Elective Inguinal Hernia Repair Research Articles

Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different?

Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair. This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications. A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P < 0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥ III (OR, 1.763; 95%CI, 1.068-3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407-3.944; P = 0.001) as risk factors of postoperative complications. Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.

Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery.

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30days. There was one conversion to open and one death within 60days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.

Higher rate of chronic pain in young men after open mesh vs nonmesh repair of elective primary unilateral indirect inguinal hernia: A nationwide questionnaire study

PurposeYoung age is a risk factor for chronic pain after inguinal hernia repair, but the role of the mesh in young patients is uncertain. The aim of this study was to assess chronic pain after open mesh versus non-mesh repair of indirect inguinal hernia in young men. Materials and methodsValidated questionnaires were sent to men aged 18–29 years at the time of an elective primary unilateral open repair of an indirect inguinal hernia between 1998 and 2015. Patients were identified in the Danish Hernia Database. Non-mesh repairs were matched 1:3 with mesh repairs (Lichtenstein) on age and follow-up time. The primary outcome was the proportion of patients with chronic pain evaluated with the Activity assessment scale. Secondary outcomes included other pain measures and sexual impairment. ResultsIn total, 661 patients were included in this study (77% mesh and 23% non-mesh) with a median follow-up of 14.8 years (range 2.3–20.0) in the mesh group and 15.9 years (range 3.6–20.0) in the non-mesh group. For the primary outcome, 12% of patients in the mesh group compared with 6% in the non-mesh group had chronic pain (p=0.03). Patients in the mesh group had higher odds of chronic pain in adjusted analysis (OR=2.30 [95% confidence interval=1.11–4.77]). More patients in the mesh group had pain during sexual activity (p=0.01), but there were no differences for most of the remaining secondary outcomes. ConclusionYoung men had a higher rate of chronic pain after open mesh compared with non-mesh repair for indirect inguinal hernia, but results should be interpreted with caution.

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

Risk factors for reoperation following inguinal hernia repair: results from a cohort of patients from an integrated healthcare system.

Inguinal hernia repair is one of the most common operations performed globally. Identification of risk factors that contribute to hernia recurrence following an index inguinal hernia repair, especially those that are modifiable, is of paramount importance. Therefore, we sought to investigate risk factors for reoperation following index inguinal hernia repair. 125,133 patients aged ≥ 18years who underwent their first inguinal hernia repair with mesh within a large US integrated healthcare system were identified for a cohort study (2010-2020). Laparoscopic, robotic, and open procedures were included. The system's integrated electronic health record was used to obtain data on demographics, patient characteristics, surgical characteristics, and reoperations. The association of these characteristics with ipsilateral reoperation during follow-up was modeled using Cox proportional-hazards regression. Risk factors were selected into the final model by stepwise regression with Akaike Information Criteria, which quantifies the amount of information lost if a factor is left out of the model. Factors associated with reoperation with p < 0.05 were considered statistically significant. The cumulative incidence of reoperation at 5-year follow-up was 2.4% (95% CI 2.3-2.5). Increasing age, female gender, increasing body mass index, White race, chronic pulmonary disease, diabetes, drug abuse, peripheral vascular disease, and bilateral procedures all associated with a higher risk for reoperation during follow-up. This study identifies several risk factors associated with reoperation following inguinal hernia repair. These risk factors may serve as targets for optimization protocols prior to elective inguinal hernia repair, with the goal of reducing reoperation risk.

Nerve identification during open inguinal hernia repair: a systematic review and meta-analyses

PurposeInguinal hernia repair is one of the most common operations worldwide and despite this, the incidence of chronic pain remains high after inguinal hernia repair. The optimal nerve handling strategy is controversial and the rate at which nerves are identified remains uncertain. This study aimed to determine the identification rates of the ilioinguinal, iliohypogastric, and genitofemoral nerves as well as nerve handling strategies.MethodsThis review was registered on PROSPERO (CRD 42023416576). PubMed, Embase, and Cochrane Central were systematically searched. Studies with more than 10 patients were included if they reported an identification rate for at least one of the nerves during elective open inguinal hernia repair in adults. Studies requiring nerve identification in their study design were excluded. Bias was assessed with the JBI critical appraisal tool and Cochrane’s RoB-2 tool. The overall estimate of the prevalence was analysed with prevalence meta-analyses.ResultsA total of 22 studies were included. The meta-analyses included 18 studies, which resulted in an identification rate of 82% (95% CI: 76–87%) for the ilioinguinal nerve, 62% (95% CI: 54–71%) for the iliohypogastric nerve, and 41% (95% CI: 27–55%) for the genitofemoral nerve. Nerves were spared in 82% of all repairs.ConclusionThe ilioinguinal, iliohypogastric, and genitofemoral nerves were identified in 82%, 62%, and 41% of surgeries, respectively. Most studies used a nerve-preserving strategy. The role of nerve identification in the development of chronic pain remains uncertain, as well as the optimal nerve handling strategy.

A comparison of post-operative parameters between the Shouldice methods modified according to Berliner darn and the Lichtenstein method in the repair of inguinal hernias

Introduction: Surgical treatment of inguinal hernia is one of the most common procedures in surgery. Various techniques can be used to repair inguinal hernias, but the two most commonly used are the Shouldice surgical technique, modified by the Berliner Darn and Lichtenstein techniques, as a non-extension technique. However, despite the long tradition of surgical hernia treatment, there is still no consensus on the best or most appropriate surgical technique for elective inguinal hernia repair. Therefore, it remains a challenge for surgeons to choose the appropriate hernia repair method on a case-by-case basis that results in low complications and faster recovery. The aim of this study is to compare the efficiency of the Shouldice surgical technique modified by the Berliner Darn and Lichtenstein techniques in the treatment of hernias with respect to certain post-operative parameters. Methods: A prospective and cohort study was conducted at the Clinical Hospital in Tetovo. The study included 100 patients diagnosed with inguinal hernia and treated in hospital. The monitored patients were divided into two groups according to the technique used: 50 patients treated with Shouldice technique modified by Berliner Darn and 50 patients treated with Lichtenstein technique. In addition, we based the selection of the groups mainly on the reproductive age of the patients. Only male patients were treated in both groups, as there were very few female cases during the study period. Results: Patients operated on with the Lichtenstein technique were more mobile postoperatively, post-operative pain was less severe and return to daily and occupational activities and length of hospital stay were significantly shorter than with the Shouldice technique. Conclusion: The Lichtenstein tension-free surgical technique is more efficient and adequate than the modified Shouldice technique according to Berliner Darn in terms of post-operative pain intensity, length of hospital stay, return to daily activities, and return to work.

A STUDY OF SINGLE DOSE PRE-OPERATIVE ANTIBIOTIC PROPHYLAXIS VERSUS CONVENTIONAL MULTIPLE DOSE POST OPERATIVE ANTIBIOTIC THERAPY IN INGUINAL HERNIA REPAIR SURGERY

Background: Elective inguinal hernioplasty is considered to be a clean procedure which does not require antibiotic prophylaxis but prosthetic material like polypropylene mesh is routinely used during procedure. This makes the topic debatable because the use of prosthetic material like mesh increases the risk of surgical site infection. The incidence of surgical site infection (SSI) after inguinal hernioplasty ranges from 0% to 14 % in international literature. It is also more controversial whether single dose antibiotic or conventional multiple doses of antibiotics for 5 to 7 days is effective. Hence our study aims to compare the efficacy of single dose versus multiple dose antibiotic prophylaxis in open inguinal hernioplasty Patients And Methods: A total of 120 cases of inguinal hernia admitted in Gadag Institute of Medical Sciences in the Department of general surgery underwent Lichtenstein tension free mesh hernioplasty and received either pre-op single dose or post-op multiple dose antibiotic therapy. The two groups were then compared for SSI. Conclusion: Our study shows that a single dose of antibiotics given half an hour prior to open surgery in elective uncomplicated inguinal hernia repair surgery is as effective as multiple doses of antibiotics post-operatively in preventing post-operative surgical site infection.

635 Giant Paratesticular Liposarcoma Imitating a Recurrent Right Inguinoscrotal Hernia

Abstract Case 48-year-old male presented for elective open recurrent right inguinal hernia (RIH) repair due to ongoing right inguinoscrotal swelling; and an ultrasound suggestive of a large indirect inguinal hernia containing peritoneal fat and extending into the scrotum with displacement of the right testis. Previous open RIH repair with mesh completed 12mths prior found a moderate direct inguinal hernia; and during a post-op phone review (given the COVID pandemic) noted he was healing well. No urinary/obstructive or systemic symptoms identified. Other history included alpha thalassemia trait, ex-smoker and non-English speaking background (NESB). Intraoperatively there was no evidence of recurrent hernia, and the mesh was intact; however a large right scrotal mass was identified as the cause. An 18x8cm soft lipomatous mass surrounded the right testicle and extended up towards the cord structures at the superficial inguinal ring. Given the concern for malignancy, a right orchidectomy and excision of scrotal mass was performed. Histology confirmed a well differentiated grade 1 liposarcoma. He recovered well and is undergoing close MRI surveillance - with no sign of recurrence. Discussion Liposarcoma is an important differential for scrotal masses and can imitate an inguinoscrotal hernia on ultrasound, MRI is the gold standard investigation. The above case highlights the importance of physical post-operative examination and barriers to care during the COVID pandemic, particularly in those with NESB. Informed consent was imperative, we could safely proceed with the appropriate surgery as the patient had been explicitly consented for testicular loss due to recurrent nature of the operation.

The first experience with the Dextile anatomical mesh in laparoscopic inguinal hernia repair.

The Dextile Anatomical mesh (Medtronic) is a polypropylene heavyweight mesh and has a 3D patented anatomical shape which adapts to the contours of the extra-peritoneal inguinal region without the need for fixation, potentially reducing the risk of hernia recurrence and chronic post-operative pain. This retrospective study will be the first study to assess the outcomes of the Dextile Anatomical mesh compared to another three-dimensional mesh, the 3DMax mesh (Bard). Between 2019 and 2022, all patients who underwent an elective unilateral inguinal hernia repair were assessed. 416 patients in the Dextile Anatomical mesh group and 540 patients in the 3DMax mesh group were included. Outcomes were intra- and post-operative complications, inguinal hernia recurrence and chronic post-operative inguinal pain. No significant differences were found between the two groups regarding intra- and post-operative complications including wound infection, antibiotic use, hematoma, seroma, urinary retention and delayed wound healing. 1-year recurrence rate was comparable for the Dextile Anatomical mesh group and the 3DMax mesh group, respectively, 3.8% and 3.0%, P = 0.45. Chronic post-operative inguinal pain was similar for the Dextile Anatomical mesh (3.4%) and the 3DMax mesh (3.0%), P = 0.72. This retrospective study comparing the relatively new Dextile Anatomical mesh (Medtronic) with the 3D Max mesh (Bard) in unilateral inguinal hernia repair showed that both meshes are safe and effective to use. There were no significant differences in intra-operative outcomes, recurrence rates and chronic post-operative inguinal pain.

Laparoscopic TAPP Inguinal Hernia Repair: Mesh Fixation &amp; Peritoneal Closure by Sutural Technique

Background: The laparoscopic transabdominal preperitoneal (TAPP) inguinal repair is an evolving technique associated with well-known advantages of a minimally invasive approach. This prospective study was conducted to evaluate the feasibility, safety and effectiveness of laparoscopic TAPP using sutural mesh fixation &amp; peritoneal closure. Intracorporeal sutural technique needs steep learning curve. Methods: Between May 2018 to December 2019, a total of 41 inguinal hernias underwent TAPP repair in 37 adults under general anesthesia. All the patients scheduled for elective inguinal hernia repair were offered the choice of the laparoscopic TAPP repair under general anesthesia. A detailed explanation of the procedure was given to all patients and informed consent was obtained. We used 2/0 vicryl for mesh fixation &amp; peritoneal closure which took only 6.80 US Dollar in comparison to Protack from Covidien which is 167.80 US Dollar. Intraoperative &amp; postoperative variables were recorded in pre structured proforma. Results: The 41 hernia includes 34(82.92%) direct, 07(17.08%) indirect. Unilateral hernia were 33(89.19%), &amp; bilateral were 4(10.81%). Mean operating time for unilateral cases was 122 minutes &amp; for bilateral 210 minutes. Mean operating time in the cases using 3D-4K image system was 70 minutes. Mean duration of hospital stay was 2.9 days. There was no conversion in this study. Postoperative complications included scrotal seroma 2(5.40%), hematoma 1(2.70%), port site infection 2(5.40%) &amp; mesh infection 1(2.70%). Assessment of intensity of postoperative pain was evaluated according to VAS. 05 patients complained of mild pain: pain on the visual analog score (VAS) = 1-3 during one month follow-up. No patient reported with chronic pain &amp; recurrence during the followup period. Conclusion: TAPP inguinal hernia repair with sutural mesh fixation &amp; peritoneal closure is a feasible &amp; safe technique with minimum postoperative morbidity and maximum patient’s satisfaction. J Bangladesh Coll Phys Surg 2023; 41: 187-192

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.

Effectiveness of the modified darn repair method in inguinal hernia repair: 10 years of experience

&lt;b&gt;Aim&lt;/b&gt;: We aimed to evaluate the effectiveness of the Modified Darn Repair (MDR) method performed in our clinic for Inguinal Hernia Repair (IHR) and to determine the postoperative complications and recurrence rates of this method.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; The records of all patients who underwent IHR with MDR method in our clinic between January 2012 and December 2021 were obtained from the hospital database. Demographic characteristics of the patients, intraoperative findings, hospitalization and return to normal activities, postoperative complications and recurrence rates were retrospectively analyzed.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: A total of 892 patients aged between 18 and 85 with a male:female ratio of 14:1 were studied. Of 1011 elective IHRs, 773 were unilateral (right/left: 452/321) and 119 (119 right + 119 left) were bilateral.&amp;nbsp; Hernia types were 667 (66%) indirect, 273 (27%) direct, 71(7%) pantaloon (combined) hernias. All procedures were performed under spinal anesthesia. The mean duration of surgery was 35 (15-75) minutes, hospital stay was 1.1 (1-3) days, and return to normal activities was 12.8 (10-20) days. The postoperative complications were wound infection in 33 (3.26%) patients, hematoma in 11 (1.09%) patients, and abscess/seroma in 15 (1.48%) patients. In addition, suture material reaction developed in 1 (0,12%) patient. Recurrence was observed in 25 (2.4%) patients and no mortality was observed in any patient.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The goal of every surgeon is to have a non-recurring repair in IHR without leaving a foreign body in the patient. Despite the criticism, we believe that the MDR technique is a safe, effective and viable option.

Elective Recurrent Inguinal Hernia Repair: Value of an Abdominal Wall Surgery Unit

BackgroundThe aim of this study was to analyze the impact of an abdominal wall surgery unit on postoperative complications (within 90 days postoperatively), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair.MethodsWe conducted a retrospective cohort study of all adult patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. Short- and long-term outcomes were compared between the group of patients operated on in the abdominal wall surgery unit and the group of patients operated on by other units not specialized in abdominal wall surgery. A logistic regression model was performed for hernia recurrence.ResultsA total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. The patients in the abdominal wall surgery group were younger (P ≤ 0.001) and had fewer comorbidities (P ≤ 0.001). There were no differences between the groups in terms of complications. The patients in the abdominal wall surgery group presented fewer recurrences (15% vs. 3%; P = 0.001). Surgery performed by the abdominal wall surgery unit was related to fewer recurrences in the multivariate analysis (HR = 0.123; 95% CI = 0.21–0.725; P = 0.021).ConclusionsSpecialization in abdominal wall surgery seems to have a positive impact in terms of recurrence in recurrent inguinal hernia repair. The influence of comorbidities or type of surgery (i.e., outpatient surgery) require further study.

Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial

Background &amp; Objective: Preemptive analgesia aims at minimizing the development of central sensitization thereby decreasing postoperative pain and analgesic requirements. Various drugs have been used for this purpose. Tapentadol, is a newer centrally acting analgesic which is effective in moderate to severe pain. The aim of this study was to analyze the effect of preoperative oral tapentadol upon postoperative analgesia and analgesic requirements in patients undergoing inguinal hernia surgeries. Methodology: One hundred adult patients undergoing elective unilateral inguinal hernia repair were randomized into two groups of fifty each. Group P received placebo tablets and Group T received tapentadol (100 mg) tablets orally 30 min before anesthesia. All patients received spinal anesthesia and the duration of postoperative analgesia and analgesic consumption in the first postoperative day was recorded. Diclofenac was administered when the patients demanded analgesia. Results: Time for first analgesic demand was significantly delayed in Group T as compared to Group P (328.00 ± 129.71 vs. 252.00 ± 101.38 min, P = 0.017) and the total analgesic consumption of diclofenac was also less than in the placebo group (73.33 ± 28.57 mg vs. 95.00 ± 31.30 mg; P = 0.006). No adverse events were observed in either group. Conclusion: Preemptive oral tapentadol is effective for minimizing postoperative pain and analgesic requirement in patients undergoing inguinal hernia surgeries under spinal anesthesia. Key words: Anesthesia, Spinal; Tapentadol; Hernia surgery; Analgesia, Postoperative Citation: Vadhanan P, Rajendran I, Kumar V. Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial. Anaesth. pain intensive care 2023;27(3):356−359; DOI: 10.35975/apic.v27i3.2230 Received: April 15, 2023; Reviewed: April 29, 2023; Accepted: May 10, 2023

OC-018 Elective recurrent inguinal hernia repair. Value of an Abdominal Wall Surgery Unit

Abstract Purpose The aim of this study is to analyze the influence of an abdominal wall surgery unit in postoperative complications (within postoperative 90 days), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair. Methods This retrospective cohort study included patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. The short- and long-term outcomes between the groups of patients operated on by the Abdominal Wall Surgery Unit and groups operated on by surgeons outside of the specialized abdominal wall group were compared. A logistic regression model was performed for hernia recurrence. Results A total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. Patients in the abdominal wall surgery group were younger (P= &amp;lt;0.001) and had less comorbidities (P= &amp;lt;0.001). Complications were similar in both groups. Patients in the abdominal wall surgery group presented fewer recurrences (15% vs 3%; P= 0.001). In the multivariate analysis, surgery performed by the abdominal wall surgery unit was related to fewer recurrences (HR= 0.164; 95% CI= 0.44–0.613; P=0.007). Conclusions Recurrent inguinal hernia repair is associated with better results in terms of recurrence when it is performed by a specialized abdominal wall unit.

OC-102 NUCK HYDROCELE DURING INGUINAL HERNIA REPAIR IN ADULT FEMALES. REPORT OF TWO CASES

Abstract Aim To present both the open and laparoscopic technique when encountering a Nuck hydrocele during an inguinal hernia repair in females. Methods Two cases of incidentally encountered cysts of Nuck during elective inguinal hernia repair in females are presented. Results Hydrocele of Nuck is a type of primary idiopathic hydrocele. It can occur due to partial remaining of the physiologically obliterated Canal of Nuck. In females, cysts of Nuck are frequently clinically misdiagnosed as inguinal hernias. A 42-year-old woman was subjected to a left TAPP repair for a symptomatic inguinal bulge. Intraoperatively a cystic lesion was attached to the round ligament of the uterus. The cyst contained clear fluid and was progressively dissected from the round ligament, excised and sent for a pathological examination. A typical TAPP repair with mesh ensued. A second case of a 45-year-old woman was submitted to a laparoscopic exploration of an ultrasonographically identified cystic lesion inside the inguinal canal. Intraabdominal reduction of the cyst was not possible, so conversion to open surgery was decided. A clear-fluid cyst was then excised and a typical Lichtenstein repair was performed. Conclusions Symptomatic inguinal bulge especially in women may warrant ultrasound examination for preoperative clarification of the underlying pathology and intraoperative management. The surgeon should be aware of the existence and pathogenesis of this rare entity.

P-052 RISK FACTORS FOR PERITONEAL TEARS DURING LAPAROSCOPIC EXTRAPERITONEAL HERNIA REPAIR

Abstract Background Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (TEP) repair of groin hernias. There are several mechanisms involved in the occurence of PTs during the course of the operation. There are many studies about the causes of peritoneal tears. Detection of independent risk factors in peritoneal tear formation may identify patients who will benefit from elective inguinal hernia repair in laparoscopic extraperitoneal hernia surgery. Methods Between April 2018 and december 2022, 518 consecutive patients undergoing 575 TEP repair surgery were recruited by the retrospective study. They were divided into two groups as with and without peritoneal tear. Patient characteristics, operative data, and postoperative outcomes were compared between patients with and without peritoneal tear. Risk factors for peritoneal tear were evaluated by univariate and multivariate analyses. Results The overall incidence of peritoenal tear was 19.7% (n=97). The median age was 45 years (18 to 83) and body mass index was 25.7 kg/m2 (15.67 to 35.20). Significant clinical factors associated with peritoneal tear included such as hernia type, previous hernia surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for peritoneal tear as indirect hernia type and previous hernia surgery. Conclusion Peritoneal tears is a major complication seen during TEP repair surgery and its incidence varies depending on many factors. Previous hernia surgery and indirect inguinal hernia the risk for peritoneal tears from during TEP repair.

OC-023 INCIDENCE OF TRUE CONTRALATERAL METACHRONOUS INGUINAL HERNIA ON LONG TERM FOLLOW-UP AFTER UNILATERAL INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW

Abstract Aim The repair of inguinal hernias is one of the most common surgical procedures with few complications. Some patients will need a second operation because of the development of a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary surgery. In this study we aim to determine how many patients, with a unilateral inguinal hernia will develop a MCIH. Methods We performed a literature review following the PRISMA guidelines. As outcome measure, the number of patients diagnosed with a MCIH were registered. A meta-analysis was performed to obtain a summary estimate of the percentage of patients with MCIH. Results A total of 19 articles with a combined total of 277.288 patients who underwent elective unilateral inguinal hernia repair were included. The combined estimate for MCIH equaled 8.3% (95%CI: 7.1%-9.5%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of the median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated as 5.2%, 8% and 17.1%, respectively. Conclusion We believe there is not enough clinical evidence to support the idea of prophylactic contralateral repair. We suggest a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long term prospective data are needed to guide the decision for prophylactic contralateral mesh placement in a clinical healthy groin.

Proper Timing for Administration of Prophylactic Intravenous Antibiotics for Elective Surgical Procedures

Background: Preoperative antibiotic prophylaxis is administering antibiotics before performing surgery to help decrease the risk of postoperative infections. The antibiotic selected should only cover the likely pathogens. It should be given at the correct time. The timing of antibiotic administration may vary, but the goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its highest at the start and during surgery. The literature supports at least 30 minutes, but no greater than 60 minutes before the skin incision is made to the optimal timing for the preoperative administration of most commonly used antibiotics. Aims and Objectives: To obtain precise information on the optimal time window for surgical antimicrobial prophylaxis (SAP). Methodology: A retrospective observational study design was used to investigate the effect of timing of SAP on the risk of surgical site infection (SSI) from September 2021 until September 2022. Patients with Inguinal hernia who performed elective inguinal hernia repair were eligible for enrollment in the study. The risk of SSI was compared between patients, categorized by the time interval between SAB administration and incision, and adjusted for confounding through Univariate Analysis logistic regression. Hakeem data base was used to collect the required data. This study was performed in King Hussein Medical Center (KHMC) at the Royal Medical Services in Amman/Jordan. Results: Data included in the current study was collected for the period between September 2021 until September 2022, in which 500 patients were randomly assigned into two arms; Patients in arm A received the in a time window of 60 to 30 minutes before the scheduled incision while Patients in arm B received the antibiotics in time window of less than 30 minutes to 0 minutes before the scheduled incision. In 52% of the procedures, SAP was administered within 60 minutes before incision Inpatient and ...........