patient demographics, type of hernia, operative time, complications, recurrence rate and hospital stay were retrospectively analyzed. Follow-up was scheduled at 1week, 4months and 1year after surgery. Forty-two hernias were treated in 32 patients (27M). Mean age was 48.6years (range 20-67), mean BMI was 26.49kg/m2 (range 16-34.9). Mean operative time was 54.8min (range 28-150). In two cases (6%) a conversion to laparoscopy was necessary. At 1week, two scrotal hematomas and four seromas were observed and treated conservatively. At 4months follow-up, one patient (3.1%) complained temporary pain. No patient had inguinal recurrence or incisional umbilical hernia and chronic pain at 1-year follow-up. RASS TAPP is feasible and safe with a high patient satisfaction. However, the surgeon experiences a technical discomfort due to the conflict of the instrumentation which influences negatively the choice of this approach, despite the better vision and augmented dexterity provided by the robot.

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach.

IntroductionTension-free repair of groin hernias with synthetic material by video-endoscopic surgery is a widely accepted method that is performed by various approaches. We aim to present our results of video-endoscopic tension-free repair of groin hernias via the total extraperitoneal (TEP) approach.MethodsBetween September 2016 and December 2018, 124 patients with groin hernias underwent tension-free repair using prolene mesh by video-endoscopic surgery via the TEP approach. This is a retrospective analysis of 110 (88.7%) male and 14 (11.3%) female patients with a mean age of 48.1 years. Groin hernia types, locations of hernias, intraoperative and postoperative complications, results of the mean 24-month follow-up, and recurrence rate were reported.ResultsA total of 134 hernias were repaired in 124 patients who had 53 (42.7%) right, 61 (49.2%) left, and 10 (8.1%) bilateral groin hernias. The most common hernia type was an indirect inguinal hernia in 83/134 (62%) groin hernias. A total of 119 (88.8%) and 15 (11.2%) hernias were primary and recurrent, respectively. Seroma was detected in two (1.6%) patients in the early postoperative period. The mean duration of hospital stay was 1.4 (1-3) days. During the follow-up period, hernia recurrence was determined in three (2.4%) patients. Hernia recurrence was detected among patients who were operated on during the first half of the study.ConclusionTension-free repair of groin hernias by video-endoscopic technique via the TEP approach can be performed with very low complication and recurrence rates. The success of the TEP approach increases parallel to increasing surgical experience. The results of hernia repair via the TEP approach are highly satisfactory and encouraging, especially when attention is paid to proper patient selection during the learning curve period.

Laparoscopic bilateral groin hernia repair with one large self-fixating mesh: prospective observational study with patient-reported outcome of urological symptoms and EuraHS-QoL scores.

Laparoscopic bilateral inguinal hernia repair may be completed with one large self-fixating mesh crossing the midline. No studies have investigated in detail whether preperitoneal mesh placement induces temporary or more lasting urinary symptoms. Urinary and hernia-related symptoms were evaluated preoperatively and postoperatively at 1, 3 and 12months using the ICIQ-MLUTS questionnaire and EuraHS-QoL score in patients undergoing bilateral inguinal hernia repair. One hundred patients were included. Voiding symptoms and bother scores were unchanged at 1 or 3months, but there was significant improvement at 12months compared with preoperative findings (symptoms P < 0.001; bother score P < 0.01). Incontinence symptoms improved at 1month (P < 0.05) but not at 3 or 12months, with a bother score significantly improved at 1month (P < 0.01) and 12months (P < 0.01). Diurnal and nocturnal frequency did not change significantly postoperatively, but 12months nocturnal bother score was decreased (P < 0.05). EuraHS-QoL scores showed statistical significant improvement in all three domains for all measurements at the different follow-up moments compared to previous measurements. Postoperative symptoms were improved at 12months, compared with preoperative pain scores (- 6.1), restriction of activity (- 10.1) and cosmetic scores (- 4.7) These findings were statistically significant (P < 0.001). At 12months, there were no patients with severe discomfort (score ≥ 5) for any of the three domains. No recurrences were diagnosed with 95% clinical follow-up at 12months. Laparoscopic bilateral groin hernia repair with one large preperitoneal self-fixating mesh did not cause new urinary symptoms and demonstrated significant improvement in voiding symptoms at 12months. Incontinence and nocturnal bother score were significantly improved. Clinical.Trials.gov: NCT02525666.

Trans abdominal patch plasty for bilateral groin hernia : is it a cost-effectiveness procedure?

I really appreciated the Editor’s kind invitation to write a comment about the papers of Ielpo and colleagues. Laparoscopic surgery is nowadays widespread all over the world and we have witnessed a frenetic race for the introduction of new instruments and devices that are able to help surgeons to perform laparoscopic operations. Consequently, this race has increased the costs of a single operation in a geometrical progression pushed by industries.

Laparoscopic versus open repair of groin hernias in children: a systematic review and meta-analysis.

Regarding groin hernia repair in children, guidelines do not favor open or laparoscopic repair. Even so, most surgeons prefer an open technique. The aim of this systematic review was to compare short- and long-term outcomes after laparoscopic and open groin hernia repair in children. Systematic searches were conducted in three databases, and all randomized controlled trials comparing laparoscopic and open groin hernia repair in children under 18years were included. Outcomes were postoperative complications, intraoperative complications, operative time, length of hospital stay, time to recovery, and wound appearance. The outcomes were compared between open and laparoscopic repairs in meta-analyses. We included ten studies with 1270 patients involving 1392 hernias. We found no differences in recurrence rate, testicular atrophy, hydrocele, hematoma, seroma, infection, pain, length of hospital stay, or time to full recovery. Laparoscopic repair was superior regarding wound appearance. Laparoscopic repair had shorter operative time than open repair for bilateral groin hernias. For unilateral groin hernias, extraperitoneal laparoscopic repair was faster than open repair, but open repair was faster than intraperitoneal laparoscopic repair. Our results indicate similar outcome after laparoscopic and open techniques for groin hernia repair in children. The surgeon's preference as well as the wishes of the patient and parents should therefore determine the surgical approach.

Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve.

Robotic groin hernia repair (r-TAPP) is demonstrating rapid adoption in the US. Barriers in Europe include: low availability of robotic systems to general surgeons, cost of robotic instruments, and the perception of longer operative time. Patients undergoing r-TAPP in our start-up period were prospectively entered in the EuraHS database and compared to laparoscopic TAPP (l-TAPP) performed by the same surgeon within the context of two other prospective studies. Operations were performed with the daVinci Xi robot and the primary endpoint was skin-to-skin operative time. Following proctoring in September 2016 by US surgeons, 50 r-TAPP (34 unilateral and 16 bilateral) procedures have been performed up to January 2017. Mean operative time for unilateral r-TAPP was 54min, with a decrease from 63min for the first tertile to 44min for the third tertile. For unilateral l-TAPP, the mean operative time was 45min. Mean operative time for bilateral r-TAPP was 78min, with a decrease from 90min for the first half to 68min for the second half. For bilateral l-TAPP, the mean operative time was 61min. There were no intraoperative complications and no conversions to conventional laparoscopy or open surgery. The operation was performed as an outpatient in 67% of cases. Urinary retention requiring urinary catheterization was the only early postoperative complication noted in 5 patients (10.2%). At 4week follow-up, 7 patients (14.3%) had an asymptomatic seroma, but no other complications were seen. Robotic TAPP was associated with a rapid reduction in operative time during our learning curve and afterwards the operative time to perform a robotic TAPP equals the operative time to perform a laparoscopic TAPP, both for unilateral and for bilateral groin hernia repairs. No complications related to the introduction of robotic-assisted laparoscopic groin hernia repair were observed.

Randomized Clinical Trial Comparing Low Density versus High Density Meshes in Patients with Bilateral Inguinal Hernia

We present a randomized clinical trial to compare postoperative pain, complications, feeling of a foreign body, and recurrence between heavyweight and lightweight meshes in patients with bilateral groin hernia. Sixty-seven patients with bilateral hernia were included in our study. In each patient, the side of the lightweight mesh was decided by random numbers table. Pain score was measured by visual analogue scale, on 1st, 3rd, 5th, and 7th postoperative day, and one year after the surgery. There were no statistically significative differences between both meshes in postoperative complications. About differences of pain average, there were statistically significant differences only on the 1st postoperative day (P <0.01) and the 7th postoperative day (P <0.05). In the review after a year, there were no statistically significative differences in any parameter. In our study, we did not find statistically significative differences between lightweight and heavyweight meshes in postoperative pain, complications, feeling of a foreign body, and recurrence, except pain on 1st and 7th postoperative day.

Totally extraperitoneal (TEP) bilateral hernioplasty using the Single Site® robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results.

Laparoendoscopic single site totally extraperitoneal (TEP) hernia repair showed to be a feasible alternative to conventional laparoscopic hernia repair; nevertheless single site surgery, with the loss of instruments triangulation can be a demanding procedure. To overcome those hurdles, the Single Site® (SS) platform of the da Vinci (DV) Si robotic system enables to perform surgical procedures through a 25-mm skin incision, with a stable 3D vision and restoring an adequate triangulation of the surgical instruments. We present in details the technique and the preliminary results of DV-SS TEP, to our knowledge the first cases reported in literature. In March 2016, three consecutive male patients (mean age 46.6years-mean BMI 25.3) with bilateral symptomatic inguinal hernia were submitted to DV-SS TEP in our institutions. Feasibility, codification of the technique, operative time and perioperative outcomes were recorded. All the procedures were completed as scheduled, with no conversion to other techniques. Mean operative time was 98.6min, ranging between 155 and 55min, reflecting the learning curve of the operating room team on this new procedure. No intraoperative or postoperative complications were experienced and all the patients were discharged within 24h after surgery. Patients reported satisfactory postoperative course, with no recurrence of inguinal hernia and satisfaction in cosmetic result at 6-month follow-up. DV-SS TEP inguinal hernia repair showed to be feasible and effective surgical option for bilateral groin hernia repair. Patients' outcome was uneventful, with optimal cosmetic results. Further studies comparing this innovative technique to TEP or LESS TEP should be promoted.

Gender disparities in the utilization of laparoscopic groin hernia repair

BackgroundClinical treatment guidelines have suggested that laparoscopic hernia repair should be the preferred approach in both men and women with bilateral or recurrent elective groin hernias. Anecdotal evidence suggests, however, that women are less likely to undergo a laparoscopic repair than men, and therefore, we aimed to delineate if these disparities persisted after controlling for patient factors and comorbidities. Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Project data were abstracted for all elective groin hernia repairs between 2005 and 2014. Univariate analysis was used to compare rates of laparoscopic surgery between men and women. Multivariable analysis was performed, controlling for patient demographics, preoperative comorbidities, and year of surgery. ResultsOver the 10-y period, 141,490 patients underwent elective groin hernia repair, of which 13,325 were women (9.4%). The rate of general anesthesia utilization was high in both men (81.3%) and women (77.2%) with 75.1% of open repairs being performed under general anesthesia. Overall, 20.2% of women underwent laparoscopic repair compared with 28.0% of men (P < 0.01). Women tended to be older, had a lesser body mass index, and slightly greater American Anesthesia Association (all P < 0.05). On multivariable regression, women had decreased odds of undergoing a laparoscopic approach compared with men (odds ratio: 0.70; 95% confidence interval, 0.67-0.73, P < 0.01). ConclusionsIn the elective setting, women were less likely to undergo laparoscopic repair of groin hernias than men. Although we are unable to ascertain underlying causes for these gender disparities, these data suggest that there remains a disparity in the management of groin hernias in women.

INGUINAL HERNIOPLASTY

Objective: To compare laparoscopic TEP Inguinal hernioplasty with &amp; withoutdissection balloon. Study Design: Observational study. Setting: Minimal Invasive SurgicalCentre Jamshoro and General Surgical Department at Dow University Hospital, Ojha CampusKarachi. Period: May 2011 and Dec 2012. Subjects and methods: Twenty (20) male patientswith uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in twogroups; group A Commercially available dissection balloon &amp; group B. Telescopic dissectionfor creating TEP working space. Results: We had 20 male patients for this study. The averageage was 43.6 &amp; ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia,4 patients 40% had direct inguinal hernia in group A &amp; 5 patients 50% had direct hernia in groupB. Peritoneum was breached in 5 (50%) patients with telescopic dissection. One patient (10%)with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP whileother group normal. The incidence of scrotal edema/seroma was greater in group B then groupA. 40% patient in group B developed seroma while 0nly 1 (10%) patient with bilateral groinhernia in group A developed seroma. Pain was scored on VAS at 1 &amp; 4 hours after surgerywas higher in group B. The mean operation time was 55 min (45-100) in the group with theballoon and 73 min (50-120) in the group without the balloon (p = 0.004). Conclusion: TEPlaparoscopic inguinal hernia repair is probably the best option amongst the two techniquesused in laparoscopic inguinal hernia repair &amp; dissection with balloon is though costly but morehelpful in dissection &amp; safer.

Groin hernia subtypes are associated in patients with bilateral hernias: a 14-year nationwide epidemiologic study.

To investigate the relation between groin hernia subtypes in patients operated for bilateral hernias. With data from the Danish Hernia Database, we identified all patients operated for primary groin hernias from 1998 to 2012. Within this cohort all patients that were bilaterally operated were analyzed. Risk factors for bilateral groin hernia operation as well as the relationship between groin hernia subtypes bilaterally, were analyzed using multivariate Cox proportional hazards analysis and Kappa statistics. A total of 108, 775 persons with primary groin hernia repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated for a DIH. Females and males operated for a unilaterally indirect inguinal hernia (IIH) had HRs of 6.93 (CI 95% 3.66-13.11) and 1.89 (CI95% 1.24-2.88) for being contralaterally operated for an IIH. The same tendency was seen for femoral hernias. All hernia subtypes were bilaterally associated in both genders and the hernia subtypes could be localized manifestations of generalized conditions or inheritable traits instead of localized defects.

NICE guidance and current practise of recurrent and bilateral groin hernia repair by Scottish surgeons

NICE (National Institute of Health and Clinical Excellence) in England recommended laparoscopic repair for recurrent and bilateral groin hernias in 2004. The aims of this survey were to evaluate the current practise of bilateral and recurrent inguinal hernia surgery in Scotland and surgeons' views on the perceived need for training in laparoscopic inguinal hernia repair (LIHR). A postal questionnaire was sent to Scottish consultant surgeons included in the Scottish Audit of Surgical Audit database 2007, asking about their current practice of primary, recurrent and bilateral inguinal hernia surgery. A response was considered valid if the surgeon performed groin hernia surgery; further analysis was based on this group. Those who did not offer LIHR were asked to comment on the possible reasons, and also the perceived need for training in laparoscopic hernia surgery. Only valid responses were stored on Microsoft Excel (Microsoft Corporation, USA) and analysed with SPSS software version 13.0 (SPSS, Chicago, Illinois). Postal questionnaires were sent to 301 surgeons and the overall all response rate was 174/301 (57.8%). A valid response was received from 124 of 174 (71.2%) surgeons and analysed further. Open Lichtenstein's repair seems to be the most common inguinal hernia repair. Laparoscopic surgery was not performed for 26.6 and 31.5% of recurrent and bilateral inguinal hernia, respectively. About 15% of surgeons replied that an LIHR service was not available in their base hospital. Lack of training, financial constraints, and insufficient evidence were thought to be the main reasons for low uptake of LIHR. About 80% of respondents wished to attend hands-on training in hernia surgery. Current practice by Scottish surgeons showed that one in three surgeons did not offer LIHR for bilateral and recurrent inguinal hernia as recommended by NICE. There is a clear need for training in LIHR.

Femoral vessel blood flow dynamics following totally extraperitoneal vs Stoppa procedure in bilateral inguinal hernias

Background Both totally extraperitoneal (TEP) and open preperitoneal (Stoppa) procedures involve the placement of prosthetic material preperitoneally. Because the prosthetic material overlies the femoral artery and vein, the aim of this study was to assess its effect on the velocities and diameters of the artery and vein using color Doppler ultrasonography in both approaches. Methods Sixty-four patients with bilateral groin hernias were prospectively randomized to undergo either TEP (n = 32) or Stoppa (n = 32) repair. All patients underwent color Doppler ultrasound 6 months after the procedures, and the median follow-up period was 18 months. Results Neither mean diameter nor mean flow velocity was changed by the insertion of the mesh preperitoneally. The only change was observed in peak systolic femoral arterial blood velocity, which was significantly decreased in the Stoppa group. Also, no patient in this study developed clinically significant deep venous thrombosis during 6 months of follow-up. Conclusions The insertion of a prosthetic mesh during TEP and Stoppa procedures does not influence the mean peak flow velocities and cross-sectional areas of the vessels in the inguinal region and can be used safely for open and laparoscopic preperitoneal approaches.