Groin Recurrence Research Articles

Patterns of recurrence and survival in vulvar cancer: A nationwide population-based study

ObjectiveTo examine the patterns of recurrence and how these patterns are associated with survival in vulvar squamous cell carcinoma. We also explored the survival impact of surgical groin staging (SGS). MethodsNationwide population-based study including women diagnosed with vulvar squamous cell carcinoma between 2012 and 2015 and registered in the Swedish Quality Registry for Gynecologic Cancer. Cumulative incidence rates (CIR), recurrence-free (RFS) and overall survival (OS) were calculated by Kaplan Meier estimates. The impact of SGS on RFS and OS was analyzed by proportional hazards models. Results489 eligible women were included. Median follow-up time was 64 months. The overall recurrence rate was 22.3%. Site of recurrence: local in 61.0%, groin in 30.0%, distant in 9.0%. The CIR for local recurrences increased with time (5.9% at 2-years, 14.7% at 5-years) while the rate of groin and distant recurrences was nearly steady (5.5% to 6.3% and 1.5% to 1.7%, respectively). Median 2-year and 4-year OS post-recurrence was 57.8% and 37.4% for local, 17.2%, 10.3% for groin and 0% for distant recurrences, respectively. SGS was omitted in 23.7% of surgically treated women with FIGO stages IB-II and significantly associated with worse RFS (Hazard ratio, HR, 1.9; 95%CI, 1.0–3.5; p = 0.04) and OS (HR 2.0; 95%CI, 1.1–3.8; p = 0.04) after adjustment for age, FIGO stage, tumor size, resection margins and performance status. ConclusionThe cumulative incidence of isolated vulvar recurrence was low but for those affected the prognosis was poor. Surgical groin staging is a crucial part of primary treatment and should not be omitted.

“Quality of Life after Varicose Vein Surgery in Patients with High-ligation and Stripping, External Valvuloplasty and Sapheno-femoral Redo Surgery”

High-ligation and stripping (HL/S) and external valvuloplasty (eVP) with the implantation of an external device to restore the valve's function, are surgical methods to eliminate reflux at the saphenofemoral junction. Furthermore, redo-surgery (RedoS) can be performed in terms of same side groin recurrences. It is unclear, if there is a difference in quality of life (QoL) between these 3 surgical treatment options. Therefore, it was the aim of our study to elucidate QoL in patients before and after surgical treatment at the saphenofemoral junction by comparing HL/S, eVP, and RedoS. A total of 303 participants (156 HL/S, 81eVP, 64 RedoS) were recruited during the daily clinical routine. QoL was measured at admission and 6 weeks after the surgical procedure by means of SF-12 (12 item short form health survey) and Aberdeen Varicose Vein Questionnaire. The mean value of Aberdeen Varicose Vein Questionnaire was 14.5 (SD 2.1) preoperatively and 4.9 (SD 3.3) postoperatively in the HL/S group, 16.4 (SD 1.4) preoperatively and 6.8 (SD 2.5) postoperatively in the eVP group and 15.5 (2.2) preoperatively and 5.8 (SD 4.2) postoperatively in the RedoS group, which was statistically significant (P< 0.05) in all groups. Postoperatively, the mean values were statistically significant within the groups. Concerning physical aspects of the SF-12 we found a significant improvement in the RedoS group, while mental aspects were significantly better in the HL/S and eVP group postoperatively. Nevertheless, the clinical relevance of these SF-12 differences is questionable under consideration of the minimal important difference. Varicose vein surgery leads to a significant improvement of QoL in all groups. The implantation of an external patch could have a negative influence in QoL.

The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of D\xfcsseldorf

BackgroundSince the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4 cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed [Woelber et al. 0% (p = 0/28) and Nica et al. 5.3% (p = 1/19)].MethodsA retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018.Results22.2% of women (n = 4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p = 0.0038).ConclusionCurrent guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

A RANDOMIZED CONTROLLED STUDY OF INGUINAL HERNIA USING MONOFILAMENT NON-ABSORBABLE SUTURE VERSUS MONOFILAMENT ABSORBABLE SUTURE IN LICHTENSTEIN TENSION FREE HERNIA REPAIR

Background: The surgical treatment of inguinal hernias has evolved through several stage, history of groin hernia is the history of surgery itself. But, chronic pain is still a major irritating post-operative complain of the patient. The objective of the present study was to compare post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in terms of postoperative pain, chronic groin pain, seroma formation, wound infection and recurrence in Lichtenstein hernioplasty. Methods: This is a single centre, prospective randomized controlled study of 152 cases of inguinal hernia comparing post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in Lichtenstein hernioplasty at Baroda Medical College and S.S.G. Hospital, between 1st December 2017 to 30th November 2018. Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value &lt;0.05). Conclusions: Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.

Laparoscopic transabdominal preperitoneal repair for recurrent groin hernia after failed anterior-posterior repair.

The International Guidelines for Groin Hernia Management recommends an anterior repair after a failed posterior repair, and laparoscopic repair after a failed anterior tissue repair or Lichtenstein repair. However, there are not enough studies to guide decision-making for patients with recurrent hernia patients after combined anterior-posterior repair. We investigate the safety and usefulness of transabdominal preperitoneal repair (TAPP) for recurrent hernia patients after failed anterior-posterior repair. We conducted a retrospective analysis of 13 consecutive patients with recurrent groin hernia who underwent TAPP after prior anterior preperitoneal mesh repair (that created anterior and posterior scarring) between September 2013 and October 2018. The control group comprised 45 patients who underwent TAPP for recurrent hernia after anterior repair (43 nonmesh repairs and two Lichtenstein repairs). There were no intraoperative complications, and chronic pain was not reported by the patients with prior anterior preperitoneal mesh repair. The mean operative time was 113 ± 31.3minutes, and the mean postoperative stay was 1.62 ± 0.87 days. The Wong-Baker FACES rating scale score for pain on postoperative day 1 was 1.91 ± 1.5; on postoperative day 7, the score was 1.0 ± 0.89. None of these findings was significantly different from the findings in patients who had a prior anterior repair. A single patient experienced a further recurrence and underwent repeat TAPP. The use of TAPP after failed combined anterior-posterior mesh repair may be feasible and safe for recurrent groin hernia. Further study is needed to determine long-term outcomes.

Radiotherapy is not indicated in patients with vulvar squamous cell carcinoma and only one occult intracapsular groin node metastasis

ObjectiveMost guidelines advise no adjuvant radiotherapy in vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis. However, several recent studies have questioned the validity of this recommendation. The aim of this study was to analyze the groin recurrence rate in patients with a single intracapsular positive lymph node treated without adjuvant radiotherapy. MethodsPatients with a single clinically occult intracapsular lymph node metastasis, treated without adjuvant radiotherapy, formed the basis for this study. Groin recurrences, and the risk of death, were analyzed in relation to the size of the metastasis in the lymph node and the lymph node ratio. Data were analyzed using SPSS, version 26.0 for Windows. ResultsAfter a median follow-up of 64 months, one of 96 patients (1%) was diagnosed with an isolated groin recurrence and another two (2.1%) were diagnosed with a combination of a local and a groin recurrence. The only isolated groin recurrence occurred in a contralateral lymph node negative groin. Size of the metastasis and lymph node ratio had no impact on the groin recurrence risk, nor on survival. The 5-year actuarial disease-specific and overall survivals were 79% and 62.5% respectively. The 5-year actuarial groin recurrence-free survival was 97%. ConclusionBecause of the low risk of groin recurrence and the excellent groin recurrence-free survival, we recommend that adjuvant radiotherapy to the groin in patients with vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis can be safely omitted to prevent unnecessary toxicity and morbidity.

Whole-length great saphenous varicose veins thermochemical ablation, a novel technique: safety, efficacy, and mid-term follow-up results

Background Despite all advances in the treatment of varicose veins, recurrence rates are still high, and multiple factors have been incriminated. This study aims to evaluate the safety and efficacy of whole-length great saphenous vein ablation, starting flush with the saphenofemoral junction down to the ankle, using a new technique combining laser and chemical ablations. Patients and methods A prospective study was conducted that included patients with varicose veins who presented to the Vascular Surgery Department, Dr. Soliman Fakeeh Hospital, KSA, in the period from May 2016 to February 2018. All patients were treated with endovenous laser ablation of the whole great saphenous vein starting flush at the saphenofemoral junction using radial fiber combining low-level laser energy with truncal injection sclerotherapy for the below-the-knee vein segment with adjusted linear endovenous energy density. Patients were followed up for 18 months. Chronic venous disease quality of life questionnaire-20 (CIVIQ-20) was obtained before treatment and after 6–12 months. Results This study included 125 patients (132 limbs), their mean age was 40.4±11.8 years, male to female ratio was 1 : 2.4, Clinical, Etiological, Anatomical, Pathological (CEAP) classification was 2–6, the presentation was bilateral in seven (5.6%) patients, technical success was achievable in 99.3% of patients, need for extra-truncal treatment at the same time of ablation (laser, injection, or phlebotomy) in 64 (48.5%) patients, postoperative deep vein thrombosis was seen in 0%, saphenous nerve injury was seen in one (0.7%) case, recanalization at 6–12–18 months was seen in two (1.5%) cases, and improvement in CIVIQ-20 from 71.25±9.6 to 32.4±4.6 and 29.7±1.2 was seen at 6 and 12 months, respectively. Conclusion The use of the radial laser fiber allows safe flush thermal ablation of the great saphenous vein, with the anticipated decrease in groin recurrence, combined with thermochemical ablation of the below-the-knee segment has promising result in short-term and mid-term follow-up.

Validation of sentinel lymph biopsy in patients with early stage vulvar cancer: A prospective trial of 1552 women (GROINSS-V II/GOG270)

Objective: The sentinel lymph node (SLN) procedure in vulvar cancer has become standard of care since our first GROINSS-V study reported a groin recurrence rate of 2.3%. In GROINSS-V II/GOG270, a study that investigated the safety of radiotherapy in patients with metastases in their SLN, all SLN-negative patients were registered in order to confirm our previous findings. Here we present the analysis of the patients with a negative SLN.

The role of the sentinel lymph node in vulvar cancer.

The aim of this study was to update clinical practice applications and technical procedures regarding sentinel lymph node (SLN) biopsy in vulvar cancer considering European experts' opinions from this field. Systematic data search performed using PubMed/medline database up to May 20, 2020. Focus was only for English language publications of original studies on SLN biopsy in vulvar cancer. Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. In early-stage vulvar cancer patients with a negative sentinel node the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We advise that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.

Comparison of pre-shaped polypropylene mesh without fixation versus flat polypropylene mesh with fixation in patients of inguinal hernia undergoing totally extraperitoneal repair

AimsOutcomes after Totally Extraperitoneal Repair (TEP) for groin hernia are being increasingly studied in the quest for an ideal mesh and ideal technique. The aim of this study is to evaluate short term outcomes of these pre-shaped 3D meshes without fixation and comparing their results to flat meshes with fixation in patients undergoing unilateral or bilateral totally extra-peritoneal repair for groin hernia. MethodsA total of 71 consecutive patients admitted for endoscopic groin hernia repair in the Department of General and Laproscopic surgery were included in the study from March 2015 to May 2016. All patients underwent TEP using either a flat polypropylene mesh fixed with tacks or a 3-D polypropylene mesh without fixation. Parameters assessed at the follow up were early post operative pain by VAS score, chronic groin pain and recurrence. ResultsEarly postoperative pain in fixation group was relatively higher compared to non-fixation group. There was no statistically significant difference between the two groups in incidence and severity of chronic groin pain at 6 months. Only one patient in the study in the flat mesh group had symptomatic recurrence of hernia 10 months after surgery. Mesh deployment time was significantly lower with pre-shaped mesh. ConclusionUse of a pre-shaped contoured mesh without the use of any additional fixation during TEP repair is feasible and safe. The incidence and severity of postoperative chronic pain is similar if pre-shaped mesh is used without fixation without any increase in recurrence in experienced hands.

Oncological outcome of videoscopic groin dissection for lymph node metastasis from melanoma.

Videoscopic inguinal lymphadenectomy (VIL) represents an innovative approach for patients with melanoma lymph node (LN) metastases, mainly aimed at lowering wound-related morbidity. However, long-term data on oncologic safety are still lacking. The aim of this study is to review the oncologic outcome of videoscopic groin dissection in a single institution caseload. Data were prospectively gathered on patients with inguinal melanoma metastasis who underwent VIL. Clinical data included age, race, sex, tumor histology, node counts and number of metastatic nodes. Disease-free survival and overall survival were monitored based on an institutional follow-up schedule. The study was approved by the local ethics committee (Video-SIIO II study). We analyzed 48 videoscopic groin dissections performed in 50 patients (2 patients underwent bilateral VIL). Median age was 54.5years. Female/male ratio was 15/33. Indication for surgery was positive inguinal sentinel biopsy and cytological confirmed clinical disease in 40 and 10 cases, respectively. Median LN retrieval count was 19. After a median follow-up of 28months, groin recurrence (lymphatic basin) was observed in one single case. VIL for melanoma LN metastases is associated with a favorable oncologic outcome. In particular, LN yield and locoregional recurrence rate obtained with videoscopic dissection are comparable to those reported with the open technique. Prospective studies are needed to confirm these results in a larger cohort of patients.

Predictive Value of an Alternative Strategy for Measuring Depth and Size of Stage 1 Vulvar Squamous Cell Carcinoma.

Despite poor reproducibility for measuring vulvar cancer depth, 1-mm or greater invasion triggers lymphadenectomy for small tumors. Previous literature suggests that measuring depth from the nearest dysplastic rete peg (alternative method) rather than highest dermal papilla (conventional method) may be acceptable. Pathologic staging and follow-up information were recorded for 100 pT1 vulvar squamous cell carcinoma (SCC) resected from 1990 to 2019. Conventional depth, alternative depth, gross/clinical size, and size of the invasive component were measured for each tumor. In this retrospective study, we evaluated which clinicopathologic factors were most predictive of lymph node involvement and recurrence. Depending on the measurements used (conventional vs alternative depth, clinical lesion size vs cumulative extent of invasive component), between 1 and 18 cases were downstaged to pT1a. All such cases were pN0, without lymphovascular or perineural invasion. Infiltrative cords (hazard ratio [HR] = 5.15; 95% CI = 1.63-16.2; p = .005) and perineural invasion (HR = 3.16; 1.18-8.45; p = .022) were most strongly associated with groin recurrence. Of staging criteria evaluated, only cumulative extent of the invasive component 2 cm or greater was significantly associated with groin recurrence (HR = 2.87; 1.01-8.17; p = .048). The Kaplan-Meier curves for local recurrence-free survival by stage did not show significant separation regardless of method. Patients downstaged using alternative measurement techniques lacked nodal disease/recurrence; one-third of those with nodal sampling experienced postoperative morbidity. Our data suggest that the use of alternative depth and cumulative extent of invasion could safely allow some conventional stage IB vulvar SCC patients to avoid groin surgery, thereby reducing treatment-related morbidity.

Laparoscopic repair of inguinal hernia: Prospective evaluation at a tertiary care center

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting.&#x0D; Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence.&#x0D; Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence.&#x0D; Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period.&#x0D; Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 54-58

Outcome of tension free open mesh repair of inguinal hernia

Background: In the practice of General Surgery, hernia repair is the second most common procedure after appendectomy. Several methods have been developed over the years to try to improve hernia repair. Good result can be expected using Bassini's, McVay's, Shouldice's techniques provided the exact nature of hernia is recognized and the repair is done without tension using healthy tissue. The introduction of synthetic mesh started a new era in hernia surgery. The use of synthetic mesh repair of primary and recurrent hernias has gradually gained acceptance among surgeons.&#x0D; Objective: To find out the outcome and complications of open inguinal hernia repair with prolene mesh.&#x0D; Methods: This is a prospective cross sectional study conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December, 2011 to May, 2012. One hundred patients of inguinal hernia admitted in different surgical units of BSMMU, Dhaka for elective surgery were studied. We have given 1 gm ijv Cephradine per operatively and then 500 gm cephradine ijv 6 hourly for 24 hours followed by oral form of Cephradine for next 5 days. Polypropylene mesh of 11 cm x 7 cm size was used in all cases. All the operations were done by open tension free prolene mesh repair technique. Patients were followed for one year to see the outcome.&#x0D; Results: Out of 100 cases of inguinal hernia, 71 patients (71%) had indirect inguinal hernia and 29 cases (29%) had direct inguinal hernia; 90 cases (90%) were primary hernia and only 10 cases (10%) were recurrent hernia; 58 cases were right sided, 34 cases (34%) were left sided and 8 cases (8%) were bilateral. Complications of mesh repair of groin hernia in this study included wound infection (5%), scrotal oedema (2%), mesh infection (0%), scrotal hematoma (2%), echymoces of peri-incisional skin (5%), early wound and groin pain (7%), chronic inguinodynia (2%), hernia recurrence (1%).&#x0D; Conclusion: In the present study an attempt is made to evaluate the outcome of patients undergoing inguinal hernia repair by prolene mesh. The results confirm that Lichtenstein tension free mesh repair of inguinal hernia is safe and reliable for both primary and recurrent groin hernia, with less recurrence rate. Patient's compliance was good with minimum morbidity.&#x0D; Journal of Surgical Sciences (2018) Vol. 22 (1): 21-24

Evolution and outcomes of sentinel lymph node mapping in vulvar cancer

ObjectivesTo characterize our institutional experience with sentinel lymph node (SLN) biopsy in patients with vulvar cancer. We describe the oncologic outcomes of these patients and the utilization of SLN detection...

Lymphoscintigraphy and sentinel lymph node biopsy in vulvar carcinoma: update from a European expert panel.

This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts. A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected. Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-99mTc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.

Spontaneous rupture of incisional hernia in a 7 month concealed pregnancy: a rare case report

Incisional hernias have been reported in up to 20% of patients undergoing laparotomy. The incidence of incisional hernia following Caesarean section by vertical incision is 3.1%. Spontaneous rupture of abdominal hernia is very rare and usually occurs in incisional and recurrent groin hernias. Conservative management such as manual reduction and use of abdominal binder until term has been applied with unreliable success. Additionally, surgical intervention such as antepartum hernial repair has also been undertaken in few women while allowing for normal vaginal delivery at term. The rarity of this condition prompted us to report a case of spontaneous rupture of incisional hernia in a 35 years old pregnant lady who had developed incisional hernia following caesarean section.

Novel robot-assisted laparoscopic total extra-peritoneal repair with primary fascial closure plus pre-peritonea mesh for large groin defects.

Since the introduction of robot-assisted laparoscopic surgery, a variety of conventional laparoscopic procedures have been explored via this approach. In the robotic era, most of the reported robot-assisted laparoscopic hernia repairs were performed with the trans-abdominal pre-peritoneal approach. According to the evidence extrapolated from laparoscopic ventral hernia repair, simultaneous fascial defect closure and mesh repair can significantly decrease the risk of seroma formation and recurrence over those without fascial closure. Therefore, we describe our novel technique of robot-assisted total extra-peritoneal (TEP) repair with primary fascial closure and pre-peritoneal mesh and its preliminary clinical outcomes. We retrospectively reviewed our prospectively collected hernia database from October 2017 to July 2019, which included 26 consecutive patients with primary or recurrent groin hernias. Patients' baseline characteristics and perioperative outcomes were compared and analyzed. Perioperative factors included operative time, visual analog scale (VAS) score (0-100), hospital stay, perioperative complications, time to return to normal activity, and the modified Medical Outcome Study (MOS; item 3-12/36 items) score. All procedures were completed successfully without conversion to open or conventional laparoscopic surgery. The patients' age ranged from 28 to 74 years (median 57.5). The mean operative time was 115 minutes (range 95-172 min). There were no major procedure-related complications. Only four cases experienced asymptomatic seromas, which were detected by ultrasonography; and all resolved spontaneously within 6 weeks after the operation. The VAS and modified MOSs revealed quick recovery after robot-assisted endoscopic TEP repair. Robot-assisted endoscopic TEP repair combined with primary fascial closure and pre-peritoneal mesh is a safe and feasible technique for groin hernia repair.

A comparative study of inguinal hernia using monofilament non-absorbable suture versus monofilament absorbable suture in Lichtenstein tension free hernia repair at tertiary care government hospital

Background: The surgical treatment of inguinal hernias has evolved through several stage, history of groin hernia is the history of surgery itself. But, chronic pain is still a major irritating post-operative complain of the patient. The objective of the present study was to compare post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in terms of postoperative pain, chronic groin pain, seroma formation, wound infection, scrotal oedema and recurrence in Lichtenstein hernioplasty.Methods: This is a single center, prospective randomized controlled study of 152 cases of inguinal hernia comparing post-operative outcomes of mesh fixation with monofilament non-absorbable v/s monofilament absorbable suture material in Lichtenstein hernioplasty at Baroda Medical College and S.S.G. Hospital, between 1st November 2017 to 30th November 2018.Results: Total 152 patients of unilateral or bilateral inguinal hernia were studied 76 in each group. Chronic groin pain mean visual analogue scale score at 3 months was higher in group with non-absorbable suture compared to monofilament absorbable group (1.3±0.9 v/s 0.95±0.8 p value &lt;0.05).Conclusions: Monofilament absorbable suture is associated with less chronic groin pain and compared to monofilament non-absorbable sutures.

Recurrence and survival rates in node negative patients after sentinel node biopsy for early-stage vulva cancer – A nationwide study

ObjectiveThe sentinel node (SN) procedure is adopted in selected patients with early-stage vulva cancer (VC) in Denmark. Due to the low incidence of VC, large population-based studies on the safety of SN outside multicenter clinical trials are lacking. The current study evaluated the risk of recurrence and survival in SN- negative VC patients. MethodsNationwide data was collected and registered prospectively in the Danish Gynecologic Cancer Database from January 2011 to July 2017. Patients with clinically stage IB-II unifocal vulva squamous cell carcinoma, tumor <4 cm and no clinically suspicious groin nodes or distant metastases, who underwent SN-procedure, were included. ResultsThe SN-procedure was performed in 286 patients, of these 190 (66.4%) patients were SN-negative. Twenty-three of the 190 SN-negative patients (12.1%) had one or more recurrences during a median follow-up of 30 months (range 1–83). Four patients (2.1%) had an isolated groin recurrence identified from 5 to 17 months after primary surgery. Fourteen patients (7.4%) experienced a local recurrence in vulva, 1 patient (0.5%) had a recurrence in the vulva and the groin and 4 patients (2.1%) had distant recurrences. The 3-year overall (OS) and disease-specific survival (DSS) for SN-negative patients was 84% and 93%, respectively. The 3-year OS for patients with recurrent disease was 58%. ConclusionsThis is the largest prospective nationwide study on SN-procedure in vulva cancer. The study confirms the safety of the SN-procedure in selected early-stage VC patients with a low isolated groin recurrence rate and a good DSS.