Bilateral Inguinal Hernia Research Articles

Laparoscopic Hernia Repair: Tapp Versus Tep. A Single Centre Experience

Summary Surgery for inguinal hernia is currently the most common surgical procedure worldwide, and every year over 20 million patients undergo open or laparoscopic hernia repair. Two generally accepted endoscopic approaches are transabdominal preperitoneal procedure (TAPP) and total extraperitoneal procedure (TEP). For nine years (2010 – 2018), 48 patients with inguinal hernia had laparoscopic hernia repair (TAPP or TEP) at Villarobledo General Hospital. Forty-three patients (89.6%)) were male, and five (10.4%) were female. Of these, ten had right inguinal hernia (RIH), 18 - left inguinal hernia (LIH), 12 - bilateral inguinal hernia (BIH), 6 had recurrent unilateral inguinal hernia (RUIH), and 2 had recurrent bilateral inguinal hernia (RBIH). In 33 patients (68.7%), transabdominal preperitoneal laparoscopic hernia repair (TAPP) was performed. Total extraperitoneal laparoscopic hernia repair (TEP) was performed on 15 patients (12%). In 8 patients (16.6%), simultaneous surgical procedures were performed: umbilical hernioplasty in 4 (8.3%) patients and laparoscopic cholecystectomy in 4 (8.3%) patients. There were no conversions in any of the surgical procedures. The average operative time was 77 minutes. Twenty-six patients underwent one-day surgery, 18 were in the hospital for one day, and four patients were discharged on the second postoperative day following surgery. In 7 patients (14%), recurrences occurred: in the first postoperative year - 1 patient; in the second year after surgery - 3 patients; in the third after surgery - 2 patients; and in the sixth year - 1 patient. The recurrence rate was 2 in 33 patients after TAPP (6%) versus 5 in 15 patients after TEP (33%), Chi-squared=5.91 (p=0.015). In one patient, perforation of the bladder occurred after TEP and was managed conservatively using a urethral catheter and preperitoneal drainage. TAPP and TEP had a considerable discrepancy in recurrence rates. Such discrepancy in recurrences is probably due to the higher complexity of the TEP technique and the required supervising of experienced surgeons during the learning curve.

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.

Single-incision laparoscopic transabdominal preperitoneal hernioplasty: 1,054 procedures and experience

PurposeAlthough there have been numerous studies on single-incision laparoscopic inguinal hernia repair (SIL-IHR), the short- and long-term outcomes in patients from a large single institution who underwent single-incision laparoscopic transabdominal preperitoneal hernioplasty (SIL-TAPP) have rarely been reported. The purpose of this study is to evaluate the short- and long-term outcomes of SIL-TAPP and its safety and feasibility in patients from a large single institution.MethodsThe details of 1,054 procedures in 966 patients who underwent SIL-TAPP at the Affiliated Hospital of Nantong University from January 2015 to October 2022 were retrospectively analysed. SIL-TAPP was performed completely through the umbilicus using conventional laparoscopic instruments. Short-term and long-term outcomes of SIL-TAPP were collected by outpatient and telephone follow-ups. In addition, we further compared the operation time, length of postoperative hospital stay, and postoperative complications of patients with simple and complicated unilateral inguinal hernias.ResultsA total of 1,054 procedures were performed for 878 unilateral inguinal hernias and 88 bilateral inguinal hernias. In total, there were 803 (76.2%) indirect inguinal hernias, 192 (18.2%) direct inguinal hernias, 51 (4.8%) femoral hernias and 8 (0.8%) combined hernias. The mean operative time was 35.5 ± 17.0 min for unilateral inguinal hernias and 51.9 ± 25.5 min for bilateral inguinal hernias. There was one (0.1%) conversion to two-incision laparoscopic transabdominal preperitoneal hernioplasty. No intraoperative haemorrhages, inferior epigastric vessel injury or nerve damage occurred. Postoperative complications were minor and could be resolved without surgical intervention. The mean length of hospital stay was 1.3 ± 0.8 days. The median follow-up was 44 months, no trocar hernia occurred, and there was one (0.1%) recurrence. The operation time in the complicated inguinal hernia group was significantly higher than that in the simple inguinal hernia group (38.9 ± 22.3 vs. 35.0 ± 15.6, p = 0.025). The length of postoperative hospital stay and complication rate of the complicated inguinal hernia group were slightly higher than those of the simple inguinal hernia group, but the difference was not statistically significant.ConclusionSIL-TAPP is safe and technically feasible, and both short- and long-term outcomes are acceptable.

Comparison of Extended Total Extraperitoneal (E-TEP) Repair and Trans-Abdominal Pre-Peritoneal (TAPP) Mesh Repair in Inguinal Hernia Repair.

To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair. A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared. In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIHand 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia.The mean duration of surgery was found to be significantly higher in the TAPP group(P<0.0000). The mean postoperative hospital stay was 2.07±0.59and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044). In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

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.

Epidemiological, Diagnostic and Therapeutic Aspects of Inguinal Hernias in the Surgical Unit General Overview of the Reference Health Centre (CSRéf) in Fana

Inguinal hernia is the spontaneous or progressive, temporary or permanent passage of viscera or part of viscera out of the cavity that normally contains it. This passage is made through an anatomically preformed area of weakness in the inguinal canal. The diagnosis of inguinal hernia is primarily clinical (inguinal swelling). Objectives: To study the epidemiological, diagnostic and therapeutic aspects of inguinal hernias in the general surgery unit of the Centre de Santé de Référence (CSRéf) in Fana. Results: 431 surgical interventions. 147 inguinal hernias including 12 cases of strangulation, The frequency of hernia was 34.11% in relation to surgical procedures, The 15-29 age group accounted for 32.7% of cases, The sex ratio was:35.75 in favour of men, In our study, farmers accounted for 53.06% of the total, Bilateral inguinal hernia which accounted for 57.14%, Patients who underwent para-rectal inguinotomy accounted for 88.4%, The Bassini technique was used in 70.75% of our patients, The operative follow-up was complicated in 19.73% of our patients, We recorded one case of death (0.7%). Conclusion: Inguinal hernia is a common surgical condition, preferentially affecting the male subjects and farmers, with a predominance of young people aged 15 to 25 years.

P-035 THE IMPORTANCE OF THE VALSALVA MANEUVER IN IMAGING DIAGNOSIS USING COMPUTER TOMOGRAPHY IN PATIENTS WITH INGUINAL HERNIAS

Abstract Aim Recently, more and more studies have demonstrated the importance of practicing the Valsalva maneuver during the abdominal computer tomography investigation, for bettering the accuracy of the imagistic diagnosis in these patients. Material and Methods In this study we introduce 118 patients with inguinal hernias (110 men - 93.22% and 8 women - 6.78%). The patients were divided into two groups. Group A was comprised of 92 patients with bilateral inguinal hernias. Group B was comprised of 26 patients with unilateral inguinal hernias. The Valsalva maneuver was performed on all the patients included in the study, during the abdominal computer tomography investigation. The diagnostic confirmation of the hernia was done intraoperatively. Results Of the 92 patients studied in group A, 60 patients were confirmed to have bilateral inguinal hernias during the abdominal CT exam - 65%, while for 31 patients the diagnosis was confirmed after the applying the Valsalva maneuver - 34%. In one of the cases, the diagnosis of bilateral inguinal hernia was only established intraoperatively - 1%. Of the 26 patients studied in group B, 23 cases had an established diagnosis of unilateral inguinal hernia due to the abdominal CT exam - 88.5% while in 3 patients the diagnosis was only established after practicing the Valsalva maneuver - 11.5%. Conclusions In cases of patients with inguinal hernias, practicing the Valsalva maneuver during the abdominal CT exam, can be considered very useful in the diagnostic accuracy for these types of patients.

OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL

Abstract Aim A remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is raising evidence that biological meshes could be advantageous concerning occurrence of chronic pain without the disadvantages of a life-long implant. The BIOLAP trial compares synthetic and biological meshes in laparoendoscopic inguinal hernia repair. To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other. Materials and Methods In 21 German hernia centres, 982 hernias were treated using TEP or TAPP techniques. In addition to the study endpoints (recurrence rate within 2 years, pain intensity after 6 months), demographic and perioperative data as well as intraoperative and postoperative complications were recorded. Results Recruitment was successfully completed in February 2021. Six month after laparoendoscopic hernia repair there is no significant difference in pain occurrence comparing biological to synthetic mesh implants. Furthermore general demographics of the patients with bilateral primary inguinal hernias are evaluated. Conclusion The study provides data from 982 hernia operations dependent of the mesh material used. According to the study protocol, at the current time pain intensity after 6 months comparing both mesh materials has been evaluated as the first endpoint. Further study endpoints will be evaluated after completion of the two-year follow-up phase.

V-010 ROBOTIC ASSISTED BILATERAL INGUINOSCROTAL HERNIA REPAIR: STEP BY STEP

Abstract Introduction Robotic surgery in the field of abdominal wall surgery is exponentially growing. In this video we will present a step by step robotic approach for bilateral inguinoscrotal hernia repair. Clinical case A 79 year-old male with history of hypercholesterolemia was diagnosed of bilateral inguinal hernia. On physical examination, a right inguinoscrotal hernia (EHS classification L3P) and left inguinal hernia (EHS classification M1P) were diagnosed. Minimally invasive surgery assisted by DaVinci Xi robot is decided. Under general anesthesia, a supraumbilical 8-mm trocar is located and 2 other trocars are positioned 8 cm laterally. Monopolar scissors and bipolar grasps are introduced. Laparoscopic examination confirmed the diagnosis. First, peritoneum is dissected, allowing to access to the preperitoneal space, dissecting the medial and lateral compartiment, reaching the pectineal ligament. Identification and reduction of the hernia sac is performed, individualizing and preserving the inguinal structures. Critical view of the miopectineal orifice is ensured. Contralateral procedure is performed. 15×15 cm Poplipropilene mesh are located at the preperitoneal space, fixated with 3/0 PDS stitches to the pectineal ligament. Fixation stitches are done at the superior section of the mesh. Peritoneal flaps are closed with V-lock suture. Conclusion Robotic surgery is a safe and feasible procedure for inguinal hernia repair in patients specially selected (BMI &amp;lt;30, bilateral hernias). Further studies are needed in order to clarify its role in the field of minimally invasive surgery.

P-039 INITIAL EXPERIENCE IN ROBOTIC APPROACH IN ABDOMINAL WALL SURGERY

Abstract Aim To evaluate the results of our robotic hernia repair case series. Material and Methods Prospective and observational study on hernia repair cases operated with a robotic approach. We have performed a descriptive analysis of demographic and surgical variables and short-term complications. Results From October 2021 to January 2023, 64 robotic interventions, including 39 men (60.1%) and 25 women (39.1%). Mean age is 60,66 years (+/- 11,72). Mean Body Mass Index (BMI) is 30,70kg/m2 (+/- 5.58). Interventions: 3 unilateral inguinal hernia (2 recurrents), 16 bilateral inguinal hernia (9 recurrents), 13 primary ventral hernias, 23 incisional hernia, 8 mixed hernias and 1 parastomal hernias. Conversion rate is 1,6% (one case). Techniques in inguinal hernia: 22 rTAPP (Transabdominal Preperitoneal) (85,91min +/- 31.90). In unilateral hernia the mean of intervention time is 50min +/- 25,98 and in bilateral hernia is 95,31min +/- 28,83. Techniques in abdominal hernia: 2 iPOM+ (Laparoscopic Intraperitoneal Onlay Mesh) (127.50 min +/- 3.54), 1 rTAPP (90min), 1 rRives (260min), 28 TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic) (135.50 min +/- 54.02), 2 eTEP (Enhanced-view Total Extraperitoneal) (165 min +/- 49.48), 4 rTAR (Transversus Abdominis Muscle Release) (122.50 min +/- 51.07), 2 rLIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) (147.50 min +/- 74.25) and 1 Pauli (155 min). Complications: 21 SSO (surgical site occurrence) (32,81%), 2 SSI (surgical site infection) (3.1%), 1 recurrence (1.6%). Conclusions Robotic surgery facilitates the approach of complex incisional hernias and the performance or retromuscular techniques. It doesn`t provide clear benefits in inguinal hernia.

V-019 Spiegel hernia repair using eTEP approach

Abstract Objective Spiegel hernia is a rare entity that accounts for less than 1% of operated hernias. Its clinical diagnosis is difficult and its treatment is varied. The objective of this work was to show the eTEP approach for the treatment of this pathology. Methods Despite the fact that this entity accounts for less than 1% of all hernia outbreaks, we had three probable cases of Spigelian hernia in the last quarter. The last of them was resolved with Extended Totally Extraperitoneal (eTEP) Approach for Hernia Repair. Results We show a 62-year-old man, previously operated on for bilateral inguinal hernia and Spiegel hernia on the right side by TAPP laparoscopic approach. He presents a left Spiegel hernia now, for which a totally extraperitoneal approach is proposed. The surgery was uneventful and the patient was discharged the day after the intervention. At two months of follow-up, the patient is asymptomatic. Conclusions Spiegel hernia is a rare hernia, difficult to diagnose and can present itself as complicated. It can be treated with various approaches. Laparoscopic Spiegel hernia repair is gaining popularity for its safety and patient benefits. The eTEP approach is useful tool in the management of the abdominal wall and, as demonstrated in our case, for the treatment of Spiegel hernia.

P-092 EARLY OUTCOMES OF ROBOTIC-ASSISTED TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR: A SINGLE-INSTITUTION EXPERIENCE

Abstract Purpose Since the introduction of the Da Vinci robot, robot-assisted hernia repairs have become more common. We aim to report our initial experience of robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. Methods A retrospective chart review was performed in patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the Da Vinci platform (Intuitive Surgical Inc). Data were collected for patient characteristics and surgical outcomes. Results A total of 21 patients underwent R-TAPP repair consecutively. The mean age was 54.1 ±16.4 years. Twenty patients (95.2%) were male, and the mean body mass index was 23.8 ± 1.9. Bilateral hernia repairs were performed on 2 (9.5%) patients. Six cases (28.5%) of huge scrotal hernias were performed by R-TAPP. The operation time was 91.8 ± 20.4 min for unilateral inguinal hernia and 154.5 ± 26.2 min for bilateral inguinal hernia. The mean console operative time was 61.4 ± 16.9 min for unilateral inguinal hernia and 128 ± 25.5 min for bilateral inguinal hernia. Scrotal vein injury was identified in one patient intraoperatively. Two minor postoperative complications were reported: one with postoperative ileus and the other with umbilical wound seroma. The length of hospital stay was 3.8 ± 0.9 days. Neither mortality nor conversion to open surgery occurred. Conclusion Our early experience has demonstrated that the R-TAPP inguinal hernia repair is a safe and feasible approach. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

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

AN OBSERVATION ON DESARDA TECHNIQUE OF INGUINAL HERNIA REPAIR

Background: Inguinal hernia repair is one of the most commonly performed procedure in surgical practice throughout the world. The non-mesh repair technique of inguinal hernia by Mohan P. Desarda is becoming popular nowadays. Study of the outcomes of the procedure and comparison with other workers is desirable for wider acceptance of the procedure. To study the Objective: outcomes of inguinal hernia repair by Desarda technique. This is an observational study of 32 patients with inguinal hernia repair by Desarda techn Methodology: ique carried out in Dept. of general surgery, Patna Medical College and Hospital, Patna from October 2020 to October 2022. Out of 32 patients included in the study 18 Result: right sided,12 left sided and 2 bilateral inguinal hernia was there. The mean age of study population was 42.72±12.137 years. Mean operating time was found to be 60.81±10.91 minutes. Majority (87.5%) of the patients experienced moderate pain (measured by VAS ) on the rst post-operative day which gradually decreased with the time. Different postoperative complications ; hematoma in 1 patient (3.125%), seroma in 2 patients (6.25%), surgical site infection in 1 patient (3.125%), scrotal swelling in 2 patients (6.125%) and cord swelling in 1 patient (3.125%) were seen. Conclusion: Non mesh Desarda repair of inguinal hernia repair is associated with less operating time, early ambulation, less post operative pain and complication. As it doesn't use mesh so it is cost effective also and should denitely be encouraged.

Major bilateral inguinal hernia involving both kidneys

Major bilateral inguinal hernia involving both kidneys

Perforated Sigmoid Diverticulitis Within a Strangulated Inguinal Hernia.

We present a rare case of perforated diverticulitis within an inguinal hernia sac adjacent to a synthetic mesh from a prior incisional hernia. An 80-year-old-female presented to the ED with abdominal pain. Cross-sectional imaging was significant for a small bowel obstruction with a transition point in the right lower quadrant (RLQ). On physical exam, the patient had palpable bilateral inguinal hernias that were reducible; however, after 48hours of nonoperative management she failed to progress. Repeat imaging was concerning for incarcerated bowel within the inguinal hernia sac. She was taken to the operating room for exploratory laparotomy where the right inguinal hernia sac was found to contain sigmoid colon with diverticular perforation. A small bowel resection, right hemicolectomy and Hartmann's procedure were performed. The previously placed synthetic mesh was not contaminated during this operation and was not removed. Her hospital course was otherwise unremarkable but prolonged by the patient's deconditioned state.

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

Atypical Mayer-Rokitansky-Küster-Hauser Syndrome with Bilateral Inguinal Hernia of Adnexa—Laparoscopic Transabdominal Preperitoneal Repair with Ovarian Plication

Atypical Mayer-Rokitansky-Küster-Hauser Syndrome with Bilateral Inguinal Hernia of Adnexa—Laparoscopic Transabdominal Preperitoneal Repair with Ovarian Plication

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 ...