Bilateral Inguinal Hernia Repair Research Articles

Outpatient Surgery and Unplanned Overnight Admission in Bilateral Inguinal Hernia Repair: A Population-based Study.

The use of outpatient surgery in inguinal hernia is heterogeneous despite clinical recommendations. This study aimed to analyze the utilization trend of outpatient surgery for bilateral inguinal hernia repair (BHIR) in Spain and identify the factors associated with outpatient surgery choice and unplanned overnight admission. A retrospective observational study of patients undergoing BIHR from 2016 to 2021 was conducted. The clinical-administrative database of the Spanish Ministry of Health RAE-CMBD was used. Patient characteristics undergoing outpatient and inpatient surgery were compared. A multivariable logistic regression analysis was performed to identify factors associated with outpatient surgery choice and unplanned overnight admission. A total of 30,940 RHIBs were performed; 63% were inpatient surgery, and 37% were outpatient surgery. The rate of outpatient surgery increased from 30% in 2016 to 41% in 2021 (p < 0.001). Higher rates of outpatient surgery were observed across hospitals with a higher number of cases per year (p < 0.001). Factors associated with outpatient surgery choice were: age under 65 years (OR: 2.01, 95% CI: 1.92-2.11), hospital volume (OR: 1.59, 95% CI: 1.47-1.72), primary hernia (OR: 1.89, 95% CI: 1.71-2.08), and laparoscopic surgery (OR: 1.47, 95% CI: 1.39-1.56). Comorbidities were negatively associated with outpatient surgery. Open surgery was associated (OR: 1.26, 95% CI: 1.09-1.47) with unplanned overnight admission. Outpatient surgery for BHIR has increased in recent years but is still low. Older age and comorbidities were associated with lower rates of outpatient surgery. However, the laparoscopic repair was associated with increased outpatient surgery and lower unplanned overnight admission.

Comparative Analysis of Bilateral Open Inguinal Hernia Repair and Rives-Stoppa Repair: A Comprehensive Review.

Inguinal hernias present a significant healthcare burden globally, necessitating effective surgical management. This comprehensive review evaluates two primary surgical techniques for managing bilateral inguinal hernias: bilateral open inguinal hernia and Rives-Stoppa repair. This review aims to provide insights into optimal surgical approaches through a comparative analysis of these techniques, including examining advantages, disadvantages, outcomes, and factors influencing technique selection. Bilateral open inguinal hernia repair offers simplicity and familiarity, while Rives-Stoppa repair may provide advantages such as reduced recurrence rates and postoperative complications. The findings underscore the importance of considering patient-specific factors, surgeon expertise, and hospital resources when selecting the optimal approach. Further research is warranted to conduct long-term comparative studies and explore innovations in surgical techniques and materials, ultimately enhancing patient outcomes and advancing inguinal hernia repair practices.

(170) Missed Urinary Leak During an Inflatable Penile Prosthesis Insertion Presenting as a Post-Operative Hydrocoele

Abstract Introduction This is a case of a revision of a three-piece penile prosthesis in a 53-year-old gentleman who had received an infrapubic implantable penile prosthesis (IPP) in Turkey over 12 months ago. He complained of an unsupported floppy shaft when the prosthesis was inflated, as well as a right hemi scrotal bulging which was exacerbated by activity but showed no signs of infection. A hydrocele had occurred 2 months following the IPP insertion and was confirmed on imaging. The MRI showed the pump within the hydrocele. He had previously had a laparoscopy gastric banding and a bilateral inguinal hernia repair with mesh. Objective Video to demonstrate the surgical case Methods This is a video demonstrating the steps of this operation. The procedure started with a transverse penoscrotal incision and dissection through the dartos muscle. The initial corporotomy allowed removal of the first cylinder of the prosthesis. Upon removing the right cylinder, the hydrocele was opened to reveal the presence of turbid fluid, 150ml of fluid was aspirated and sent for microbiology investigations. The next stage involved removal of the left cylinder and 7.5cm of rear-tip extenders (RTE) were subsequently removed intact, with further RTE from the right removed separately using a nasal speculum. Therefore, a 20cm IPP was removed with 7.5cm RTE on each side. An antibiotic salvage wash (Rifampicin/Gentamicin) was performed several times. At this point a 26cm + 1cm (13mm) malleable prosthesis was inserted as a spacer. The previous infrapubic wound was opened to remove the reservoir, 75ml of fluid was aspirated from around the reservoir prior to removal. Attempts are made to identify a possible fistula with flexible cystoscopy, but normal urethra, bladder neck and bladder are seen. Giving no evidence of any fistula into the abdominal cavity or urethral injury to explain fluid in the corporal cavities or around the components of the prosthesis. Methylene blue and distention were also used to attempt to identify a bladder leak, however this was also unremarkable. A suprapubic catheter was inserted to ensure the decompression of the urinary system to allow any small/undetected leaks to heal. This was done under direct vision using a cystoscope prior to being secured. Results The patient had a replacement of the inflatable penile prosthesis to a malleable prosthesis, a suprapubic catheter inserted and a drainage of his hydrocele. The patient recovered well from surgery and on examination the prosthesis tips were seated nicely in the glans. The fluid microbiology culture did not grow any organism. A subsequent cystogram showed no signs of any bladder leak. The patient was happy with the outcome and underwent a trial without catheter. He has a planned review and will be considered for an exchange to an inflatable device at this time. Conclusions This is an unusual presentation of a hydrocele, in the absence of any infective symptoms which is suggestive of a contained urine leak and even a missed bladder injury from the first prosthesis surgery. However, no fistula was found during the surgery or the post-operative cystogram. Disclosure No.

Comparison Between Caudal and Combined Caudal with Spinal Anesthesia in Paediatric Bilateral Inguinal Hernia Surgery

Objective: To compare the analgesic efficacy and adverse effect profile of using caudal anaesthesia versus caudal combined with spinal anaesthesia for paediatric patients undergoing bilateral inguinal hernia surgery. Study Design: Prospective longitudinal study. Place and Duration of Study: Anaesthesia Department of Combined Military Hospital, Rawalpindi Pakistan, from Mar to Aug 2022. Methodology: Eighty paediatric patients between ages 5-10 years requiring bilateral inguinal hernia repair were included in the study. The Caudal Group received 0.25% Bupivacaine per the Armitage regime at a 1 ml/kg volume to reach an effective sensory level of T10. The Combined Group received spinal anaesthesia at a dose of 0.3 mg/kg for &gt;15 kg patients and 0.4 mg/kg for 5-15 kg patients in the L4-L5 epidural space for an effective spinal level of T10. Once the spinal was administered, the same caudal dose as per the caudal Group's Armitage regime. Results: The total duration of block and subsequent reversal to the S1 level was 326.2±12.6 minutes in the Caudal Group versus 441.22±31.8 minutes in the Combined Group (p&lt;0.001). The mean time for the first dose of analgesia for pain was required after 5.27±0.24 hours in the caudal versus 7.03±0.20 hours in the Combined Group. Conclusion: We conclude that the combined caudal spinal approach offers better and superior pain control, resulting in less IV analgesic requirement and less hospital stay, offering a good alternative to general anaesthesia in paediatric surgeries.

Surgical Approach to Bilateral Inguinal Hernia. A Case-Control Study.

Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally invasive, in an elective sce-nario. The choice of surgical approach depends on the patient's status, hernia characteristics, surgeons and patient preferences. Whether age criteria should be considered when selecting between the two approaches is still a matter of debate. Considering that there is no consensus regarding the best repair in bilateral inguinal herniorrhaphy, the aim of the study is to perform an analysis regarding elective surgical approach of patients with bilateral inguinal hernias. Material and Methods: To study the relationship between exposure to an open versus laparoscopic approach in patients with bilateral inguinal hernia, we conducted a case-control study. In our retrospective analysis, cases (23 patients) were the open-approach hernia repair, and controls (82 patients) were laparoscopic hernia repair. We analyzed two sets of variables: first, related to patient characteristics (age 65 years, BMI 30 kg/m2, smoking habit, HTA status, COPD status, DM status, use of anticoagulants, presence of neoplastic status) and second, variables related to hernia features (inguinoscrotal hernia, recurrent hernia and complicated hernia). Results: The mean age for cases was 73.26 (Ã+-12.99) years and that of controls, was 56.48 (Ã+-15.15) years. Univariate analysis demonstrated four variables with statistical significance: age 65 years, inguinoscrotal hernia, neo-plastic status, and anticoagulant use. When introduced into the multivariate analysis, we noted that only two variables, age 65 years (OR=4.183, 95% CI [1.289, 13.572], p=0.017) and use of anticoagulants (OR=38.876, 95% CI [1.305, 1158.011], p=0.035) reached statistical significance. Conclusion: This study demonstrates that when we refer to bilateral inguinal hernia repair, patients aged 65 years are at risk of having an open procedure at least fourfold more than patients aged 65 years. In addition, the use of anticoagulants increases the risk of open hernia repair 38 times more than that of minimally invasive repair for the same age group. Interestingly, in our study, hernia characteristics were not found to be associated with open hernia repair and age 65 years. In our study we found that age 65 years is associated with electing open hernia repair over minimally invasive repair, which can be linked to age-related risk factors. Further re-search is needed to investigate the impact of age and age-related risk factors on surgical outcomes of bilateral inguinal hernia repair.

970 A Parisian Pain in the Groin; a Case of De Garengeot’s Hernia

Abstract Introduction 77-year-old gentleman presented with a four-day history of a painful right sided irreducible groin swelling. Background of previous bilateral mesh inguinal hernia repair thirty years prior. Differential diagnosis- recurrent incarcerated inguinal hernia. Description Emergency presentation with a painful right sided groin lump with history of previous inguinal hernia repair. Past medical history of AF on rivaroxaban, HTN and BPH. Patient systemically well with an irreducible lump in the right groin. CTAP showed recurrence of hernia in right inguinal region containing fat stranding and a 2cm-sized fluid-filled structure (suspected appendix). Taken to theatre the following day - oblique incision in right groin. Obvious femoral hernia identified. Haemorrhagic fluid and a necrotic appendix contained in hernia sac. Open appendicectomy performed through groin incision and femoral canal plicated using 2.0 prolene. No mesh used due to risk of contamination. Discharged day 2 post-op. Pathology confirmed acute appendicitis. Discussion Extremely rare case presentation. Femoral hernias account for 3% of all hernias and De Garengeot hernias only 1% of all femoral hernias. Furthermore, De Garengeot hernia with acute appendicitis accounts for only 0.01% of femoral hernias and are much more common in females than males with a 4:1 ratio. Femoral hernias are fifteen times more common in patients who have undergone previous inguinal hernia repair with 33% of men and 4% of women with De Garengeot hernia having undergone previous right inguinal hernia repair. Difficult pre-operative diagnosis given rarity with only 30% of cases diagnosed on pre-operative imaging-initial diagnosis Amyand hernia on CT imaging.

Robotic inguinal hernia repair with the new Hugo RASTM system: first worldwide case series report

Introduction Robotic-assisted surgery has been a part of surgical procedures for more than two decades. Recently new robotic platforms with a different design entered the market. The modular design with independent arms enables increased flexibility of arm docking to increase the range of motion and instrument maneuverability. We herein present the first case series of robotic inguinal hernia repair using the Hugo RAS system (Medtronic, Minneapolis, MN, USA). Material and methods Thirteen inguinal hernia repairs were performed on ten patients. A description of the Hugo RAS system as well as the new concept of modular design is presented along with the description of the operation setup. Results Mean docking time was 9.5 min and mean console time was 50.3 min and 74.7 min for unilateral and bilateral inguinal hernia repair, respectively. No intraoperative or postoperative complications occurred. There was one conversion to laparoscopic surgery due to a technical issue with the robot. Conclusions: The modular design of independent arms seems to enhance maneuverability of the instruments and contribute to fewer arm collisions. Further clinical data and experience with this new surgical system are necessary to understand if this new design has advantages over the standard robotic platforms.

Sigmoido-vesical fistula secondary to hernia mesh migration; a long-term rare complication of laparoscopic transabdominal preperitoneal inguinal hernia repair

A 47-year old male presented with frequent urinary tract infections (UTIs), hematuria and pneumaturia with a past history of laparoscopic bilateral inguinal hernia repair 5 years ago. Ultrasonography (USG) and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, cystoscopy revealed a mesh in the urinary bladder making apparent the diagnosis of Sigmoido-vesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon and urinary bladder with rent closure of the fistulous opening was done successfully. Our case thus, highlights the long-term rare complication of transabdominal preperitoneal (TAPP) surgery.

Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair.

Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657.One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.

P-004 APPENDICITIS CAUSING CHRONIC MESH INFECTION: A CASE SERIES OF TWO PATIENTS

Abstract Aim To discuss appendicitis as a cause of chronic mesh infection. Methods This study reports two patients with previous inguinal hernia repair who presented with recurrent groin infections resulting from appendicitis. Results Patient 1 had a history of laparoscopic bilateral inguinal hernia repair, followed by an open repair of a unilateral recurrence. He presented twice with groin pain and discharge. Sinugram demonstrated a superficial tract, but intra-operatively the sinus tract extended to the deep ring where the appendix was adherent and inflamed. There was also a meshoma of the preperitoneal mesh. He underwent appendicectomy and excision of meshoma. Patient 2 presented with perforated appendicitis with a large pelvic collection extending into the anterior abdominal wall. This was treated with percutaneous drainage and antibiotics. Further presentations with recurrent abscesses prompted a laparoscopy where an inflamed appendix was found adherent to the previous mesh through a hole in the peritoneum in a pre-peritoneal abscess cavity. He underwent appendicectomy and washout without mesh removal. Both patients remain symptom free at 10 months and 1 month respectively. Conclusion Literature review found reports of mesh-related appendicitis but no cases of appendicitis causing chronic mesh infection. Whilst rare, appendicitis causing chronic mesh infection should be considered in patients presenting with recurrent groin pain and abscesses having previously undergone inguinal hernia repair. Whilst we do not have long term follow up data, our experience indicates that these patients can be managed with or without mesh removal, providing the appendix is removed and the source of sepsis controlled.

Comparative Analysis of Laparoscopic vs Open Inguinal Hernia Approach for Repair of Recurrent Bilateral Inguinal Hernia

Comparative Analysis of Laparoscopic vs Open Inguinal Hernia Approach for Repair of Recurrent Bilateral Inguinal Hernia

INGUINAL ABSCESS FOLLOWING TRANS-ABDOMINAL PREPERITONEAL MESH REPAIR FOR INGUINAL HERNIA

Introduction – Introduction of synthetic mesh was a landmark breakthrough in management of hernia repair and has signicantly reduced recurrence rates. But in addition to benets, some more problems have come in picture major being 'mesh infection'. Prolene mesh has shown promise when used in abdominal and inguinal hernia repair, especially when used in planned surgeries. Being a foreign material, slightest breach in asepsis can lead to favourable environment for bacterial proliferation and form a 'biolm'. It appears that laparoscopic hernia repair is a promising method but having chances of mesh infection owing to difcult approach and lack of uniformity in sterilization of laparoscopic instruments. Improper sterilization or protocols might lead to such a large ventral wall sinus or abscess increasing morbidity and cost of treatment. Case Report A 39 year old male patient presented to OPD with abdominal pain since 15 days, low grade fever , anorexia and weight loss 1.5 months following TAPP repair of bilateral inguinal hernia 1.5 months ago. Work-up showed acute diverticulitis with diverticula perforation involving descending colon and adjacent sigmoid colon in left iliac fossa with collection in left iliac fossa. Lower Midline Exploratory laparotomy was performed. Around 100 cc pus was drained around mesh beneath parietal peritoneum, the infected mesh was removed. Post operatively patient recovered excellently. TAPP is a safe procedure for treat groin hernias, unless, mesh complications Conclusion like foreign body reaction, deep-seated infection, mesh migration and perforation into viscera can occur even 20 years later of the procedure with no dened incidence. The chance of recurrence of hernia following management of infected mesh should always be considered

MP61-01 SIMULTANEOUS HERNIA REPAIR FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY IS SAFE WITH LOW RATES OF MESH-RELATED COMPLICATIONS

You have accessJournal of UrologyCME1 Apr 2023MP61-01 SIMULTANEOUS HERNIA REPAIR FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY IS SAFE WITH LOW RATES OF MESH-RELATED COMPLICATIONS Marcio Covas Moschovas, Jaber Abdel, Travis Rogers, Roshane Pereira, Marco Sandri, Shady Saikali, Shannon Roof, Keila Morales, Carlos Ortiz, and Vipul Patel Marcio Covas MoschovasMarcio Covas Moschovas More articles by this author , Jaber AbdelJaber Abdel More articles by this author , Travis RogersTravis Rogers More articles by this author , Roshane PereiraRoshane Pereira More articles by this author , Marco SandriMarco Sandri More articles by this author , Shady SaikaliShady Saikali More articles by this author , Shannon RoofShannon Roof More articles by this author , Keila MoralesKeila Morales More articles by this author , Carlos OrtizCarlos Ortiz More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted radical prostatectomy (RARP) is known as the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP concomitant with hernia repair with mesh is debatable, as the current literature is not supported by well-designed or sufficient studies. Some argue that this procedure may result in mesh infections due to possible contact with urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy. METHODS: From August 2008 to August 2021, we prospectively collected the data of 244 patients who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) with mesh placement. After a propensity score match (PS), these patients were retrospectively compared with with 244 patients from 6275 RARPs operated on during the same period without hernia repair. We report the preoperative demography and perioperative outcomes up to 90 days after the surgery. RESULTS: Median follow-up was 36.6 months for the control and hernia groups, respectively (p=0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112 min for the control group and 160 min for the hernia groups (p<0.001). Estimated median blood loss was 100mL and 50mL for the control and hernia groups, respectively (p=0.41). We did not find statistically significant differences in minor complications (Clavien≤2). Although the postoperative readmissions within 90-days were higher in the hernia group (18 vs.7, p=0.038), none were associated with mesh complications. CONCLUSIONS: Robotic-assisted radical prostatectomy with concomitant hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts related to an additional surgical procedure. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e852 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcio Covas Moschovas More articles by this author Jaber Abdel More articles by this author Travis Rogers More articles by this author Roshane Pereira More articles by this author Marco Sandri More articles by this author Shady Saikali More articles by this author Shannon Roof More articles by this author Keila Morales More articles by this author Carlos Ortiz More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF downloadLoading ...

Simultaneous hernia repair following robotic-assisted radical prostatectomy is safe with low rates of mesh-related complications.

Robotic-assisted radical prostatectomy (RARP) is the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP along with a concomitant hernia repair with mesh is debatable because of the lack of well-designed studies on this subject. Some argue that this procedure may result in mesh infections and increased complications due to possible contact of mesh and urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy. We compared 244 patients (from August 2008 to August 2021) who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) and mesh placement with 244 patients from 6275 RARPs operated on the same period without hernia repair. We performed a propensity score matching analysis using preoperative covariates and compared the perioperative outcomes, and complications in 90days after surgery. Median follow-up was 36.6months for the control and hernia groups respectively (p = 0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112min for the control group and 160min for hernia groups (p < 0.001). We did not find statistically significant differences in minor complications (Clavien ≤ 2). Although the postoperative readmissions in 90-days were higher in the hernia group (18 vs. 7, p = 0.038), none was associated with mesh complications. Limitation includes the retrospective design of the study. Robotic-assisted radical prostatectomy with simultaneous hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts of an additional surgical procedure.

Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study

BackgroundInternational guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain.MethodsWe performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis.ResultsA total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p < 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p = 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient’s region of residence (OR 2.04, 95% CI 1.88–2.21). Other factors were age < 65 years (OR 1.65, 95% CI 1.52–1.79) and recurrent inguinal hernia (OR 1.31, 95% CI 1.15–1.49). The type of approach for BIHR was not independently associated with perioperative complications.ConclusionsDespite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient’s region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.Graphical abstract

Unilateral Scrotal Swelling: Diagnosis and Management

A 58-year-old male presented with a 2-year history of a right scrotal swelling, which he noted to be progressively increasing in size and discomfort. He denied any significant past medical history. His surgical history was notable for a bilateral laparoscopic inguinal hernia repair with mesh approximately 10 years prior.

SURGICAL MANAGEMENT OF BILATERAL INGUINAL HERNIAS: A PROSPECTIVE STUDY OF LICHTENSTEIN, STOPPAS AND TEP REPAIR.

BACKGROUND: The choice of surgery for bilateral inguinal hernia repair still remains a debatable question for surgeons. This study was aimed at analysing the effectives as well as comparing Lichtenstein, Stoppas and laparoscopic TEP(total extraperitoneal repair) approaches for Bilateral inguinal hernia. Prospective study invol MATERIALS AND METHODS: ving 60 patients of Bilateral inguinal hernia, were divided into 3 groups, 20 patients each in Lichtenstein, Stoppas and TEP. As per relevant rating scales, parameters analysed were duration of surgery, post operative pain, post operative analgesia requirement, duration of hospital stay, return to normal activity, cost effectiveness, surgical complications, recurrence over 6months. Minor complications such as seroma, scrotal RESULTS: oedema, wound infection were common in Lichtenstein compared to Stoppas and TEP. Shorter duration of surgery, early discharge and early return to normal activities was seen in Stoppas and TEP compared to Lichtenstein. One recurrence was seen in TEP and Lichtenstein. Post operative pain was least with TEP than the other two groups. Open surgery proved to be more cost effective than TEP. TEP in CONCLUSION: comparison with Stoppas and Lichtenstein is safer with lesser complications and earlier recovery, but less cost effective than open surgery. In developing countries, where cost effectiveness plays a crucial role in deciding the surgery, Stoppas is safe with minimal complications and rapid recovery. This study also demonstrates the effect of surgeon's experience on clinical outcome, with learning curve being shorter in open vs TEP repair

Physical Rehabilitation of Patient with Infrarenal Section Abdominal Aortic Aneurysm Presenting with Hydrocele and Inguinal Hernia: A Case Report

Infrarenal Abdominal Aortic Aneurysm (AAA) is an abnormal dilation of distal abdominal aorta. The risk factors are age older than 60 years, smoking, hypertension and caucasian ethnicity. Testicular pain is an uncommon clinical presentation. There is a high prevalence of inguinal hernia in patients with infrarenal AAA. The purpose of the present case report is to describe the functional activity limitation in a patient affected by an infrarenal AAA presenting as a symptom of inguinal hernia and groin pain despite successful infrarenal AAA repair with aortofemoral bypass surgery and bilateral inguinal hernia repair. A 62-year-old male patient, presented with pain in the groin region and mild swelling over the scrotal region, which was severely limiting his activities of daily living. A Computerised Tomography (CT) angio abdomen revealed a fusiform aneurysm on the distal abdominal aorta and a saccular aneurysm of bilateral common iliac arteries. Given the minimum of four days of referral waiting time to receive treatment for infrarenal AAA, the patient underwent surgery and was followed by the postoperative physiotherapy intervention. The rehabilitation programme started five days postsurgery. The treatment goals directed mainly decreasing postoperative pulmonary complications and improving functional mobility. The present case report contributes new light on the possible pathogenesis and timely management. It reports the unexpected and unusual presentation of the disease and unveiling the link between the presentation of infrarenal AAA and inguinal hernia and hydrocele.

A Case Series of Patients Operated for Stoppa Repair for Bilateral Inguinal Hernia

Background: Inguinal hernia repair is one of the most commonly performed general surgical procedures all across the world. Recent advancement in surgical techniques has paved way for the Stoppa’s repair for inguinal hernia; based on the principal of providing strong posterior wall to the inguinal canal which is both physiologically dynamic and mobile. Aims and Objectives: To study a case series of 10 patients operated for stoppa’s repair for bilateral inguinal hernia and its advantages in technicality and patient’s perspective. Methods: This study was carried out in GCS medical Hospital between June 2022 and December 2022. Total of 10 patients were included in this study which were managed by Stoppa’s open pre-peritoneal prolene mesh hernioplasty. Results: This procedure has inherent advantages of wider operative field, potential inspection of all hernia sites, decreased operative time and post op morbidity of pain and is tensionless and sutures less in its true sense. Conclusion: This advanced technique of bilateral inguinal hernia repair has excellent results in terms of early ambulation, minimal post-op pain, and minimal scar and so is an excellent option for patients of bilateral inguinal hernias.

Bronchoscopic guided intubation through laryngeal mask airway in a patient with ankylosing spondylitis

Patients with ankylosing spondylitis present with airway difficulties. There are various techniques to secure a definitive airway for general anaesthesia in these patients. We report the case of an ankylosing spondylitis patient with fixed neck deformity for laparoscopic bilateral inguinal hernia repair surgery managed with an Ambu® AuraGain™ laryngeal mask (LM) insertion and followed by a fibreoptic bronchoscopic-aided endotracheal tube insertion for definitive airway through the LM airway according to the All India Difficult Airway Association guidelines.