Groin Bulge Research Articles

The Prevalence of Inguinal Hernia Among Athletes in Saudi Arabia: A Cross-Sectional Study.

Introduction An inguinal hernia is the most common type of hernia. It might manifest as a groin bulge, lump, or enlarged scrotum. Swelling may be uncomfortable and painful and even cause intestinal obstruction. This study aimed to measure the prevalence of inguinal hernia among athletes in Saudi Arabia. Subject and methods This is a cross-sectional study conducted among Saudi Arabian athletes. A self-administered questionnaire was distributed among athletes using an online survey through different Saudi Olympic Training and Fitness Centers throughout the kingdom. The questionnaire includes sociodemographic characteristics (i.e. age, gender, etc.), risk factors, and complications of inguinal hernia. Results Of the 594 athletes, 55.6% were females and 57.6% were aged between 18 and 24 years. The most common type of sport was running (31%). The most common risk factor for inguinal hernia was previous abdominal surgery (57.5%). The prevalence of inguinal hernia among Saudi athletes was 12.3%. Being older in age and being male were the independent significant predictors associated with increased risk for inguinal hernia, whereas weightlifting was the independent significant factor of decreased risk for inguinal hernia. Conclusion The prevalence of inguinal hernia among athletes was 12.3%. Older male athletes were most likely at a greater risk to suffer from inguinal hernia as compared to the rest of the athletes. Further research is needed to extract more data about the prevalence of inguinal hernia among Saudi Arabian athletes and determine its risk factors.

P-137 DE GARENGEOT`S HERNIA: AN UNUSUAL PRESENTATION OF APPENDICITIS. CASE REPORT AND REVIEW OF THE LITERATURE

Abstract Introduction The presence of the appendix within a femoral hernia was first described by René De Garengeot in 1731. Less than 200 cases have been reported in the literature with an incidence of 0.5–5% of all the femoral hernias. Case Description A 69-year-old woman presented with a 72-hour history of painful right-sided groin swelling. She denied fever or any gastrointestinal symptomatology. Clinical examination revealed a non-reducible right mass. X-ray did not show any bowel obstruction. Laboratory found an increased leukocyte count (14.10 K/μL) with 77% neutrophils. She underwent emergency surgery. An inguinotomy was performed, observing the presence of the appendix incarcerated within the femoral ring. It showed clinical signs of appendicitis with no presence of abscess or perforation. Appendectomy was performed. The hernia was repaired with a polypropylene plug fixed to Cooper's and Gimbernat's ligaments. Discussion De Garengeot`s hernia affects women four times more compared to men. The most common symptoms are tenderness and a groin bulge (usually right-sided). The diagnosis is usually performed intraoperatively, although CT-scan is useful as a complementary test. Due to its low incidence, there are still no standardized recommendations on the treatment of this type of hernia. The most common approach in the literature is an open surgery via inguinal incision. Laparoscopic approach has been described too. Mesh use should not be considered in a contaminated field. Conclusion The treatment of this entity is the emergency surgery. We should consider this type of hernia to make an early diagnosis in order to prevent complications.

P155 DE GARENGEOT HERNIA: A CASE REPORT

Abstract Aim “The De Garengeot’s hernia, from Rene De Garengeot, who was the first to describe the appendix inside a femoral hernia sac in 1731, is a rare type of crural hernia. The diagnosis is challenging and surgery must be performed without delay. The incidence of appendicitis in this type of hernia is about 0.08-0.13%. The aim of this work is to describe our experience in the management of this rare subtype of hernia in a 82-year-old women” Material and Methods “A 82-year-old patient with a right groin bulge presented to the Emergency. At the physical examination the abdomen was treatable; there was no sign of bowel obstruction. Blood test values were normal, except for a high PCR value. The US of the groin region demonstrated a right femoral hernia containing a bowel tract, irreducible at the probe’s pressure. The patient underwent surgery, with diagnosis of De Garengeot’s hernia; a direct hernia repair followed by an open appendectomy were performed. The patient did not present any complications and was discharged on the second postoperative day” Results “The De Garengeot hernia is a rare entity that requires an early treatment; the preoperative diagnosis is difficult and often clinical features are similar to a common incarcerated hernia. There are many surgical options for the management of the De Garengeot hernia, but there is not a consensus for the best surgical approach” Conclusions “De Garengeot's hernia is rare, being indistinguishable from an incarcerated femoral hernia in general. This case report is about a De Garengeot’s hernia patient, who presented a good recovery after surgery.”

Amyand’s Hernia: A Rare Case Report

Abstract: Amyand’s hernia is described in the inguinal hernia sac as being the presence of an appendix vermiformis. It is a rare condition the incidence is about 1 per cent of all inguinal hernias. It is often diagnosed incidentally during inguinal hernia surgery. The main treatment method of Amyand’s hernia is surgery. We report a case of 63 years old man who presented with right inguinal groin bulge for 1 month with the previous repaired right inguinal hernia 5 years ago. On clinical examination revealed a 6 cmx8 cm firm, nontender, irreponible mass in the right inguinal region. He was diagnosed as right sided irreponible inguinal hernia. He was undergoing the elective surgery. Intra-operative, the hernia sac was laterally found in the inferior epigastric vessels and separated from sperm cord to deep inguinal ring. The hernia sac was opened. A non-inflamed appendix was seen. Appendectomy was performed, and the hernia was repaired by Halsted’s repair. Amyand’s hernia is a rare condition. The correct diagnosis is usually made intraoperative. Keywords: Amyand’s hernia, appendectomy, hernia repair, inguinal hernia.

De Garengeot hernia: a systematic review.

A De Garengeot hernia is a femoral hernia that contains the appendix. This rare type of hernia was first described by René-Jacques Croissant De Garengeot in 1731. Numerous case reports have been published since then, yet collective analysis about the presentation, diagnosis, management, and outcomes of patients with this unique hernia is lacking. A systematic review was performed using PubMed, Google Scholar, Embase, and Web of Science for cases of De Garengeot hernias. Keywords searched included "De Garengeot hernia" OR "femoral appendicitis" OR "femoral hernia appendix" OR "crural hernia appendix." To facilitate review, a classification system was created based on the gross appearance of the appendix and related structures in the femoral hernia. Two hundred and twenty-two cases were identified in 197 manuscripts. Cases most commonly came from Europe but have been reported worldwide. There was a female predominance (n = 180, 81.1%) and the mean age at presentation was 69.8years. The most common presenting symptoms were a groin bulge and groin tenderness (82.4%, n = 183 and 79.7%, n = 177, respectively). A groin bulge was observed on physical exam in 95.0% (n = 211) of cases, and erythema over the hernia was present in 33.3% (n = 74). A pre-operative diagnosis of a De Garengeot hernia was established with imaging in only 31.5% (n = 70) of cases. The most common surgical approach was through a groin incision. Complications occurred in 9.5% (n = 21) of cases, most commonly surgical site infections. The most common condition of the appendix was congested/inflamed, found in 44.1% (n = 98) of cases and corresponding to class 2A in the classification system devised. Overall, De Garengeot hernias were found to be rare and clinically heterogeneous, as highlighted by our classification system. A systematic approach to categorizing this unique hernia may improve management decisions and help avoid complications.

Long-term outcomes after bilateral transabdominal preperitoneal (TAPP) repair for asymptomatic contralateral inguinal hernia.

Surgical management of an asymptomatic inguinal hernia is controversial but given that most of the patients will develop symptoms, the hernioplasty seems to be a reasonable option. We aimed to compare postoperative outcomes after transabdominal preperitoneal (TAPP) repair between patients with symptomatic bilateral hernia (SBH) and patients with one symptomatic hernia and an asymptomatic contralateral hernia (ACH). A consecutive series of patients undergoing bilateral laparoscopic TAPP from July 2014 to June 2018 were included. Symptomatic hernia was defined as a groin bulge associated to pain and altered patient's daily activities. Patients were divided into two groups, those with SBH and those with one symptomatic hernia in whom an ACH was diagnosed by physical examination or ultrasound when clinical assessment was inconclusive. Demographics, operative, and postoperative outcomes were compared. Quality of life (QoL) was assessed before and after surgery in both groups. A total of 305 bilateral TAPP repairs were included; 102 (33, 4%) patients had SBH and 203 (66, 6%) had ACH. There were no significant differences between groups regarding age, gender, body mass index, active smoking, and comorbidities. Operative time (SBH: 125 vs. ACH: 132min, p = 0.13) and overall 30-day morbidity were similar between groups (SBH: 14, 7% vs. ACH: 13, 8%, p = 0.82). After a mean follow-up of 30 (10-48) months, the recurrence rate was 1, 4% and 2, 2% in SBH and ACH, respectively (p = 0.53). QoL after surgery improved significantly and similarly in both groups. Bilateral laparoscopic TAPP in the setting of an asymptomatic hernia did not increase morbidity and had similar outcomes when compared to patients with bilateral symptoms. A comprehensive preoperative evaluation of the contralateral groin should be routinely performed, mainly by physical examination, and a bilateral repair may be proposed if an asymptomatic contralateral hernia is detected.

Amyand hernia repair with mesh and appendectomy

BackgroundAmyand hernias have been described in case reports in the literature and are a rare occurrence in the career of a surgeon. Their management is even less well described and often poses problems in the management of repair due to concerns with contamination associated with appendectomy. Here, we describe a patient with an Amyand hernia seen on CT imaging preoperatively, who underwent appendectomy along with a lightweight mesh plug repair of his hernia.Case presentationAn 88-year-old male presented with a right groin bulge and underwent preoperative imaging which indicated the presence of his appendix within his hernia. He was taken to the operating room electively where an appendectomy was performed due to significant chronic inflammatory changes. A lightweight mesh plug was used to repair the hernia to prevent recurrence. He did well post operatively without any complications.ConclusionsA review of the literature supports the use of mesh repair in these of hernias even with appendectomy at the time of the hernia repair. This will guide surgeons who encounter this clinical rarity in their practice.

Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women.

Prevalence, management, and risk of emergency operation for primary ventral or groin hernia in pregnancy are unknown. The objective of this study was to estimate the prevalences of primary ventral or groin hernia in pregnancy and the potential risks for elective and emergency repair. This single-institutional retrospective study included all pregnant women attending one or more prenatal consultations at Hvidovre Hospital, Denmark, during a 3-year period. Patients' medical records were electronically retrieved. A free-text search algorithm and subsequent manual review was conducted to identify patients registered with a primary ventral or groin hernia in pregnancy. Follow-up was conducted by review of medical record notes within the Capital Region of Denmark supplemented with structured telephone interviews on indication. In total, 20,714 pregnant women were included in the study cohort. Seventeen (0.08%) and 25 (0.12%) women were registered with a primary ventral and groin hernia, respectively. None underwent elective or emergency repair in pregnancy, and all had uncomplicated childbirth. In 10 women, the groin bulge disappeared spontaneously after delivery. During postpartum follow-up of median 4.4years (range 0.2-6.0years), five (0.02%) and four (0.02%) underwent elective primary ventral and groin hernia repair, respectively. Primary ventral or groin hernia seems rare in pregnancy, and the incidence of emergency repair is extremely low. Watchful waiting strategy is recommended during pregnancy in women suspected for a primary ventral or groin hernia.

Strangulated Appendix After Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair

Laparoscopic inguinal hernia repair can be performed totally extraperitoneal or transabdominal preperitoneal (TAPP). Both repairs are associated with mesh-related complications. This is the first report of a mesh-strangulated appendix, with subsequent necrosis and perforation, after TAPP inguinal hernia repair. A 48-year-old male, 10-years status post-bilateral TAPP inguinal hernia repair presented with acute right groin bulge, pain, nausea, emesis, and fever. He was found to have a large, tender, nonreducible right groin mass. He was taken to the operating room for right groin exploration and found to have gross purulent material but no evidence of a recurrent hernia. A laparoscope was inserted into the abdomen where the appendix was found strangulated between the mesh and the transversalis fascia. Mesh-related complications after TAPP inguinal hernia repair are rare. This is the first report of a strangulated appendix secondary to mesh entrapment after TAPP repair.

Inguinal Hernias in Men Undergoing Open Radical Retropubic Prostatectomy

To determine the incidence of inguinal hernias in men undergoing open radical retropubic prostatectomy (RRP). The incidence of preoperative and postprostatectomy inguinal hernias were determined by a retrospective chart review and questionnaire survey of 1130 consecutive men who underwent open RRP by a single surgeon from October 2000 to October 2005. A preoperative inguinal hernia was diagnosed by the physical examination or abdominal computed tomography findings. The incidence of new postoperative hernias was ascertained by the patients' responses to a survey indicating the development of a new groin bulge or hernia. Of the 1130 patients, 146 (13%) had a preoperative inguinal hernia. Increasing age and lower body mass index were significantly associated with the detection of a preoperative inguinal hernia. The sensitivity of detecting an inguinal hernia by physical examination and routine abdominal computed tomography preoperatively was 96.3% and 42.5%, respectively. Also, 8% of men developed a new hernia. Although abdominal computed tomography can identify inguinal hernias in men undergoing open RRP, the test's sensitivity is inferior to that of a simple physical examination. All candidates for open RRP should undergo a careful physical examination to identify asymptomatic inguinal hernias. Our findings suggest that the previously reported high incidence of symptomatic inguinal hernias that developed after open RRP can be explained by a failure to diagnose preexisting inguinal hernias and the development of new hernias.