Diagnosis Of Hernia Research Articles

EP20.22: Absent fetal stomach in third trimester for the diagnosis of hiatal hernia

EP20.22: Absent fetal stomach in third trimester for the diagnosis of hiatal hernia

EP03.09: Prenatal diagnosis and postnatal outcome of congenital diaphragmatic hernia: experiences from Vietnamese tertiary centres

EP03.09: Prenatal diagnosis and postnatal outcome of congenital diaphragmatic hernia: experiences from Vietnamese tertiary centres

The Relationship between Magnetic Resonance Imaging and Functional Tests Assessment in Patients with Lumbar Disk Hernia.

Although magnetic resonance imaging (MRI) findings are the gold standard for diagnosing herniated discs, there are many limitations to accessing MRI scanning devices in practice. This study aimed to evaluate the relationship between functional tests (the visual analog scale (VAS), the SLUMP test, the Sciatica Bothersomeness Index (SBI), the Oswestry Disability Index (ODI), and the LASEGUE test and MRI findings (LSA, IVDH L4-L5, IVDH L5-S1, DHS L4-L5, and DHS L5-S1) in patients diagnosed with disc herniation. Seventy-eight patients who met the inclusion criteria participated in the study. Radiologists and neurologists evaluated patients with disc herniation. After the disc hernia diagnosis, the patients were referred to a physical therapist for conservative management of the disk hernia. The physical therapists assessed the pain level and performed functional tests on patients. All statistical analyses were performed using R (Core Team) software. The correlation between the measured variables was conducted using the Pearson and Spearman tests. The study results indicated statistically significant correlations between DHS L4-L5 vertebral level and functional tests (VAS: r = 0.49, p = 0.00; SBI: r = 0.44, p = 0.00; ODI: r = 0.49, p = 0.00; LASEGUE: r = -0.48, p = 0.00; SLUMP: r = 0.50, p = 0.00). In conclusion, physiotherapists may prefer functional tests to diagnose the herniated disc, and these functional tests may contribute to performing evidence-based assessments.

Laparoscopic Right Hemicolectomy for Inflammatory Bowel Disease: Is Intracorporeal Anastomosis Feasible? A Retrospective Cohort Comparison Study.

Background: Inflammatory bowel disease (IBD) affects all ages and backgrounds, and many individuals require surgical intervention during their disease course. The adoption of laparoscopic techniques in this patient population has been slow, including intracorporeal anastomosis (ICA). The aim of our study was to determine if ICA was feasible and safe in patients with IBD undergoing laparoscopic right hemicolectomy (LRHC). Methods: This is a retrospective, single institution cohort study of elective and emergent cases of LRHC at a single academic center. Patients included underwent LRHC or ileocolic resection for IBD. Exclusion criteria: conversion to laparotomy, resection without anastomosis, or unconfirmed diagnosis of IBD. Main outcomes studied were anastomotic leak rate, surgical site infection (SSI), postoperative length of stay, 30-day readmission/reoperation, and operative time. Secondary outcomes were incisional hernia rates and rates of disease recurrence. Results: A total of 70 patients were included, 12 underwent ICA and 58 extracorporeal anastomosis. Anastomotic leak rate (intracorporeal 8.3% [n = 1], extracorporeal 8.6% [n = 5], P = .97), and SSI rates (intracorporeal 0%, extracorporeal 6.9% [n = 4], P = .36) were similar. Mean postoperative length of stay, rates of 30-day readmission/reoperation and diagnosis of hernia at 1 year were not significantly different. Rates of IBD recurrence and location of recurrence at 1 year were similar. However, operative time was significantly longer in those undergoing ICA (intracorporeal 187 minutes versus extracorporeal 139 minutes, P = < .05). Conclusions: ICA is a safe option in patients with IBD undergoing LRHC.

Dynamic ultrasound examination: a useful tool for the diagnosis of multiple muscular hernias.

Muscular hernias are an uncommon condition that typically present as subcutaneous nodules on the legs that appear or enlarge while standing or exercising. They are usually asymptomatic, although they may sometimes be tender or painful and may cause cramps, especially in athletes. Physical examination and ultrasound imaging are the key for determining the diagnosis. We present a 67-year-old woman with tender subcutaneous nodules on both lower legs in which dynamic ultrasound examination confirmed the diagnosis of muscular hernias.

Paraconduit hernia following esophagectomy: Is it safe to watch and wait?

ObjectivesWe hypothesized that emergency complications related to asymptomatic paraconduit hernias may occur less often than generally believed. Therefore, we assessed the occurrence and timing of paraconduit hernia diagnosis after esophagectomy, as well as outcomes of these asymptomatic patients managed with a watch-and-wait approach. MethodsFrom 2006 to 2021, 1214 patients underwent esophagectomy with reconstruction at the Cleveland Clinic. Among these patients, computed tomography scans were reviewed to identify paraconduit hernias. Medical records were reviewed for timing of hernia diagnosis, hernia characteristics, and patient symptoms, complications, and management. During this period, patients with asymptomatic paraconduit hernias were typically managed nonoperatively. ResultsParaconduit hernias were identified in 37 patients. Of these, 31 (84%) had a pre-esophagectomy hiatal hernia. Twenty-one hernias (57%) contained colon, 7 hernias (19%) contained pancreas, and 9 hernias (24%) contained multiple organs. Estimated prevalence of paraconduit hernia was 3.3% at 3 years and 7.7% at 10 years. Seven patients (19%) had symptoms, 4 of whom were repaired electively, with 2 currently awaiting repairs. No patient with a paraconduit hernia experienced an acute complication that required emergency intervention. ConclusionsThe risk of paraconduit hernia increases with time, suggesting that long-term symptom surveillance is reasonable. Emergency complications as a result of asymptomatic paraconduit hernias are rare. A small number of patients will experience hernia-related symptoms, sometimes years after hernia diagnosis. Our findings suggest that observation of asymptomatic paraconduit hernias (watch and wait) may be considered, with repair considered electively in patients with persistent symptoms.

Measurements of abdominal wall defect and hernia sac volume in the treatment of incisional hernia: Application of ultrasonic volume auto-scan in 50 cases.

Abdominal incisional hernia is one of the most common complications after surgery. The preoperative evaluation of the area of abdominal wall defect and the hernia sac volume(HCV) is very important for the selection of patch size and incisional herniorrhaphy. Meanwhile the overlap range of reinforcement repair is controversial. This study aimed to explore the value of ultrasonic volume auto-scan(UVAS) in the diagnosis, classification and treatment of incisional hernia. Both the width and the area of abdominal wall defect and HCV were measured by UVAS in 50 cases with incisional hernias. In 32 of these cases, the measurements of HCV were compared with those of CT. Classification of incisional hernia based on ultrasonic images were compared with operative diagnosis. The measurements of HCV by UVAS and CT 3D reconstruction had good consistency, of which the mean ratio was 1.0084. According to the location and width of abdominal wall defect, UVAS, which showed good accuracy rate (90%, 96%), reached a good agreement in the classification of incisional hernias with operative diagnoses (Kappa=0.85, Confidence Interval [0.718,0.996]; Kappa=0.95, Confidence Interval [0.887,0.999]). The patch area should be at least two times as large as the defect area. UVAS is an accurate alternative to measure the abdominal wall defect and HCV and classify the incisional hernia, with additional benefits of no radiation exposure and instant bedside interpretation. The use of UVAS is conducive to preoperative assessment of the risk of hernia recurrence and abdominal compartment syndrome.

Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repair.

Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals. We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40kg/m2, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index. A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40kg/m2, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42-0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40kg/m2 compared to males (11%) and other races (11-15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001). Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.

İnkarsere Karın Ön Duvarı Fıtıklarında Üçüncü Basamak Hastane Deneyimi

Background: This study aims to evaluate the results of incarcerated anterior abdominal wall hernia cases in which we performed emergency surgery in light of the literature. Materials and Methods: The records of 124 patients who underwent emergency surgery for incarcera-ted anterior abdominal wall hernia between January 2016 and December 2019 were retrospectively reviewed. The patients' files, computer records, epicrisis reports, surgery reports, and outpatient clinic records were evaluated. Patients; Age, gender, hernia type, location, time of admission, previous hernia surgery history, affected organs, type of anesthesia applied, surgical techniques, resection status, length of hospital stay, morbidity, and mortality rates were recorded. Results: The mean age of 124 patients was 59.47 ± 17.75 (17-94) years. Of the patients, 64 (51.6%) were female, and 60 (48.4%) were male. The mean hospital stay was 4.12±3.52 (1-19) days. Thirteen (10.5%) patients had additional disease. General anesthesia was applied to 100 (80.6%) patients, and regional anesthesia was applied to 24 (19.4%) patients. 25 patients were operated on with the diagnosis of recur-rence and 99 with the diagnosis of a primary hernia. The most frequently compressed organs in the hernia sac were the omentum (64.5%) and small intestine (32.2%). Bowel resection was performed in 16 of the patients. Mesh was applied to 90 patients during the operation. The most common hernia types were inguinal, umbilical, and incisional. 31 (13.7%) complications developed in 17 patients. Sepsis, wound infection, ileus, atelectasis, and respiratory failure were the most common. Mortality was developed in 6 (4.8%) of the patients. Conclusions: This study showed that additional disease increases morbidity in hernia cases, and intestinal resection due to strangulation increases morbidity and mortality. Therefore, patients presenting with an incarcerated hernia should be operated on as soon as possible before strangulation develops.

1069 Radiological Diagnosis of Groin Hernia - The New Norm?

Abstract Aim Ultrasound is an effective means for diagnosis of groin hernia however, RCS England and The British Hernia Society recommend that herniae should be diagnosed clinically and ultrasound should not be arranged at a primary care level. Following an increase in radiologically-diagnosed herniae referred to the general surgery department, we sought to determine whether ultrasound was used as a primary diagnostic tool. Method Ultrasound requests received from primary care between January and December 2021 were identified using radiology department records. Exclusion of incomplete, follow up and paediatric scans (&amp;lt;16 years old) was ensured. Electronic records were reviewed for clinical history, examination, radiology request and imaging report. Results 342 patients were included. 193 patients had the right groin scanned and 149, the left. The predominant symptoms for which scans were requested were “lump/swelling” (46%) and “pain” (36%). 13% were for suspected recurrence. 27% had a hernia on examination and 45% had no documented examination findings. The most common clinical question on imaging requests was “?hernia” (63%). 143 (42%) of ultrasound scans positively identified a hernia. Of these, 52% had a documented hernia on examination. Conclusions Ultrasound imaging is commonly used to diagnose or confirm diagnosis of groin hernia in the primary care setting. This study was conducted during the COVID-19 pandemic; reduced access to face-to-face consultations may have resulted in increased use of imaging and absence of clinical examination in the assessment of these patients. Patients with suspected hernia should be reviewed by a secondary care specialist prior to diagnostic imaging.

Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention-A EHS, ESCP and EAES Collaborative Project.

Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline. Methods: We updated a previous systematic review with de novo evidence search of PubMed from inception up to June 2022. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30day or in-hospital complications Clavien-Dindo ≥3. We utilised the revised Cochrane Tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables. Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [-0.14 to 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18-0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25-1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45-1.30], I2 = 0%, low certainty of evidence). Conclusion: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.

Evaluation of the double mesh and intraperitoneal onlay mesh techniques in giant incisional hernias

&lt;b&gt;Background:&lt;/b&gt; Giant incisional hernias are difficult to manage. The present study aims to comparatively evaluate the intraperitoneal onlay mesh (IPOM) technique to double-mesh repair techniques in patients with a midline abdominal wall incisional hernia larger than 15 cm (transvers width) that cannot be closed primarily.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; Patients who underwent repair surgery with the diagnosis of incisional hernia in our hospital between January 2017 and December 2019 were retrospectively evaluated. The repair was performed with open surgery using the IPOM technique in 19 patients and the double-mesh technique in 13 patients for 2 years to evaluate for postoperative complications, pain, and recurrence.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The mean age, gender distribution, body mass index, defect size, and American Society of Anesthesiologists scores were similar between the groups. The total rate of postoperative complications was 42.1% in Group A and 30.8% in Group B, with no significant difference between the groups (p &amp;gt; 0.05). Recurrence occurred in three patients (15.8%) in Group A, but it did not in Group B. Although the absence of recurrence in Group B was a remarkable finding, the difference was not statistically significant (p&amp;gt;0.05).&lt;br /&gt; &lt;b&gt;Discussion:&lt;/b&gt; The IPOM and double-mesh techniques can be used safely to perform tension-free abdominal wall reconstruction in patients with complex and giant incisional hernias. However, the double-mesh technique may be preferred owing to its lower recurrence rate.

Diagnosis and management of diaphragmatic pericardial hernia: A case report

Introduction: Diaphragmatic hernias can be congenital or acquired. Congenital diaphragmatic hernia is a relatively common malformation and can be diagnosed in the prenatal period using ultrasound. After birth, computed tomography is the most accurate diagnostic test and helps to assess the anatomical relationships between the viscera. Traumatic diaphragmatic hernia (TDH) is characterized by the passage of part of the abdominal contents into the thoracic cavity through trauma to the thoracoabdominal transition. Pericardial diaphragmatic hernia is a direct communication between the pericardium and the peritoneal cavity, through a defect in the diaphragm. It can be congenital or associated with diaphragmatic rupture after trauma. Case presentation: V.B, 57, complaining of chronic constipation, presented with hiatus hernia on chest X-ray and CT scan. The images showed herniation of fat content and intestinal loops into the chest through the anteromedial wall of the left hemidiaphragm, compressing the medial aspect of the lingula, with no evidence of complications. On April 6, 2023, she underwent diaphragmatic herniorrhaphy via the thoracic route. She returned for post-operative follow-up complaining of nausea, vomiting and asthenia. A new total abdominal tomography scan showed the presence of an anterior diaphragmatic hernia on the left. Subsequently, she underwent a thoracic surgical approach with a proposal to correct the diaphragmatic hernia. However, an inventory of the cavity revealed plication of the lateral diaphragm without herniation points. The decision was therefore made to open the pericardium, showing a diaphragmatic pericardial hernia, with a 0.5 cm ring containing the epipelon, transverse colon and stomach in the pericardium. Adhesions were lysed and the contents returned to the abdominal cavity. The patient evolved satisfactorily in the postoperative period. Discussion: Both diaphragmatic hernia and pericardial diaphragmatic hernia can be serious and require immediate medical intervention. They are rare pathologies that can be confused with other respiratory or cardiac diseases, making it difficult for doctors to diagnose them. Surgery is necessary to repair the hernia and reduce the risk of complications, which increase over time. Final considerations: In this case report, we have highlighted the complexity and importance of early and accurate diagnosis of diaphragmatic hernias, including the rare pericardial diaphragmatic hernia. Diaphragmatic hernia, whether congenital, acquired through trauma or associated with diaphragmatic rupture, can result in painful complications if not recognized and controlled. The clinical situation presented in this case, in which a pericardial diaphragmatic hernia was identified during the postoperative period of a thoracic diaphragmatic hernia, highlights the importance of continuous surveillance after surgical intervention.

HIATAL HERNIA, PANORAMIC REVIEW OF DIAGNOSIS AND MANAGEMENT

Introduction: Hiatal hernia (HH) occurs frequently in the population, characterized by various non-specific symptoms, however most of these symptoms are found to be related to gastroesophageal reflux disease. A hiatal hernia is said to be a medical condition in which the upper portion of the stomach or other internal organ protrudes through an opening in the diaphragm. Objective: to detail current information related to hiatal hernia, description, etiology, classification, diagnosis, differential, prognosis, management and complications. Methodology: a total of 38 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 27 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: hiatal hernia, hiatal repair, diagnosis, management. Results: The incidence of symptomatic cases of hiatal hernia is related to the diagnosis of gastroesophageal reflux disease (GERD). The incidence of hiatal hernias increases with age. About 55%-60% of individuals over 50 years of age have a hiatal hernia. However, approximately 9% have symptoms and it depends on the type and competence of the lower esophageal sphincter (LES). The largest percentage of these hernias are type I sliding hiatal hernias. Type II, paraesophageal hernias, represent approximately 5% of hiatal hernias in which the LES remains stationary, with the stomach protruding superiorly to the diaphragm. There is also a high prevalence in women, attributable to increased intra-abdominal pressure during pregnancy. The estimated overall 30-day mortality rate in relation to antireflux surgery is approximately 0.19%. Conclusions: Hiatal hernia (HH) is relatively common in the general population. It is caused by increased intra-abdominal pressure, leading to protrusion of the stomach and other abdominal viscera into the mediastinum. Hiatal hernias can be congenital or acquired. The current anatomical classification of hiatal hernias consists of four types or categories, each with its different characteristics. Diagnosis of hiatal hernia can be challenging because of the change in the anatomy of the esophagogastric junction on swallowing, breathing and movement. The pre-surgical study of the individual supports the diagnosis and the exclusion of other pathologic entities to properly direct the surgical intervention. The success of hiatal hernia surgery can be measured by the improvement of symptoms, such as esophageal acid exposure, complications and the requirement for reoperation. Complications of surgery are usually mild and are not directly linked to the surgery itself. KEY WORDS: surgery, hernia, hiatus, diagnosis, management.

The Effect of Deep Sedation in Endoscopic Diagnosis of Hiatal Hernia

The Effect of Deep Sedation in Endoscopic Diagnosis of Hiatal Hernia

Renal Replacement by Thoracic Approach in Traumatic Diaphragmatic Hernia with Thoracic Kidney: Case Report

An acquired diaphragmatic hernia usually occurs after thoracoabdominal trauma, causing a defect in the diaphragm that allows the migration of intraperitoneal structures into the thoracic cavity. The finding of renal involvement has a low incidence. The diagnosis of diaphragmatic hernias is based on chest x-ray and computed tomography. Treatment is surgical, due to the risk of strangulation, and consists of content reduction, resection of the sac, and closure of the hernia defect. It can be performed through the thoracic or abdominal approach, with an increasing number of minimally invasive techniques, which reduce trans and postoperative complications. We present the case of a patient with a diagnosis of late-onset post-traumatic diaphragmatic hernia with renal involvement, treated surgically through a thoracic approach with an attempt to preserve the kidneys, who finally underwent nephrectomy due to urinoma secondary to a lesion of the renal pelvis during the mobilization of the kidney to the abdominal cavity.

First-trimester prenatal diagnosis of Coffin-Siris syndrome-related congenital diaphragmatic hernia: The role of exome sequencing in determining genetic etiology.

First-trimester prenatal diagnosis of Coffin-Siris syndrome-related congenital diaphragmatic hernia: The role of exome sequencing in determining genetic etiology.

Femoral Hernia Presenting as Richter’s Variant: A Rare Case Report

Background: Richter's hernia occurs when a portion of the anti-mesenteric border of a bowel wall is captured within the hernia sac, resulting in ischaemia, gangrene, and perforation. Only part of the circumference of the bowel wall is involved in Richter's hernia, which causes strangulation without obstruction. Femoral hernia presenting as a Richter’s hernia is rare. Aim: This is to report a case of Richter’s hernia in a femoral hernia occurring in an adult female. Case Report: In this case, a 62-year-old woman presented with a history of sudden generalized abdominal pain. Before the presentation, she had a six-year history of reducible left inguino-labial swelling that became irreducible two weeks ago. Pallor was present. Her temperature was 39.2°C, her pulse rate was 112 per minute, and her blood pressure was 132/62 mmHg. A diagnosis of a left femoral hernia was made. She was revived, and the groin swelling was explored through a midline incision over the abdomen. There was ischaemia of the anti-mesenteric border of the ileum, along with strangulated preperitoneal fat. The bowel vascularity over the anti-mesenteric border was doubtful, so a resection anastomosis of the segment of the bowel was done followed by a reduction of the bowel loop and herniorraphy. Conclusion: It is rare for a femoral hernia to present with a Richter's hernia, but it can happen even in the absence of obstructive symptoms. Any time there is groin swelling, it is important to get a quick, correct diagnosis and treatment. If there is a delay in identification and treatment, a spontaneous faecal fistula, an uncommon complication, may develop. The relevant authorities must address this as it reflects the status of healthcare in the developing world.

Strangulated Littré Hernia Apropos of a Case in the Department of General and Visceral Surgery of the National Hospital Ignace Deen CHU Conakry

Littré's hernia is the presence of Mekel's diverticulum in the hernial sac. Meckel's diverticulum is the most common birth defect of the digestive tract. It results from the involution of the omphalomesenteric or vitelline duct which normally becomes obliterated around the sixth week of intrauterine life. Although this condition is common, its presence in the hernial sac during the cure of a hernial strangulation is an extremely rare case in our practice. We report a case concerning a 42-year-old sportsman, admitted to the general and visceral surgery department of the Ignace Deen National Hospital for painful, irreducible, non-impulsive and non-expansive right inguino-scrotal swelling on coughing in whom, at the end of the clinical examination the diagnosis of a strangulated right inguino-scrotal hernia was made, he benefited from a surgical management during which the exploration revealed a hernial sac containing hail with a formation oblong on the antemesenteric surface without necrosis with peritoneal fluid. We proceeded to a resection carrying the diverticulum followed by the end-to-end ileal-ileal anastomosis plus the cure of the hernia according to Desarda. The medium-term follow-up with a follow-up of six months did not note any particularity. The diagnosis of this condition is difficult and often arises intraoperatively and the treatment is surgical.

Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.