Common General Surgery Operations Research Articles

Outpatient surgery benchmarks and practice variation patterns: Case controlled study.

Despite numerous potential benefits of outpatient surgery, there is currently a lack of national benchmarking data available for hospitals and surgeons to compare their own outcomes as they transition toward outpatient surgery. Patients who underwent 14 common general surgery operations from 2016-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Operations were selected based on frequency and the ability to be performed both in- and outpatient. Postoperative complications and readmissions were compared between patients who underwent inpatient vs outpatient surgery. After adjusting for patient comorbidities, multivariable models assessed the effect of patient characteristics on the odds of experiencing postoperative complications. A separate multiinstitutional study of 21 affiliated hospitals assessed practice variation. In 13 of the 14 studied procedures, complications were lower for patients who were selected for outpatient surgery (all P<0.01); minimally invasive (MIS) adrenalectomy showed no difference (P=0.61). Multivariable analysis confirmed these findings; the odds of experiencing any adverse events were lower following outpatient surgery in all operations but MIS adrenalectomy (OR 0.97; 95% CI 0.47-2.02). Analysis of institutional practices demonstrated variation in the rate of outpatient surgery in certain breast, endocrine, and hernia repair operations. Institutional practice patterns may explain the national variation in the rate of outpatient surgery. While the present data does not support the adoption of outpatient surgery to less optimal candidates, addressing unexplained practice variations could result in improved utilization of outpatient surgery.

Comparison of Perioperative Complication Rates of Total Extraperitoneal and Transabdominal Preperitoneal Repairs in Primary Inguinal Hernia.

Hernia may be defined as a protrusion of viscus through layers anatomically designed to contain that viscus. Most abdominal hernias occur at well-described sites of potential weakness. Repair of inguinal hernia is one of the most common operations in general surgery. Objectives: To compare the perioperative complication rates of total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs of primary inguinal hernias. It is a randomised comparative study, conducted at the department of general surgery. A total of 50 patients were included and divided into two groups with 25 in each. Group A represents the laparoscopic TEP repair and group B represents the laparoscopic TAPP repair. Patients above 18 years with primary unilateral inguinal hernia were included. Patients having complicated inguinal hernia and history of previous abdominal surgery were excluded. We observed that hernia occurrence is more common in the 31-50 years of age group and right-sided hernia is more common. Scrotal oedema and conversion to open surgery chances are similar in both TEP and TAPP groups. The duration of surgery in TEP is significantly higher as compared to TAPP. Patients who underwent TEP experienced less pain as compared to TAPP as per visual analogue scale. Postoperative hospital stay and time taken to resume the routine activity were significantly less in case of TEP. TEP is preferred over TAPP for laparoscopic hernia repair because it preserves the peritoneal integrity and has lesser postoperative pain. The early recovery and return to the routine work were seen with the patient treated with the TEP and also showed better visual analogue score than the TAPP repair group.

Is It Safe to Perform Laparoscopic Cholecystectomy and Transabdominal Preperitoneal Hernia Repair Simultaneously?

Abstract Background/Aims: Cholecystectomy and inguinal hernia repair are the most common operations in general surgery. With the laparoscopic approach, the risk of postoperative pain and infection is lower, patients can return to their daily activities in a shorter time, and the cosmetic appearance is better. However, surgical procedures in which laparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP) are performed simultaneously are limited. The safety of this procedure is questioned in this article. Methods: The records of 38 patients who had undergone simultaneous laparoscopic cholecystectomy and TAPP were retrospectively reviewed, and patient demographic characteristics, indications for surgery, parameters associated with surgery, and postoperative complications were elicited. Results: The mean age of the patients was 48 ± 6.7 years, the youngest patient was 32 years old, and the oldest patient was 68 years old. The average operation time of the patients was 124 ± 26 minutes, and the average postoperative hospital stay was 2.1 ± 0.4 days. As for intraoperative complications, bleeding due to a double cystic artery in one patient, and perforation of the gallbladder in one patient were observed. In the postoperative period, one patient was found to have a seroma in the hernia area (in the patient with gallbladder perforation), and one patient had a recurrence in the hernia area in the late phase. Conclusions: Our study demonstrated that laparoscopic cholecystectomy and TAPP surgery could be safely performed simultaneously. The results of our study also include that prioritizing cholecystectomy does not increase the mesh infection rate.

Surgical Procedures at Critical Access Hospitals Within Hospital Networks.

To compare surgical outcomes and expenditures at critical access hospitals that do versus do not participate in a hospital network among Medicare beneficiaries. Critical access hospitals provide essential care to more than 80 million Americans. These hospitals, often rural, are located more than 35 miles away from another hospital and are required to maintain patient transfer agreements with other facilities capable of providing higher levels of care. Some critical access hospitals have gone further to formally participate in a hospital network. This was a cross-sectional retrospective study from 2014 to 2018 comparing 16,128 Medicare beneficiary admissions for appendectomy, cholecystectomy, colectomy, or hernia repair at critical access hospitals that do versus do not participate in a hospital network. Thirty-day mortality and readmissions were risk adjusted using multivariable logistic regression accounting for patient and hospital factors. Price-standardized, risk-adjusted Medicare expenditures were compared for the 30-day total episode payments consisting of index hospitalization, physician services, readmissions, and postacute care payments. Beneficiaries (average age = 75.7 years, SD = 7.4) who obtained care at critical access hospitals in a hospital network were more likely to carry ≥2 Elixhauser comorbidities (68.7% vs. 62.8%, P < 0.001). Rates of 30-day mortality were higher at critical access hospitals in a hospital network (4.30% vs. 3.81%, OR = 1.11, P < 0.001). Similarly, readmission rates were higher at critical access hospitals that were in a hospital network (15.13% vs. 14.34%, OR = 1.06, P < 0.001). Additionally, total episode payments were found to be $960 higher per patient at critical access hospitals that were in a hospital network ($23,878 vs. $22,918, P < 0.001). Critical access hospitals within hospital networks provided care to more medically complex patients and were associated with worse clinical outcomes and higher costs among Medicare beneficiaries undergoing common general surgery operations.

Retrospective Identification of Barriers to On-Time Discharge in Common General Surgery Operations

Introduction: Increased durations of hospital stays are associated with increased nosocomial infections, higher mortality rates, lower patient satisfaction, and increased cost. This study aimed to identify barriers to safe and on-time discharge. Methods: Data was collected from electronic health records for all elective surgeries performed at an academic medical center over the last 5 years. The top 4 operations were selected: coronary artery bypass graft surgery (CABG) (n = 342), video-assisted thoracoscopic surgery (VATS) (n = 216), cholecystectomy (n = 350), and ventral hernia repair (n = 153). The primary outcome is length of stay (LOS), specifically extended LOS. Extended LOS was defined by a longer LOS compared with the average LOS provided by the Medicare Severity Diagnosis Related Groups (MS-DRG). Results: There were 6,473 patients and 10,468 operations analyzed. Extended LOS represented 23% of cases. There was no association between extended LOS and demographics, payor type, or employment status. Disposition to short-term nursing facility was associated with extended LOS in CABG and VATS. Unemployed and retired patients were associated with extended LOS among cholecystectomy patients. Conclusion: We identified predictive factors (disposition to a skilled nursing facility, and employment status) contributing to extended LOS postoperatively. We suspect that referral processes, number of facilities, and selection biases associated with short-term nursing facilities are major contributors to extended LOS and improvements in these processes can improve outcomes while decreasing identified risks associated with longer hospital stays.

A Comparison of outcome between Transabdominal Preperitoneal (TAPP) and Lichtenstein operation for primary inguinal hernia repair – An institutional study

Introduction: Inguinal hernia repairs are one of the most common operations in general surgery. Apart from the classical open repairs, minimally invasive approaches are increasingly preferred to manage groin hernia repair. However, the optimal surgical approach still remains controversial.&#x0D; Methods: This is a prospective observational study done in Shree Birendra Hospital, a 750- bedded tertiary care military hospital located in Kathmandu from July 2021 to December 2021. A total of 120 patients operated for inguinal hernia by either open Lichtenstein repair or Transabdominal Preperitoneal (TAPP) in the department of surgery were included in this study.&#x0D; Results: The mean age of patients between open Lichtenstein repair and TAPP was 59.3 (22-79) and 63.4 (27-70) years respectively. The majority of patients were male among both the groups constituting of more than 95%. The mean intraoperative duration among the two groups was 44.12±7.23 minutes and 77.43±8.77minutes, respectively (p=0.021). The mean postoperative pain was less in TAPP procedure compared to open procedure (p=0.037). The mean duration of the postoperative hospital stay was 2± 1.12 and 1±0.79 respectively. At the three-month evaluation, there were four cases of recurrence of which one of them underwent open procedure while three underwent TAPP procedure.&#x0D; Conclusion: Both the open Lichtenstein repair and the TAPP procedures are safe and effective in the repair of primary inguinal hernia. In a view of postoperative pain, seroma formation and length of hospital stay TAPP procedure has been found superior to open procedure in our study.

Qualitative analysis of theses on laparoscopic cholecystectomy

Objectives: The purpose of this study was to examine bibliographically the theses on laparoscopic cholecystectomy in our country and to provide the researchers with a perspective on the elimination of the deficiencies in this field. Materials and methods: Content analysis and descriptive analysis methods, which are among qualitative research methods, were used in the study. The study group conducted research in the field of general surgery in Turkey until December 31, 2020, with the keyword “laparoscopic cholecystectomy” indexed in the National Thesis Center database of the Council of Higher Education (CoHE). A thesis review form was created to analyze theses with digital copies that can be accessed after a list of theses was created. The thesis supervisor, institution, research method, data analysis techniques, advisor titles, working group, and research subjects, as well as the year the theses were published, were all examined. Results: The research included 45 theses. It was determined that most theses were recorded between 1995 and 2000. Thirty-two of them (71.1%) were made in universities. The institution with the most theses on this subject was GATA/Haydarpaşa Training Hospital. There were 32 prospective and 39 clinical trials. Only two of the studies were randomized, while the other two were experimental. Conclusion: It was determined that the majority of the theses were about clinical research and operation results, but there were very few experimental and randomized controlled studies, and no animal experiments were found. It can be concluded that studies on this subject, which is one of the most common general surgery operations, are needed.

P144 SPERMATIC CORD LIPOSARCOMA - A VERY RARE FINDING DURING INGUINAL HERNIA SURGERY

Abstract Aim Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding. Material and Methods We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses. Results After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision. Conclusions Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Defining the Deficit in US Surgical Training: The Trainee’s Perspective

Self-efficacy is the personal judgment of how well one can successfully complete a task. The goal of this study was to assess self-efficacy of PGY5 residents for common general surgery operations. We hypothesized there are deficits in self-efficacy of PGY5 residents, and self-efficacy of a given operation correlates with experience performing the operation without attending assistance (independently) and teaching the operation from start to finish. A survey was linked to the 2020 American Board of Surgery In-Training Examination. From the ACGME case log's 15 most commonly performed surgeon-chief operations and AHRQ's 15 most common operations, 10 operations were selected. Residents evaluated their ability to perform these operations independently using a 5-point self-efficacy scale. Residents were asked whether they had experience performing these operations independently or teaching the operation from start to finish. Descriptive statistics and Pearson correlation were used to examine the relationship between self-efficacy and operative experience. In all, 1,145 of 1,367 PGY5 residents (84%) responded. Highest self-efficacy was in performing wide-local excision (90.24%) and lowest was in performing open thyroidectomy (19.58%). Eighty-eight (7.7%) reported self-efficacy in all procedures. Statistically significant positive correlations were identified between experience and self-efficacy for cases performed without assistance (r= 0.98, p < 0.01) and cases taught (r= 0.91, p < 0.01). With 5 months left in training, 92.3% of residents report deficits in preparation for practice, as defined by self-efficacy to complete common procedures independently. Resident self-efficacy increased in direct relation to performed cases and cases taught.

Analysis of Publications on Laparoscopic Inguinal Hernia Surgery

Repair of inguinal hernia is one of the most common operations in general surgery. The aim of the current study is to analyze the scientific studies in the field of laparoscopic inguinal hernias by ISI Web of Knowledge-Web of Science (WoS) software by using keywords. Overall,2832 papers were found related to laparoscopic inguinal hernia. The first publication and the first citation were from Australia in 1991. The biggest scientific contribution was from the USA (n = 650), the types of publications dominantly were articles (76.80%), most of publications were in English (93.18%), and the most contributed author was Bittner R (n = 63) from Germany. Our study revealed that scientific studies on this field will probably continue to rise in parallel with this increasing interest.

Hospital Variation in Geriatric Surgical Safety for Emergency Operation

The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortality vary in hospitals performing nonelective operations in geriatric patients? Second, can the differences in hospital-based mortality be explained by patient-, operative-, and hospital-level characteristics among outlier institutions? Patients 65 years and older who underwent 1 of 8 common emergency general surgery operations were identified using the California State Inpatient Database (2010 to 2011). Expected mortality was obtained from hierarchical, Bayesian mixed-effects logistic regression models. A risk-adjusted hospital-level standardized mortality ratio (SMR) was calculated from observed-to-expected in-hospital deaths. "Outlier" hospitals had an SMR 80% CI that did not cross the mean SMR of 1.0. High-mortality (SMR >1.0) and low-mortality (SMR <1.0) outliers were compared. We included 24,207 patients from 107 hospitals. SMRs varied widely, from 2.3 (highest) to 0.3 (lowest). Eleven hospitals (10.3%) were poor-performing high-SMR outliers, and 10 hospitals (9.3%) were exceptional-performing low-SMR outliers. SMR was 3 times worse in the high-SMR compared with the low-SMR group (1.7 vs 0.6; p < 0.001). Patient-, operation-, and hospital-level characteristics were equivalent among outlier-hospitals. Significant hospital variation exists in standardized mortality after common general surgery operations done emergently in older patients. More than 10% of institutions have substantial excess mortality. These findings confirm that the safety of emergency operation in geriatric patients can be significantly improved by decreasing the wide variability in mortality outcomes.

Developing a Practical and Sustainable Opioid Reduction Strategy Individualized to the Prescriber for Common General Surgery Operations

Developing a Practical and Sustainable Opioid Reduction Strategy Individualized to the Prescriber for Common General Surgery Operations

Akut apandisit tanısı konmuş hastalarda komplikasyon belirteçleri olarak C-reaktif protein ve kırmızı küre dağılım indisinin yeri ve önemi

Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated, mortality and morbidity increases. We aimed to find out whether use of C-reactive protein (CRP) and red cell distribution width (RDW) may help to find out development of complications with acute appendicitis at initial evaluation in an emergency department. Methods: Files of the patients who underwent operations for acute appendicitis between January 2017 and August 2017 were reviewed. Development of complications was recorded and the patients were grouped as with and without complications and were compared about age, sex RDW, CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Diagnostic efficiency of CRP and RDW on the development of complications in acute appendicitis was investigated with regression analysis and by receiver operator characteristic curve analysis. Results: Age, CRP and RDW were found to be significantly related to perforation (p&amp;lt;0.001 for all) (Bonferoni correction), while white blood cell (WBC), AST and ALT were found to be insignificant (p=0.052, p=0.806 and p=0.804, respectively. There was a significant correlation between RDW and CRP in the Spearman non-parametric correlation analysis (correlation coefficient r=0.244 and p&amp;lt;0.001). There was no significant correlation of WBC to CRP and RDW. Conclusion: CRP and RDW are biochemical parameters that help us to identify the development of complications in acute appencitis. CRP may be elevated in acute appendicitis; however, it must be kept in mind to be cautious about a potentially complicated acute appendicitis after a certain level, RDW in our study has been found to be elevated in complicated appendicitis cases; but, it may not helpful to detect for perforated or gangrenous appendicitis.

Evaluation of laparoscopic total extraperitoneal hernioplasty versus open hernioplasty in the management of uncomplicated inguinal hernia

Background: Inguinal hernia repair is one of the most common operations in general surgery. Inguinal hernias are among the most common of abdominal wall hernias accounting for almost 75% with lifetime risk of 27% in men and 3% in women. Laparoscopic techniques for inguinal hernia repair, shown to be superior to open repair in terms of postoperative pain and recovery.Methods: In this study, 54 patients with inguinal swelling were taken, 27 cases each for laparoscopic TEP repair and 27 for open mesh repair were studied and results were analyzed.Results: This study shows the maximum number of patients were in the age group of 51-60years in open repair whereas 41-50years in laparoscopic TEP repair. In both the groups, right sided hernia is common. Time duration of surgery varies from 47minutes to 90minutes in open hernia repair whereas in laparoscopic repair it was 85minutes to 136.67minutes. This longer duration of surgery was attributed to learning curve. The mean duration of hospital stay was 3.26days in laparoscopic TEP repair compared to 5.85days in open repair group.Conclusions: Laparoscopic TEP repair offers a significant advantage over open mesh hernia repair. It is associated with less postoperative pain and complications, early post-operative recovery and reduced hospital stay and early resumption of normal activity and better quality of life. However, operative time was prolonged in laparoscopic TEP repair as compared to open due to the learning curve in the institution.

Gap in knowledge – Repair of inguinal hernia is one of the most common operations in general surgery

Background: Existing guidelines have been endorsed by the European Hernia Society on the treatment of inguinal hernia in adults. However, since implementation, there has been no national benchmark to evaluate the management of inguinal hernia in Portugal. Thus, it remains unknown what are the patterns of provision of care and the difficulties that need to be tackled on a national level. Aim: to characterise the patterns of provision of care in elective inguinal hernia repair in Portugal. Inclusion criteria: patients over 18 years old with appropriate informed consent submitted to inguinal hernia repair, in an elective setting. Exclusion criteria: inability to provide informed consent or to comply with followup schedule. Primary outcome measures: proportion of patients submitted to preoperative imaging examinations (ultrasound, CT, MRI, herniography); incidence of antibiotic prophylaxis; proportion of procedures done as day surgery; employment of a field block (ilioinguinal, iliohypogastric, genitofemoral nerve) in patients undergoing open repair procedures. Secondary outcome measures: overall 30day adverse event rate according to the ClavienDindo classification of postoperative complications; proportion of repair procedures done laparoscopically. Study design: a prospective, multicentre, observational study running in three separate periods of twoweek duration each, across a national setting. Data collection will cover baseline demographic data including risk factors for surgical site infection, preoperative investigations, intraoperative management and postoperative data. Informed consent will be collected on the day of surgery, before the procedure. Postoperative data collection will cover early follow up until discharge and a further phone contact will be made at 30 days postoperatively.

Risk of bowel resection in patients with hernia

Introduction: Repair of hernia is one of the most common general surgery operations. Strangulation of the hernia contents requiring bowel resection is one of the serious complications of hernias. The aim of the present study is to evaluate the risk factors of bowel resection in patients undergoing emergency surgical repair of hernia. Methods: A retrospective study reviewed the medical records of all patients who underwent emergency surgery for hernia from January 2014 to December 2017 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were stratified into two groups: bowel resection was required (Group 1) or not (Group 2). Extracted patients' data for each group included four different fields: (1) personal data and patients' characteristics, (2) preoperative assessment, (3) intraoperative assessment, and (4) postoperative length of hospitalization and complications. The data were analyzed to determine the risk factors for bowel resection. Results: A total of 83 patients underwent emergency surgery hernia repair during the study. A univariate multiple logistic regression model identified three variables that were independent risk factors for bowel resection: duration of symptoms >24 h (odds ratio = 6.093), previous abdominal surgery (odds ratio = 4.531), and high American Society of Anesthesiologists (ASA) classification score (odds ratio = 8.273). Conclusion: Risk factors for bowel resection in emergency hernia repair include high ASA score, previous abdominal surgery, and prolonged the duration of symptoms. Further prospective studies are recommended to confirm the findings of this study.

Common Bile Duct (CBD) exploration for patients with unsuspecting choledocholithiasis - a ten-year study of outcomes

Introduction: Cholecystectomy is one of the most common general surgery operations performed world-wide. A proportion of patients who undergo cholecystectomy (laparoscopic or open) also have concurrent stone disease within the biliary tree requiring bile duct exploration at time of operation. The aim of our study was to review the outcomes of patients with unsuspected choledocholithiasis who underwent CBD exploration at Northern Health. Method: CBD exploration is the standard treatment for patients with choledocholithiasis at Northern Health. An on-call service with 5 available surgeons performs explorations using a choledochoscope. A retrospective audit of patients who underwent CBD exploration for the management of choledocholithiasis between 2008 and 2018 was performed. Analysis was undertaken on factors suspicious for choledocholithiasis, patient demographics and operative features. Result: 6499 patients underwent cholecystectomy in the 10-year period, of which 604 (9.3%) underwent CBD exploration. Unsuspected choledocholithiasis represents 27% of CBD explorations (n = 163). Compared to patients with suspected choledocholithiasis, patients with unsuspected choledocholithiasis are more likely to be younger (median age of 44 vs 51, p=.037), female (75.5% vs 61%, p=.001) and an elective admission (35.9% vs 11.6%, p<.001). Patients with unsuspected choledocholithiasis have similar success rates (93.9% vs 89.8%, p=ns) and surgical times (median 165 vs 163 minutes, p=ns), but reduced length of stay (4 vs 5 days, p<.001) and fewer minor complications (3.1% vs 9.3%, p=.005). Conclusion: Unsuspected choledocholithiasis contributes to a significant proportion of patients who require CBD exploration for the management of choledocholithiasis. Given the success rate, length of stay and low rate of complications, proceeding to CBD exploration should be considered in all patients with unsuspected choledocholithiasis.

Comparison between Cyanoacrylate, Sutureless and Polypropylene Sutures in Mesh Fixation on Lichtenstein Tension free in repair of Open Inguinal Hernia

Background: inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become gold standard in open inguinal hernia repair. Despite the low recurrence rates; postoperative pain and discomfort remain a problem for a large number of patients. Aim of the work: the aim of this study is to compare between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia regard as postoperative pain, infection, recurrence,& cost benefit. Methods: a total of thirty patients with primary unilateral uncomplicated inguinal hernia were randomized to undergo lichtenstein tension free hernioplasty, and were randomized using close envelope into three groups: Group A: Inguinal hernioplasty with mesh fixation using polypropylene sutures (10 patients), Group B: Inguinal hernioplasty with mesh fixation using cyanoacrylate glue (10 patients) and Group C: Inguinal hernioplasty with mesh placement without sutures (10 patients). Primary outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours, morbidity rate and recurrence rate. Follow-up time was 6 months. Results: significantly, less postoperative pain was reported in group B compared to the other two groups (A&C). Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay and earlier return to daily activities were seen in patients within group(B).Clinical recurrence was reported in only one patient in Group C after a period of four months follow up postoperatively. Conclusion: cyanoacrylate glue seemed to be a simple, original, reasonable, feasible, reproducible technique and competitive alternative to the standard tissue-penetrating meshfixation devices in open inguinal hernioplasty. It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate.

Inguinal neuroanatomy: Implications for prevention of chronic postinguinal hernia pain

Inguinal hernia repairs represent one of the most common general surgery operations worldwide. Advances in the understanding of groin anatomy, operative technique, and prosthetics have improved the efficacy of these repairs with overall low recurrence rates and favorable outcomes. Chronic postherniorrhaphy inguinal pain has arguably become the most important and most frequent complication of inguinal hernia repair, with significant impact on patients' quality of life. Neuropathic inguinodynia may be caused by direct nerve injury, manipulation, entrapment, scarring, and interaction with mesh. Development of chronic postinguinal hernia repair pain is independent of the method of hernia repair as all inguinal hernia repair techniques may potentially cause injury. Understanding the neuroanatomy of the inguinal canal and the potential mechanisms for injury leads to lower rates of nerve injury and chronic pain and helps to guide prevention and treatment of inguinodynia. In this article, the neuroanatomy of the anterior inguinal canal and the prevention of nerve injury are addressed.