Complicated Hernia Research Articles

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

A Multimodal Approach to the Management of Diverticular Abscess with Paraesophageal Hernia Complication

This study aims to evaluate the management of acute diverticulitis complicated by hernia and the role of electroacupuncture in managing postoperative ileus. The case involved a 51-year-old male patient who presented with left lower abdominal pain, fever, and defecation disorder. Physical examination showed signs of infection with localized peritonitis, while laboratory tests revealed neutrophilia. CT scan showed diverticulitis with abscesses in the descending and sigmoid colon, as well as free air around the colon and perihepatic region, and paraesophageal hernia. The patient underwent left hemicolectomy with Hartmann's procedure. Postoperatively, the patient developed ileus which was treated using electroacupuncture. The results showed that the relationship between diverticulosis and hernia is due to connective tissue changes. Approximately 10-20% of diverticulosis cases progress to acute diverticulitis. CT scan is the gold standard for diagnosis, staging and management of diverticulitis. In cases of Hinchey III diverticulitis, laparoscopic washing does not give better results compared to colonic resection. The Hartmann procedure is recommended for patients with multiple comorbidities. Electroacupuncture proved to be an effective adjunctive therapy in managing postoperative ileus. The conclusion of this study is that a multimodal approach, including surgery and complementary therapies such as electroacupuncture, is essential in the management of diverticulitis and its complications. The implication of this study is the need for a holistic approach in managing patients with acute diverticulitis, especially in cases with multiple comorbidities and risk of postoperative complications.

Asuhan Keperawatan Pada Nn. S dengan Post Operasi Hernioraphy : Hernia Inguinalis Lateralis Dextra di Ruang Mawar 2 RSUD dr. Soeselo Kabupaten Tegal

Inguinal hernia is a condition where an organ protrudes into a cavity through a thin or weak part of the wall. The small intestine is usually the organ that enters the cavity, causing the protrusion. In 2018, hernia ranked 8th in Indonesia with a total of 18,145 cases or around 1.05%. The number of hernia cases in Central Java is estimated to be over 500, or approximately 1.01% of cases. If an inguinal hernia is not treated promptly, it will continue to grow and exert significant pressure on the surrounding tissues. A common consequence of untreated hernia is that it will enlarge and interfere with the patient's daily activities. One of the complications of hernia is swelling around the lump. One of the treatments for hernia is surgery. The writer is expected to provide optimal nursing care for patient. S, who has experienced a right lateral inguinal hernia post- operatively following herniorraphy in Mawar 2 ward of dr. Soeselo Regional Hospital, Tegal Regency.

Optimal timing of surgery for inguinal hernia in premature neonates

AbstractAimThe surgical repair of inguinal hernias represents a significant risk for premature infants. Despite ongoing discourse, the optimal approach to hernia management remains contentious. Our investigation aims to establish the most favourable timing for inguinal repair in premature neonates.Patients and MethodsOur investigation involved the analysis of medical records for 536 neonates, born prematurely, who underwent inguinal hernia repair from January 2018 to December 2023. We dichotomised the cohort into two groups: those who received early repair and those who underwent late repair. The timing of the surgery was primarily determined by the surgeon's decision, in conjunction with familial consent to the surgical intervention. The primary endpoints were the incidence of recurrence or incarceration within 1 year after surgery. The secondary endpoints encompassed length of neonatal intensive care unit stay, post‐operative ventilator dependency, and frequency of return visits, whether to the inpatient and emergency department or an outpatient clinical setting, for hernia‐related issues.ResultsThe analysis encompassed a total of 454 neonates born prematurely, of which 163 underwent early repair, while 291 received late repair for inguinal hernia. The demographic data between the two groups demonstrated no significant differences. The occurrences of hernia recurrence and post‐operative apnoea presented similar trends across both cohorts. Notably, the late repair group exhibited an increased incidence of preoperative incarceration and return visits due to hernia complications. In this group, testicular atrophy or ovarian necrosis was observed in five cases, despite the overall absence of significant differences.ConclusionsOur findings suggest that the surgical repair of inguinal hernia in preterm neonates, performed at the time of presentation to our clinics, is both safe and feasible. However, a delay in hernia repair appears to be associated with a heightened risk of severe complications, such as testicular atrophy or ovarian necrosis.

Role of Ultrasound and Duplex in Evaluation of Complicated Hernia; Correlated with the Surgical Findings and Post-Surgical Outcome

Role of Ultrasound and Duplex in Evaluation of Complicated Hernia; Correlated with the Surgical Findings and Post-Surgical Outcome

Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy.

The objective was to assess intraoperative and postoperative complication rates, along with perioperative and surgical outcomes, following single-port robotics-assisted sacrocolpopexy. This retrospective case series included 200 patients who underwent single-port robotics-assisted sacrocolpopexy to treat Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 symptomatic prolapse between April 2020 and August 2023 by a single surgeon. Intraoperative and postoperative complications and perioperative outcomes were evaluated for all the patients, whereas surgical outcomes for 74 patients were assessed at 1-year follow-up. Surgical failure was defined as the presence of any of the following: the presence of vaginal bulging symptoms, any prolapse beyond the hymen, or retreatment for prolapse. During the study period, 200 single-port robotics-assisted sacrocolpopexies were performed. The median age and body mass index were 65.0 years and 24.6kg/m2 respectively. Most patients had POPQ stage 3 or 4 prolapse and underwent concomitant total hysterectomy. The median total operation time was 212.0min, and none of the patients required conversion to laparoscopy or laparotomy. The intraoperative cystotomy rate was 2.5%, and one patient had a blood transfusion owing to presacral vessel injury. Postoperative complications of mesh exposure and wound hernia were 0.5% and 2.0% respectively. At 1 year postoperatively, the rate of composite surgical failure was 9.5%, with a 5.4% anatomical recurrence rate. None of the patients experienced apical prolapse recurrence, and one received anterior colporrhaphy for anterior compartment prolapse recurrence. Single-port robotics-assisted sacrocolpopexy is safe and effective, with low complication rates and favorable perioperative and surgical outcomes.

A Rare Case of Spontaneous Diaphragmatic Hernia with Gastric Perforation Presenting Like an Empyema

Diaphragmatic hernias are rare and mostly congenital, rarely spontaneous. Perforation and other complications of diaphragmatic hernias are even rarer and associated with significant morbidity and mortality. We report a patient presenting to the emergency department with features of empyema requiring intercostal drainage. However, on clinical worsening, radiological imaging showed features of diaphragmatic hernia and a subsequent thoracostomy revealed a herniated gastric perforation. Such cases are very rare and need a high index of suspicion for the diagnosis and early appropriate surgical management. Otherwise, it is associated with very high rates of mortality.

Long-term mesh-related complications from minimally invasive intraperitoneal onlay mesh for small to medium-sized ventral hernias

IntroductionIntraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs.Methods and proceduresAdult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.ResultsA total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8–5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up.ConclusionIntraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.

Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy

Postoperative hiatal hernia is a rare and specific complication after esophagectomy. This complication leads to emergency and affects mortality. Incidence of this complication has increased due to the great number of minimally invasive procedures over the past decades. In addition, chronic cough, preoperative hiatal hernia and transhiatal approach also increase the risk of recurrent hernias. Most post-esophagectomy hiatal hernias do not require emergency surgery. About 70% of patients have symptoms reducing the quality of life. About 25% of cases are asymptomatic and discovered incidentally during follow-up examinations. The role of surgery for asymptomatic post-esophagectomy hernias is a matter of debate because the risk of symptoms or complications is poorly predictable. Surgical treatment is the only radical method for symptomatic or complicated hernias. However, there is still no consensus regarding surgical approach and technique. Most surgeons prefer open surgery fearing severe adhesive process and other technical difficulties. Laparoscopic approach is widely accepted as the "gold standard" for primary hiatal hernia. However, minimally invasive access for post-esophagectomy hiatal hernias is not sufficiently studied and described in several case reports. Currently, it is very important to study the risk factors of hiatal hernias after esophagectomy. We present successful laparoscopic repair of hiatal hernia after hybrid McKeown esophagectomy.

Amyand hernia with perforated appendix simulating as testicular torsion in a neonate: A case report

Background: Amyand hernia is defined as the presence of the vermiform appendix within the hernial sac. A perforated appendix is an uncommon complication of Amyand hernia. Rarely it may simulate a testicular torsion. Case Presentation: A twenty-five-day-old male infant presented with right-sided scrotal swelling, exhibiting symptoms of crying, irritability, and poor feeding over a two-day duration. The swelling was non-reducible, confined to the scrotum, and the spermatic cord showed thickening with erythematous scrotal skin. Following preparation, an inguinal incision was made, and an appendectomy and herniotomy were performed. Conclusion: Amyand hernia, a rare type of inguinal hernia, poses challenges in preoperative diagnosis. The occurrence of a perforated appendix is especially rare in neonates with Amyand hernia. Surgical management entails appendectomy through an inguinal incision coupled with meticulous hernia repair.

Математичне моделювання частоти патології вагінального відростка очеревини в дитячій популяції залежно від віку та статі

The pathology of the processus vaginalis of the peritoneum (inguinal hernia, hydrocele testis) is quite widespread among the pediatric population, both in our country and throughout the whole world. More than 99% of inguinal hernias in children are oblique, right-sided localization is more than 3 times more common than left-sided. High interest of scientists in the study of the pathology of the processus vaginalis of the peritoneum is caused by data on the appearance of infertility as a complication of inguinal hernias and dropsy of the testicles. In the structure of the causes of this situation, 30% belongs to the male factor, and this percentage has a constant tendency to increase. This became the reason for an additional study of the mathematical component of the prevalence of the pathology of the processus vaginalis of the peritoneum among the children’s population. Purpose - to create a mathematical model of the prevalence of pathology of the processus vaginalis of the peritoneum depending on age and gender among the children’s population. Materials and methods. 205 patients under the age of 18 who underwent surgical correction of the pathology of non-obliterated processus vaginalis of the peritoneum (inguinal hernia, hydrocele testis) took part in the conducted scientific study. For mathematical modeling, software built into Microsoft Excel was used (Trend line, polynomial regression equation of the 4th degree). Results. In the course of mathematical modeling, characteristic features were identified: they occur both in the female part of the pediatric population and in the male, similar fluctuations are noted in the general pediatric population, namely periods of increase in the frequency of pathology of the vaginal peritoneum, which alternate with periods of its decline. a rapid increase in the frequency of pathology of the vaginal peritoneum, and, accordingly, their surgical correction, in children under 3-4 years of age, followed by a decrease in frequency by the age of 11-13 years. The following slight increase in the frequency of diagnosis of pathology of the vaginal peritoneum and its surgical treatment was detected by the age of 15-16 years, followed by a gradual decrease in the frequency by the age of 18 years Conclusions. Therefore, there are two mathematically confirmed peaks of growth in the frequency of detection of the pathology of the processus vaginalis of the peritoneum, which fall on the age of verticalization of the child and the age of “specialized” loads. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Modified multilayer alloplasty of complicated inguinal hernias.

Aim. To enhance the treatment outcomes of complicated inguinal hernias (characterized by a high inguinal gap, a large hernia orifice, a weakened posterior wall of the inguinal canal, or recurrence) through the implementation of a developed technique involving multilayer alloplasty.Materials and Methods. Within the overall cohort of 396 patients who underwent inguinal hernia surgeries between 2019 and 2023, the prevalence of complicated hernias was investigated. The main study group comprised 28 patients with complicated inguinal hernias who underwent surgery following the proposed method utilizing a two-layer prosthesis.Results. Complicated inguinal hernias, necessitating additional reinforcement of the posterior wall of the inguinal canal, predominantly manifest in patients with a large hernia orifice size (W3 — 6.57 ± 1.25 %), a significant inguinal gap (13.13 ± 1.70 %), and a history of relapses (8.59 ± 1.41 %). An associated condition complicating hernioplasty and elevating the risk of recurrence (0.618) is obesity (61.76 ± 8.33 % in the recurrent hernia group). The application of the developed hernioplasty method shows no significant difference in terms of complication risk and subjective sensations compared to the Lichtenstein method. Notably, no hernia recurrences were observed with the utilization of the duplication plasty technique.Conclusion. The suggested duplication design of the prosthesis proves effective in providing ex- tensive reinforcement for the inguinal gap in cases of problematic hernias. It is easy to position and is associated with minimal discomfort, as reported by the subjective sensations of patients.

Incidence of post open appendectomy incisional hernia in Erbil City

Background: since acute appendicitis is the most common presenting diseases in the surgical emergency departments, Appendectomy regarded as a common emergency surgical procedure that is done by the surgeons in the general surgery specialty. The complication of an incisional hernia development after open appendectomy is rare, found in about 0.12% of the appendectomy operations; interstitial type of incisional hernia complication following open appendectomy surgery is extremely rare condition, small number of reports found to deal with the incisional hernia development at the site of appendectomy in a range of (0.4-0.7%).
 Objective: To assess the incidence of incisional hernia following open appendectomy in Erbil province – Kurdistan region- Iraq.
 Patients and Methods: This retrospective study involved 598 cases between the period of first of July 2015 to 30th of April 2020, the cases presented with features of acute appendicitis, after admission and complete history taking, surgical intervention (open appendectomy) has been done for all of them, follow up for the diagnosis of the post appendectomy incisional hernia development done throughout revising the files and ID s of the patients and contacting them or their close relatives via personal mobile numbers, others re-consulted us for any operation site discomforts, any patient with suspicion of operation site problems asked to return to the outpatient surgical room for follow up and excluding or confirmation of operation site incisional hernia. The patients followed up for about 2-3 years after the operation days and contacting period with the patients or their close relatives to exclude incisional hernia development at open appendectomy site took about 6 months.
 Results: Out of 598 cases included in this retrospective study, 286 cases were male and 312 cases were female, the ages ranged between 5 and 91 years old with a mean and Standard Deviation (SD) 24.13, the age group of up to 10 years old included 13 cases, 2nd decade age group included 258 cases, while the third age group (21 – 30 years old) was included 167 cases. Risk factors for development of incisional hernia assessed among all cases, 56.85% of all cases had at least one of the risk factors and the remaining 43.15% devoid of any risk factors, the risk factors distributed among constipation (19.4%), pregnancy among female patients (18.9%), followed by diabetes mellitus, chronic cough and heavy working occupations (4.85% ,4.52% and 3.34% respectively), and BPH and anemia with other immunocompromised risk factors made only about 5.8%, only three patients (0.5%) developed incisional hernia after open appendectomy.
 Conclusion: Post open appendectomy incisional hernia is rare in patients without risk factors of wound dehiscence, with minimizing the risk factors of incisional hernia and wound dehiscence, the incidence of open appendectomy wound incisional hernia can be minimized to lowest rate.

Surgical Approach to Bilateral Inguinal Hernia. A Case-Control Study.

Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally invasive, in an elective sce-nario. The choice of surgical approach depends on the patient's status, hernia characteristics, surgeons and patient preferences. Whether age criteria should be considered when selecting between the two approaches is still a matter of debate. Considering that there is no consensus regarding the best repair in bilateral inguinal herniorrhaphy, the aim of the study is to perform an analysis regarding elective surgical approach of patients with bilateral inguinal hernias. Material and Methods: To study the relationship between exposure to an open versus laparoscopic approach in patients with bilateral inguinal hernia, we conducted a case-control study. In our retrospective analysis, cases (23 patients) were the open-approach hernia repair, and controls (82 patients) were laparoscopic hernia repair. We analyzed two sets of variables: first, related to patient characteristics (age 65 years, BMI 30 kg/m2, smoking habit, HTA status, COPD status, DM status, use of anticoagulants, presence of neoplastic status) and second, variables related to hernia features (inguinoscrotal hernia, recurrent hernia and complicated hernia). Results: The mean age for cases was 73.26 (Ã+-12.99) years and that of controls, was 56.48 (Ã+-15.15) years. Univariate analysis demonstrated four variables with statistical significance: age 65 years, inguinoscrotal hernia, neo-plastic status, and anticoagulant use. When introduced into the multivariate analysis, we noted that only two variables, age 65 years (OR=4.183, 95% CI [1.289, 13.572], p=0.017) and use of anticoagulants (OR=38.876, 95% CI [1.305, 1158.011], p=0.035) reached statistical significance. Conclusion: This study demonstrates that when we refer to bilateral inguinal hernia repair, patients aged 65 years are at risk of having an open procedure at least fourfold more than patients aged 65 years. In addition, the use of anticoagulants increases the risk of open hernia repair 38 times more than that of minimally invasive repair for the same age group. Interestingly, in our study, hernia characteristics were not found to be associated with open hernia repair and age 65 years. In our study we found that age 65 years is associated with electing open hernia repair over minimally invasive repair, which can be linked to age-related risk factors. Further re-search is needed to investigate the impact of age and age-related risk factors on surgical outcomes of bilateral inguinal hernia repair.

Traversing Boundaries: An Analysis of the Unremitting Psychic Unity in The Waste Land

Known as ‘Pope of Russel Square’ in the history of English literature from the 20th century, T. S. Eliot’s, literary ingenuity augmented the modernist writings. ‘The Waste Land’ is one such eventuality that, retrospectively from the publication, permuted worldwide, giving boundless definitions and ceaseless critical appraisals. Contriving the idiom of modern poetry, his career as a part never went over the hill since it was chiselled out of the emotional and intellectual retaliation to a gest which was his life itself. The close-grained, fragmented study of his works, has seemingly been immense and comprehensive. Being portrayed as the literary arbiter, his personal life was lucid and full of drama. The oeuvre hence hollers the zeitgeist of his era. As a philosopher, his happy hunting ground was both religion and the emphasis on conforming to the basic moral values of life. His ethical involvement with life emanates from the underlying desolation and devastation regarding his personal life. When he assiduously carried his position in poetry, politics, and literature, he was tagged as heedless in his personal life. The childhood limitations sprouted out from the complications of inguinal hernia, later when he was at Harvard while studying Sanskrit and Indian philosophy, the commencement of WWI and the escape from Oxford after witnessing a society which was wartorn, a love affair with Emily Hale which closed out in two shakes of a lamb’s tail and the hasty entry into wedlock with Vivienne Haigh-Wood whose alleged adultery with Bertrand Russel and her ailment that followed took a toll on his burgeoning literary career. The shuffling was wilfully implemented, as alluded to by many critics. But for a feeler who, exasperated by the atrocities of war, could not necessarily keep the word restrained to the end and the overscrupulous side of Eliot could not have missed the slightest of the change either.

A Rare Case of a Direct Incarcerated Inguinal Hernia Containing an Epiploic Appendage and a Literature Review

Inguinal hernias are a widespread condition, responsible for a large number of acute abdomen cases. Typically, indirect, rather than direct, hernias lead to complications, as a consequence of their narrower hernial defect. We report a 71-year-old male patient with a rather rare incidence of a direct incarcerated hernia who presented with acute pain in the left inguinal area at a university general hospital in Thessaloniki, Greece, in 2017. Upon clinical examination, an irreducible inguinal mass was palpated. Therefore, the existence of a complicated hernia was suspected. The patient underwent an emergency repair, during which it was established that the hernia was direct and incarcerated and that its sac contained an ischaemic epiploic appendage. The hernia was successfully repaired with mesh, the patient recovered uneventfully and was discharged five days later. Despite the rarity of complicated direct inguinal hernias, they should always be included in the differential diagnosis of irreducible groin masses as they can increase severe complications. Keywords: Direct Inguinal Hernia; Appendix Epiploica; Case Report; Greece.

EGS P15 Perforated Stomach within an Inguinal Hernia: A Rare Case Report and Surgical Management

Abstract Background Inguinal hernias are a common surgical condition requiring urgent medical attention. While complications of inguinal hernias are frequently encountered, the presence of a stomach herniation within this anatomical site is an exceptionally rare occurrence. This rare phenomenon presents diagnostic challenges and necessitates prompt surgical intervention. This case report aims to provide a detailed account of a patient with a perforated stomach within an inguinal hernia, emphasizing the unique clinical presentation, diagnostic dilemmas, and the subsequent surgical management required for such a complex condition. Methods We report the case of an 83-year-old male who presented with severe abdominal pain and a tender mass in the left groin. Clinical examination revealed an irreducible inguinal hernia with signs of peritonitis. CT scan confirmed a giant incarcerated inguinal hernia containing part of the stomach with associated gas and fluid collection. An emergency open hernia repair was attempted but swiftly converted to an exploratory laparotomy. The hernia content was reduced intraabdominally, surprisingly revealing a posterior stomach wall perforation. Damage-control suture repair, washout, and laparostomy were performed. Tragically, he succumbed to multiorgan failure soon after in ITU. Results The occurrence of a perforated stomach within an inguinal hernia is an exceptionally rare and diagnostically challenging entity. Timely diagnosis and intervention are vital to prevent life-threatening complications. Imaging, particularly CT scan, aids in diagnosis and surgical planning. Prompt surgical management, involving hernia reduction and gastric repair, is crucial for optimal outcomes. play a critical role in identifying the gastric perforation and guiding the surgical approach. Conclusions This case underscores the importance of recognizing rare complications, such as stomach herniation in inguinal hernias. Heightened awareness and appropriate use of imaging facilitate accurate diagnosis and guide surgical interventions. Timely surgical intervention is essential in reducing morbidity and mortality associated with this rare presentation.

Laparoscopic versus robotic TAPP/TEP inguinal hernia repair: a multicenter, propensity score weighted study.

The objective of this retrospective study was to assess safety and comparative clinical effectiveness of laparoscopic inguinal hernia repair (LIHR) and robot-assisted inguinal hernia repair (RIHR) from multi-institutional experience in Taiwan. Medical records from a total of eight hospitals were retrospectively collected and analyzed. Patients primarily diagnosed of inguinal hernia, recurrent inguinal hernia or incarceration groin hernia patients who either underwent laparoscopic or robot-assisted inguinal hernia repair between January 2018 and December 2022 were included in the study. Baseline characteristics, intra-operative and post-operative results were analyzed. To compare two cohorts, overlap weighting was employed to balance the significant inter-group differences. We also conducted subgroup analyses by state of a hernia (primary or recurrent/incarceration) and laterality (unilateral or bilateral) that indicated complexity of surgery. A total of 1,080 patients who underwent minimally invasive inguinal hernia repair from 8 hospitals across Taiwan were collected. Following the application of inclusion criteria, there were 279 patients received RIHR and 763 patients received LIHR. In the baseline analysis, RIHR was more often performed in recurrent/incarceration (RIHR 18.6% vs LIHR 10.3%, p = 0.001) and bilateral cases (RIHR 81.4 vs LIHR 58.3, p < 0.001). Suturing was dominant mesh fixation method in RIHR (RIHR 81% vs LIHR 35.8%, p < 0.001). More overweight patients were treated with RIHR (RIHR 58.8% vs LIHR 48.9%, p = 0.006). After overlap weighting, there were no significant difference in intraoperative and post-operative complications between RIHR and LIHR. Reoperation and prescription rates of pain medication (opioid) were significantly lower in RIHR than LIHR in overall group comparison (reoperation: RIHR 0% vs. LIHR 2.9%, p = 0.016) (Opioid prescription: RIHR 3.34mg vs LIHR 10.82mg, p = 0.001) while operation time was significantly longer in RIHR (OR time: RIHR 155.27min vs LIHR 95.30min, p < 0.001). This real-world experience suggested that RIHR is a safe, and feasible option with comparable intra-operative and post-operative outcomes to LHIR. In our study, RIHR showed technical advantages in more complicated hernia cases with yielding to lower reoperation rates, and less opioid use.

Gastric incarceration: A rare complication of parastomal hernia

Gastric incarceration: A rare complication of parastomal hernia

Treatment of recurrent hiatal hernia, complicated by pleural empyema, mediastinitis and sepsis

An observation of a rare complication of a hiatal hernia is presented – migration of the stomach with an antireflux cuff into the mediastinum with the development of acute gastric dilation, necrosis of the gastric wall in a 51-year-old woman. The effectiveness of stage-by-stage treatment of severe intrapleural complications of recurrent hiatal hernia accompanied by sepsis and multiple organ failure is shown.