Bilateral Inguinal Hernia Research Articles

Robotic versus laparoscopic transabdominal preperitoneal (TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis

BackgroundSince the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP.Materials and methodsAll consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated.ResultsIn total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001).ConclusionIn this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.

The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it

PurposeTo describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospitalMethodsWe describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR.ResultsWe performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009).ConclusionA structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.

P8.121: Inguinal Herniation After Kidney Transplantation

Introduction: There have been some reports of transplant ureteral obstruction due to inguinal hernia after kidney transplantation (KT). This study aims to clarify the clinical features and the outcomes of ipsilateral inguinal hernia after kidney transplantation. Method: From 2011 to 2020, eight patients who diagnosed as inguinal hernia on the ipsilateral side of KT were included in this study. We retrospectively reviewed those patient’s clinical data from medical records. All values were expressed as the median and range. This study was approved by the ethics committee of the Institutional Review Board. Results: All patients were male. The age was 68 (range, 28 - 75) years. Of the eight patients, living donor KT was performed in 5 and deceased donor KT was performed in 3. The median post-transplantation period was 6.8 (0.5 - 18.0) years. Right side inguinal hernia was observed in all patients, including one case of bilateral inguinal hernia. Six patients were direct type and two were indirect type of inguinal hernia. The hernia contents were transplanted ureter and bladder in 2, transplanted kidney and ureter and small intestine in one, transplanted kidney and small intestine in one, bladder and small intestine in 3, and only bladder in one patient. Five out of 8 patients showed transplant urinary tract obstruction due to inguinal hernia. All hernias were repaired by using meshes (mesh plug method in 6, Lichtenstein method in 2). The operative time was 120 (86 - 155) minutes and blood loss was 7 (3 - 85) ml. Serum creatinine levels in five urinary obstructed patients were improved (p < 0.01) and transplanted urinary tract obstruction was disappeared after surgery. During follow-up period, no recurrence of inguinal hernia was observed and only chronic pain in the groin area (Clavien-Dindo grade II) was complicated in one patient. Conclusion: According to the previous 23 published cases, the median age at presentation was 59 years and median post-transplantation period was 11.5 years. Right side inguinal hernia was 65%, and 91% of inguinal hernias were presented ipsilaterally to the graft. As initial treatment to avoid graft failure, percutaneous nephrostomy (61%) and ureteral stenting (39%) were frequently reported. Transplant ureteral obstruction due to inguinal hernia is a rare complication after kidney transplantation. However, transplant ureter or bladder herniation should be considered in the differential diagnosis of graft hydroureteronephrosis for preventing allograft loss. Surgical intervention for inguinal hernia after kidney transplantation was safe and effective treatment to prevent worsening kidney graft function.

A case of bilateral inguinal hernia associated with Marfan syndrome

Marfan syndrome, a connective tissue disease, is associated with a high incidence and recurrence rate of inguinal hernia. We herein report a three-year-old boy with bilateral inguinal hernia associated with Marfan syndrome. While preoperative contrast-enhanced computed tomography (CT) revealed a left indirect inguinal hernia and a right direct inguinal hernia, laparoscopy showed bilateral patent processus vaginalis (PPV) and vulnerability of the abdominal wall at the bilateral medial inguinal fossae. In addition to laparoscopic percutaneous extraperitoneal closure (LPEC), open iliopubic tract repair was also performed. To our knowledge, this is the first report of a therapeutic strategy for pediatric inguinal hernia with Marfan syndrome. • Children with Marfan syndrome may develop direct inguinal hernias. • Computed tomography while awake in the prone position led to the diagnosis. • Combined laparoscopic and open hernia repair were useful.

Study of Operative Outcomes of Hernioplasty Using Mosquito Net Mesh at a Tertiary Hospital.

BackgroundSynthetic mesh is the most efficient way to repair groin hernias. However, many patients in low and middle-income countries cannot afford the above-mentioned mesh. This study's goal was to describe the mosquito net mesh's (MNM) safety, viability, complications, and recurrence rate in hernioplasty done in rural populations.Material and methodsThis study was a single-centre, prospective, descriptive study, conducted in patients >18 years of age, of either gender, with unilateral or bilateral primary inguinal hernias (reducible/irreducible/bilateral hernia), admitted for elective or emergency open inguinal hernia mesh repair. The surgery was performed using reasonably priced (affordable to people of low socioeconomic status) polyethylene mosquito net mesh, which was cut into 8x16 cm rectangles and wrapped in two sealed plastic bags. They were sterilised using the ethylene oxide sterilisation (EtO) method. The type of hernia (unilateral or bilateral), post-operative pain, and complications were noted.ResultsAmong 400 study participants, the incidence of inguinal hernia was highest in the 60-79 year age group (51.5%). Direct inguinal hernia (67.5 %) was higher compared to indirect inguinal hernia (32.5 %). While a majority of the participants had a hernia on the right side (50%), 164 patients (41%) had a hernia on the left side, and 36 patients (9%) had a bilateral inguinal hernia. The average operative time for unilateral inguinal hernia was 73.96 minutes and for bilateral inguinal hernia was 106.66 minutes. Out of 400 patients, 355 patients (88.75%) had no complications. Among the postoperative patients, 14 patients (3.5%) experienced surgical site infection; 9 patients (2.25%) experienced headache; 5 patients (1.25%) experienced hematoma; 12 patients (3%) experienced urinary retention; and 5 patients (1.25%) experienced testicular pain. The average hospital stay of patients was 4.25 days. Patients returned to their daily activities and employment in an average of 7.29 days. The market cost of a single standard polypropylene mesh was Rs.1,660/-. For making a single mosquito net mesh of the same size, we had an expenditure of Rs. 11.83/- including the cost of sterilization. In this study, 382 patients (95.5%) gave us good feedback, 11 patients (2.75) gave satisfactory feedback, and 7 patients (1.75%) gave excellent feedback.ConclusionIn environments with limited resources, using mosquito net mesh for hernioplasty is reasonable, acceptable, doable, and economical.

Cost analysis of robotic assisted general surgery cases in a single academic institution.

Laparoscopy is currently the standard approach for minimally invasive general surgery procedures. However, robotic surgery is now increasingly being used in general surgery. Robotic surgery provides several advantages such as 3D-visualization, articulated instruments, improved ergonomics, and increased dexterity, but is also associated with an increased overall cost which limits its widespread use. In our institution, the robotic assisted approach is frequently used for the performance of general surgery cases including inguinal hernias, cholecystectomies and paraesophageal hernia (PEH) repairs. The primary aim of the study was to evaluate the differences in cost between a robotic and laparoscopic approach for the above-mentioned cases. With IRB approval, we conducted a retrospective cost analysis of patients undergoing inguinal hernia repairs, cholecystectomies and PEH repairs between June 2018 and November 2020. Patients who had a concomitant procedure, a revisional surgery, or bilateral inguinal hernia repair were excluded from the study. Cost analysis was performed using a micro-costing approach. Statistical significance was denoted by p < 0.05. There were no differences among the different groups in relation to age, gender, ethnicity, and BMI. The overall cost of the robotic (R-) approach compared to a laparoscopic (L-) approach was significantly lower for cholecystectomy ($3,199.96 vs $4019.89, p < 0.05). For inguinal hernia repairs and PEH repairs without mesh, we found no significant difference in overall costs between the R- and L- approach (R- $3835.06 vs L- $3783.50, p = 0.69) and (R- $6852.41 vs L- $6819.69, p = 0.97), respectively. However, the overall cost of PEH with mesh was significantly higher for the R- group compared to the L- group (R- $7,511.09 vs L- $6,443.32, p < 0.05). Based on our institutional cost data, use of a robotic approach when performing certain general surgery cases does not seem to be cost prohibitive.

Validity Evidence for ENTRUST as an Assessment of Surgical Decision-Making for the Inguinal Hernia Entrustable Professional Activity (EPA)

As the American Board of Surgery (ABS) moves toward implementation of Entrustable Professional Activities (EPAs), there is a growing need for objective evaluation of readiness for entrustment of residents. This requires not only assessment of technical skills and knowledge, but also surgical decision-making in preoperative, intraoperative, and postoperative settings. We developed and piloted an Inguinal Hernia EPA Assessment on ENTRUST, a serious game-based online virtual patient simulation platform to assess trainees' decision-making competence. This is a prospective analysis of resident performance on the ENTRUST Inguinal Hernia EPA Assessment using bivariate analyses. This study was conducted at an academic institution in a proctored exam setting. Forty-three surgical residents completed the ENTRUST Inguinal Hernia EPA Assessment. Four case scenarios for the Inguinal Hernia EPA and corresponding scoring algorithms were iteratively developed by expert consensus aligned with ABS EPA descriptions and functions. ENTRUST Inguinal Hernia Grand Total Score was positively correlated with PGY-level (p < 0.0001). Preoperative, Intraoperative, and Postoperative Total Scores were also positively correlated with PGY-level (p = 0.001, p = 0.006, and p = 0.038, respectively). Total Case Scores were positively correlated with PGY-level for cases representing elective unilateral inguinal hernia (p = 0.0004), strangulated inguinal hernia (p < 0.0001), and elective bilateral inguinal hernia (p = 0.0003). Preoperative Sub-Scores were positively correlated with PGY-level for all cases (p < 0.01). Intraoperative Sub-Scores were positively correlated with PGY-level for strangulated inguinal hernia and bilateral inguinal hernia (p = 0.0007 and p = 0.0002, respectively). Grand Total Score and Intraoperative Sub-Score were correlated with prior operative experience (p < 0.0001). Prior video game experience did not correlate with performance on ENTRUST (p = 0.56). Performance on the ENTRUST Inguinal Hernia EPA Assessment was positively correlated to PGY-level and prior inguinal hernia operative performance, providing initial validity evidence for its use as an objective assessment for surgical decision-making. The ENTRUST platform holds potential as tool for assessment of ABS EPAs in surgical residency programs.

Indications and Outcomes of a Hybrid Method Combining Laparoscopic and Anterior Approaches for Inguinal Hernia Repair.

IntroductionSurgery for complex inguinal hernia (IH) (recurrent IH or IH after radical prostatectomy (RP)) may be difficult because of the presumed scar or adhesion in the retropubic space. A hybrid method combining the laparoscopic and anterior approaches (HLAA) in a bidirectional surgical technique may be an option in complex IH cases.MethodsPatients at our institution who underwent IH repair for complex IH using HLAA from April 2018 to November 2019 were included. We retrospectively evaluated the patient characteristics, IH diagnosis, intraoperative variables, complications, and hernia recurrence during the follow-up period.ResultsTwenty patients were involved in this study. Seven patients underwent hLAA for recurrent IH, whereas the remaining 13 underwent hLAA for IH after RP. Five patients had bilateral IH, all of whom had IH after RP. The type of IH was lateral in 21 patients, medial in six patients, and lateral and medial in two patients. Hernia repair was performed using a patch alone in two patients and a plug and patch in 18 patients. Seroma or hematoma was observed in five patients, and one patient experienced chronic pain. No hernia recurrence was observed during the median follow-up period of 24 months.ConclusionhLAA could facilitate precise diagnosis and intraoperative confirmation of repair for recurrent IH and IH after RP. The intraoperative findings and the cause of recurrence can be easily shared among surgeons in hLAA. Further investigations are necessary to determine the long-term efficacy of hLAA in a larger cohort.

Laparoscopic bilateral inguinal hernia repair: Should it be the preferred technique?

Inguinal hernias are amongst the most common conditions requiring general surgical intervention. For decades, the preferred approach was the open repair. As laparoscopy became more popular and available and more surgeons became familiarized with this modality, laparoscopic inguinal hernia repair became an alternative. The aim of this study is to assess the effectiveness of laparoscopic inguinal repair, with a focus on bilateral inguinal hernias. Initial reports have shown promising clinical outcomes compared to those of conventional repair of bilateral hernias. However, there are only a few studies concerning laparoscopic repair of bilateral hernias. It is yet to be proven that laparoscopy is the “gold standard” in the treatment of bilateral inguinal hernias. So far, the choice of an inguinal hernia repair technique has been up to each surgeon, depending on their expertise and available resources after taking into consideration each patient’s needs.

Contralateral patent processus vaginalis repair in boys: a single-center retrospective study

To ascertain the prevalence of contralateral patent processus vaginalis (CPPV) in life and the significance of the prevalence trends for treatment. We performed a retrospective review of all inguinal hernias (IHs) that underwent repair in our hospital from 2014 to 2018. We analyzed the frequency of occurrence and treatment in boys. We assessed and compared the history, initial sides of hernia, CPPV and prognoses in different age groups. We assessed all IH cases repaired in our hospital and selected male patients of a variety of ages, including boys and men. Recurrent cases were not enrolled. A total of 3243 cases were enrolled: 2489 [right-sided IH 1411 (56.69%) vs. left-sided IH 975 (39.17%), bilateral IH 103 (4.14%)] in children and 754 [right-sided IH 485 (64.32%) vs. left-sided IH 236 (31.30%), bilateral IH 33 (4.38%)] in adults. A total of 1124 CPPVs were identified in children with unilateral IH (2386), and 12 were identified in adults (267) (p < 0.0001). There were no significant differences in recurrence rate between different subgroups of children (p > 0.05). The incidence of IH in boys was significantly higher than that in men. The number of incident cases declines rapidly with age in boys. The processus vaginalis is normally obliterated and involuted but may instead remain patent for a long period before closure; routine exploration on the contralateral side may eliminate the possibility of spontaneous PPV closure.

Repair of Bilateral Inguinal Hernia in Children with a Single Cosmetic Incision. Our Experience in Tertiary Care Center

Aim: To evaluate the advantages/benefits of a single cosmetic incision approach for the repair of bilateral inguinal hernia in children. Study design: A cross-sectional study Place and Duration of study: Pediatric surgery department, Liaquat University of Medical &amp; Health Sciences Jamshoro from February 2017 and June 2022 Methodology: Bilateral inguinal herniorrhaphies were performed on a total of 178 children and infants who received treatment in succession. A single, transverse, 2.5-cm long suprapubic incision was performed in 89 (50%) of the patients, and the Scarpa fascia was punctured using cautery. The external ring was located and opened after retracting the wound, and the ilioinguinal nerve was safeguarded. After testicular vascular and sac separation from vas deference, the hernial sac is delicately Trans ligated with 3-0 Vicryl (Ethicon), closed was the external oblique aponeurosis. The wound was then retracted to the opposite side and treated there using the same technique. Results: Ages ranged from 3 months to 11 years at the time of operation (average, 29.8 months). 56.93% of the patients—96—were under the age of one, with 51 of them—28.65%—being under the age of six months. 48 patients were 1 to 5 years old, and 24 were over the age of 5. The average operating time was 8–10 minutes shorter than it had been in the past for children who had undergone bilateral inguinal incisions, which typically took 30–40 minutes. The visual look and overall outcomes have pleased the patients and parents. There haven't been any recurrences so yet. Conclusion: In order to improve therapeutic impact and lower the risk of complications and recurrence, we develop a single incision method for bilateral inguinal herniorrhaphies. Depending on the availability of a paediatric surgeon with the necessary experience and skills, a single incision technique for treating a child's bilateral inguinal hernia is practical, safe, and can be provided to patients. Keywords: single incision approach, inguinal herniorrhaphies, children, cosmetics

Initial experience in a novel robotic system: Hugo™ robotic assistant surgery system for robotic inguinal hernia repair

The Hugo Robotic Assistant Surgical (RAS)TM system is a modular portable robotic surgical assistant pioneered by Medtronic Limited currently being used as a research device. It was used in performing a trans-abdominal pre-peritoneal repair for bilateral inguinal hernia at Institutes of Hernia Surgery and Abdominal Wall Reconstruction, Apollo Hospitals, Chennai, India. This reports our initial experience in using a novel robotic surgical assistant system in performing robotic inguinal hernia repair.

Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair

Urinary catheters are commonly placed during laparoscopic inguinal hernia repair as a presumed protection against postoperative urinary retention (PUR), one of the most common complications following this operation. Data from randomized clinical trials evaluating the effect of catheters on PUR are lacking. To investigate the effect of intraoperative catheters on PUR after laparoscopic inguinal hernia repair. This 2-arm registry-based single-blinded randomized clinical trial was conducted at 6 academic and community hospitals in the US from March 2019 to March 2021 with a 30-day follow-up period following surgery. All patients who presented with inguinal hernias were assessed for eligibility, 534 in total. Inclusion criteria were adult patients undergoing laparoscopic, elective, unilateral, or bilateral inguinal hernia repair. Exclusion criteria were inability to tolerate general anesthesia and failure to understand and sign the written consent form. A total of 43 patients were excluded prior to intervention. Patients in the treatment arm had placement of a urinary catheter after induction of general anesthesia and removal at the end of procedure. Those in the control arm had no urinary catheter placement. PUR rate. Of the 491 patients enrolled, 241 were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively; P = .79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement. Intraoperative urinary catheters did not reduce the risk of PUR after laparoscopic inguinal hernia repair. While their use did not appear to be associated with a high rate of iatrogenic complications, there may be a low rate of catastrophic complications. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered. ClinicalTrials.gov Identifier: NCT03835351.

Perineal hernia repair after abdominoperineal resection (APR) with the laparoscopic-peritoneal dual fixation technique.

Perineal hernia (PH) following abdominoperineal resection (APR) is a rare but challenging problem. Although different techniques have been described in literature, the recurrence rate is still remarkable, and there is no consensus regarding the optimal repair approach. In the present study, we reported our experience based on a consecutive series of ten cases. Ten symptomatic large perineal hernias were repaired exclusively with the same laparoscopic-perineal dual fixation technique. Key steps consist laparoscopic adhesiolysis, hernia contents reduction, open excess perineal hernia sac resection, and mesh placement and dual fixation. Frist, a coated mesh was fixed to the sacrum and pelvic sidewalls with the metallic tacks in the laparoscopic step, second, the mesh was fixed anteriorly to urogenital diaphragm and laterally to the sacrotuberous ligament with permanent sutures in the perineal step. Ten symptomatic PHs were repaired by the same laparoscopic-perineal dual fixation technique, 6 males and 4 females, median age at the time of repair was 69.5years (range 66-77years), the BMI was 24 ± 1. Four concomitant procedures were performed, including bilateral inguinal hernia repair with the transabdominal preperitoneal repair (TAPP) in one case, and laparoscopic parastomal hernia repair in two patients. The average operative time was 171 ± 45min; the postoperative average hospital stay was 14 ± 4days. There was no perineal hernia recurrence during the follow-up period (the median follow-up was 42months; range 1-63months). Perineal hernia after APR is a rare and challenging postoperative complication, although many different approaches have been described, the recurrence is still high and the best method cannot be drawn. The present laparoscopic-perineal dual fixation approach proved to be a reproducible, effective and durable technique, and gave excellent results during the medium-long-term follow-up.

053 Totally extraperitoneal approach (TEP) for gonadectomy for differences in sex development (DSD): Report of 2 cases

Introduction: 17-β-hydroxysteroid dehydrogenase type-3 deficiency (17βHSD-3) is a rare cause of 46XY DSD. Gonadectomy is often offered to prevent further virilization and to continue living in a female gender role [ [1] Chuang J. Vallerie A. Breech L. Saal H.M. Alam S. Crawford P. Rutter M.M. Complexities of gender assignment in 17β-hydroxysteroid dehydrogenase type 3 deficiency: is there a role for early orchiectomy?. Int J Pediatr Endocrinol. 2013; 12: 15 Crossref Google Scholar ]. Both laparotomic and laparoscopic approaches to gonadectomy had been described for DSDs [ [2] Dellaportas D. Chatzipapas I. Pandraklakis A. Michala L. Laparoscopic bilateral gonadectomy and inguinal hernia repair with mesh for complete androgen insensitivity syndrome: A case report. J Pediatr Adolesc Gynecol. 2019; 32 (Epub 2019 Feb 27): 443-445 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. Retrieval and removal of testes located in the inguinal canal can be technically challenging and requires collaboration with surgical colleagues. Cases: We present 2 cases of DSD with 17βHSD-3. One of them is 16 years old, while the other one is 20 years old. Both cases presented with amenorrhea and clitoral enlargement, whereas the second case also had deepening of voice. Blood tests for both revealed elevated testosterone and androstenedione. MRI findings were similar showing bilateral gonads located in the inguinal canals. Genetic tests revealed 46 XY karyotype and HSD17B3 gene mutation. Both subjects opted to continue with a female gender role and opted for gonadectomy to prevent further virilization. Gonadectomy was performed with a totally extraperitoneal laparoscopic approach. An infraumbilical incision was made and care was taken to enter the potential space above the rectus sheath. Then a balloon was placed via the port to distend the extraperitoneal space and then the laparoscope was inserted. Secondary ports at the suprapubic region and the left lower quadrant were placed. The gonads were mobilized and gonadectomy performed. Gonadectomy was successfully performed for the first case, but for the second case, there was failure to mobilize the gonad and operation was completed with inguinal incisions. Conclusion: Totally extraperitoneal laparoscopic approach for hernia repair is a well-established technique familiar to surgeons [ [3] McKernan J.B. Laws H.L. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc. 1993; 7: 26-28 Crossref PubMed Scopus (264) Google Scholar ]. This was the first time the TEP approach has been described for gonadectomy for DSD. By cooperating with surgeons who has abundant experience in operating in this region, one can allow utilization of techniques which were already commonly used. It raises the importance as gynecologists, we should be mindful of technological advances in other specialties as with other aspects of DSD, collaboration with other specialties may lead to advances in patient management.

Laparoscopic inguinal hernia repair in bladder exstrophy, a new modified solution to an old problem: A cohort study.

PurposeOpen inguinal hernia repair in children with bladder exstrophy is challenging and associated with a high recurrence rate (15%–22%).We report our initial experience with laparoscopic repair of inguinal hernias in five children with repaired bladder exstrophy. This study is the third describing inguinal hernia repair in bladder exstrophy patients using the laparoscopic approach. In this study, we report a different laparoscopic technique.MethodsThis retrospective study was performed on data regarding laparoscopic inguinal hernia repair collected over one year (July 2019–2020). We carried out the laparoscopic inguinal hernia repair, closing the internal inguinal ring using a non-resorbable sliding knot suture and incorporating the transversalis fascia for reinforcement, followed by purse-string closure of the peritoneum.Peri- and postoperative outcome parameters, including recurrence rate, were evaluated over a follow-up period of 14 months.ResultsA total of seven male patients from July 2019 to 2020 were admitted to our center with a history of repaired bladder exstrophy and reducible inguinal hernias. Two patients had open inguinal hernia repair due to parental preference and five patients had laparoscopic repair. In the laparoscopic group three patients had bilateral inguinal hernias in one of them a metachronous hernia was discovered intraoperstively, and the remaining two patients had unilateral hernias, one on the right side and the other on the left side. All patients in the laparoscopic group had an uneventful recovery and were discharged within 24 h and there were no complications or recurrences during follow-up.ConclusionLaparoscopic inguinal hernia repair is a better alternative to managing inguinal hernias in children with bladder exstrophy.

Major bilateral inguinal hernia involving both kidneys

Major bilateral inguinal hernia involving both kidneys

Recurrence following laparoscopic repair of bilateral inguinal hernia in children under five

BackgroundReported recurrence rates after laparoscopic versus open inguinal hernia repair have been limited to high volume centers with short follow-up. We sought to compare national rates of recurrence after laparoscopic versus open bilateral inguinal hernia repair. MethodsChildren under five who underwent bilateral inguinal hernia repair between 2010 and 2020 were identified using the PearlDiver Mariner database. Time to recurrence was compared using Kaplan Meier analysis and Cox proportional hazards regression models. ResultsHernia recurrence requiring reoperation occurred in 182 (2.2%) of 8,367 children. Rate of recurrence was higher following laparoscopic repair compared to open (1-year: 2.8% vs. 1.5%; 3-year: 3.7% vs. 2.0%; p < 0.01). This difference remained after adjustment for demographic and operative characteristics (adjusted hazard ratio [aHR]: 2.00 [95% confidence interval [CI]: 1.31, 3.05]). ConclusionsRisk of recurrence was higher after laparoscopic compared to open repair of bilateral inguinal hernia repair in a national cohort of children under age five.

Six‐month survival of a monochorionic monoamniotic twin with sirenomelia

Sirenomelia is a congenital malformation of the lower body characterized by a single midline lower limb and severe urogenital and gastrointestinal malformations. Sirenomelia is rare (estimated incidence of approximately 1/100,000) and usually lethal in the perinatal period. A 2,042 g Japanese male infant, one of monochorionic monoamniotic twins, was born at 34 weeks of gestation by elective caesarean section. Sirenomelia was prenatally diagnosed. Single midline lower limb, bilateral dysplastic kidneys, an omphalomesenteric fistula, colon atresia, imperforate anus, indiscernible genital structures, and myelomeningocele were detected at birth. The amniotic fluid volume was normal throughout the pregnancy course, which led to appropriate lung maturation of the twin with sirenomelia. Although renal replacement therapy was initiated soon after birth, stable peritoneal dialysis was difficult because of the limited intraperitoneal space, and the infant frequently developed peritonitis. He died of sudden cardiorespiratory arrest at 6 months of age. Postmortem examination showed bilateral dysplastic kidneys, agenesis of the ureters and urinary bladder, abnormal branching and agenesis of the distal colon, bilateral inguinal hernias, and small testes. Infants with sirenomelia, even those with end-stage kidney disease at birth, may survive if they have a stable cardiorespiratory status at birth and renal replacement therapy is appropriately initiated.

Bilateral Female Inguinal Hernia Repair in Margaret Marquart Catholic Hospital and Review of Literature.

Background:Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan Africa for same time repairs in complicated or elective hernia surgeries is largely unknown.Aims and Objectives:Our aim is to report a rare case of same time bilateral inguinal hernia obstruction and review the outcome of bilateral nylon darn posterior wall repairs after herniotomy.Design of the Study:This was a retrospective analysis of bilaterally operated inguinal hernia female patients data that was retrieved for the past 6-year period. Settings: All complete records of female patients who had same time bilateral inguinal hernia repairs at the Margaret Marquart Catholic Hospital (district hospital), for the period January 2015 to December 2020 were included in the study.Materials and Methods:Patient biodata, clinical notes on diagnosis, surgical management, postoperative care, and complications were extracted from hospital records and analysed.Results:A total of 14 patients aged between 40 and 87 years which represented 1.85% of the total hernia repairs were female with same time bilateral inguinal hernia repairs. Seven (50%) patients presented at the emergency with hernias detected over a year. Surgical site infection and pains after surgery were the predominant complications and occurred more common after emergency repairs.Conclusion:Emergency bilateral inguinal hernia repairs were three times associated with surgical site infection compared to elective repairs.