Technique For Hernia Repair Research Articles

The Enhanced-View Totally Extraperitoneal Repair for Ventral and Incisional Hernia: Midterm Results of an Evolving Technique.

Introduction: In the field of abdominal wall hernias, several innovative procedures have been developed, including the extended/enhanced-view totally extraperitoneal (eTEP) hernia repair technique. Initially introduced for laparoscopic hernia repair by J. Daes, it was subsequently applied to ventral hernia repair (VHR) and incisional hernia repair (IVHR) by I. Belyansky et al. This article presents the midterm experience and outcomes of our center's experience with the endoscopic technique based on the principles of eTEP during IVHR and VHR. Method: A review was conducted of a prospectively collected database of abdominal wall hernia. Patients who underwent eTEP VHR or IVHR between October 2018 and February 2021 were identified. Results: A total of 51 patients underwent an eTEP-RS or eTEP-TAR procedure, with a 24-month follow-up period. Of the 51 patients included in the study, 43 underwent eTEP-RS treatment, while 8 required an additional transversus abdominis release (3 unilaterally). One patient developed a large hematoma necessitating reoperation and drainage via the eTEP approach. Seven patients developed seromas, which were treated conservatively, while 2 patients experienced surgical site infections, which were managed with a single-use negative pressure wound therapy system. Two patients exhibited recurrence at sites above the epigastric edge of the mesh. Conclusion: Moreover, the advancement of minimally invasive surgical techniques for abdominal wall reconstruction has rendered the eTEP approach a viable option for both primary and incisional VHR, with promising midterm outcomes.

A Novel Technique for Inguinal Hernia Repair in Patients With Nonmalignant Ascites

A Novel Technique for Inguinal Hernia Repair in Patients With Nonmalignant Ascites

Outcomes of porcine small intestinal submucosa mesh compared to polypropylene mesh in laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective cohort study.

To compare the long-term outcomes of porcine small intestinal submucosa (SIS) mesh and polypropylene (PP) mesh after an laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Mesh-based surgical techniques for inguinal hernia repair are recommended in the guidelines due to the lower rate of recurrence. Biologic meshes (BMs) may have advantages in terms of chronic pain due to the different postoperative remodeling, without the disadvantages of a permanent implant. SIS mesh is the most commonly used BMs, mostly used for young male patients. Until now, the long-term efficacy of SIS mesh in laparoscopic inguinal hernia repair (LIHR) has rarely been reported and remains elusive. We retrospectively reviewed prospectively collected data from consecutive LIHR performed at Beijing Chaoyang Hospital between January 1, 2014 and December 31, 2018. Two groups of meshes were selected: SIS mesh and PP mesh. To reduce potential selection bias, patients were matched based on the logit of propensity scores through age, gender, and body mass index (BMI). Follow-up was until January 30, 2024. Long-term outcomes were analyzed, including the rate of recurrence, the rate of re-operation, and the postoperative discomfort. A total of 2,348 patients with LIHR were eligible. After exclusion criteria, a total of 1,240 unilateral hernias treated using the TAPP approach were included for statistical analysis. Of these, 143 hernias (11.5%) were operated on with SIS mesh. Applying propensity score matching resulted in 115 matched pairs for comparative analysis. The mean operative time with the SIS mesh was 63.2 ± 18.5min, which was longer than the operative time with PP mesh of 50.1 ± 17.6min (P < 0.001). The SIS mesh was used more frequently to repair indirect hernias, while the PP mesh was more often employed to direct and femoral hernias at a higher rate (P = 0.009). The mean follow-up was 84.2months and a total of seven patients (3%) were lost to follow-up. Overall, five (2.3%) patients experienced hernia recurrence postoperatively, all in the SIS group, but no statistical difference was observed between the two groups (4.4% vs. 0%; P = 0.06). All underwent a second operation, with three in TAPP approach and two in Lichtenstein approach, no recurrence was found afterward. More patients in the SIS group reported postoperative discomfort than those in the PP group (8.8% vs. 0.9%; P = 0.006), notably experiencing discomfort more frequently and to a greater degree during movement. The SIS mesh in TAPP hernia repair leads to more frequent discomfort and a higher recurrence rate (though not statistically significant) compared to PP mesh. Continued follow-up and an increased sample size are needed to analyze the effectiveness of SIS mesh and to explore risk factors for recurrence.

Post Operative Outcome of Desarda Technique Versus Lichtenstein Mesh Hernioplasty for Inguinal Hernia Repair

Background: Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations to some extents are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured because of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered. In the year 2001, Mohan P Desarda first described a physiological repair technique of inguinal hernia, which is practiced in many centers with significantly positive outcome. To evaluate the post-operative outcome of Desarda technique versus Lichtenstein mesh hernioplasty in inguinal hernia repair, this research has performed. Materials and methods: This Quasi experimental study was carried out in Surgery Department of Chittagong Medical College Hospital, during December 2017 to January 2019. A total of 100 patients with inguinal hernia underwent surgery were included in this study. Samples were selected by convenient technique. Among them 50 patients were selected for Desarda Technique was considered as group I and the rest 50 patients were selected for Lichtenstein Mesh Hernioplasty was considered as group II. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The proposed sample size was 50 in each group. The study group included male patient above 18 years of age undergoing Desarda Technique and Lichtenstein Mesh Hernioplasty for inguinal hernia repair. The mean age was 43.14±14.44 years in group I and 48.33±12.63 years in group II. Indirect hernia was found 37(74.0%) and 28(56.0%) in group I and group II respectively. The mean 3rd POD pain (NPRS) was 4.44±0.97 in group I and 5.52±0.71 in group II. The mean 10th POD pain Numeric Pain Rating Scale (NPRS) was 0.76±1.02 in group I and 2.62±1.21 in group II. The mean 1 month pain (NPRS) was 0.08±0.27 in group I and 0.72±0.7 in group II. The mean 3rd month pain (NPRS) was 0.02±0.14 in group I and 0.34±0.48 in group II. The mean 6th month pain (NPRS) was 0±0 in group I and 0.2±0.45 in group II. Pain (NPRS) was significantly (p&lt;0.05) higher in group II in 3rd POD and all subsequent follow-up. Seroma was found 5(10.0%) at 10th POD in group I and 5(10.0%) in group II. The difference was statistically not significant (p&gt;0.05) between two groups. Wound infection found 2(4.0%) in 3rd POD in group Iand 5(10.0%) in group II. Wound infection didn’t develop in subsequent follow-up in group I but in group II, 1(2.0%) found in 10th POD, 1(2.0%) in 1 month, 1(2.0%) in 3rd month, 1(2.0%) in 6th month. The difference was not significant (p&gt;0.05) between two groups. Recurrence was not observed in either group during this study period. Conclusion: Desarda technique of inguinal hernia repair in our set up is useful with comparable results to Lichtenstein hernioplasty. IAHS Medical Journal Vol 7(1), June 2024; 91-96

Transrectus Extraperitoneal Versus Minimally Invasive Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

Purpose: Recent guidelines have recommended minimally invasive surgery (MIS) for unilateral inguinal hernia due to reduced chronic pain. The most performed approaches consist of posterior mesh placement by the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. However, it remains debatable whether the advantage of those techniques stems from the MIS approach or posterior mesh placement or both. As the transrectus preperitoneal (TREPP) technique is an open option for posterior mesh placement, we conducted a systematic review and meta-analysis comparing TREPP and MIS techniques for groin hernia repair. Material and Methods: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TREPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, cumulative surgical site occurrences (SSO), surgical site infection (SSI), and postoperative pain. Results: Twenty-nine studies were screened, and eight were thoroughly reviewed. Three studies were included, of which two compared TREPP with the TEP technique, and one compared TREPP with both TEP and TAPP techniques. We found lower SSI rates for the MIS approaches (0.61% versus 0.33%; risk ratios (RRs) 3.96; 95% confidence interval (CI): 1.04-15.16; P = .04). We did not find statistically significant differences regarding recurrence (2.42% versus 2.51%; RR 1.01; P = .98), postoperative pain (4.2% versus 6.4%; RR 0.61; P = .4), and SSO (4.2% versus 4.0%; RR 0.6; P = .43) between TREPP and MIS techniques. Conclusion: Our systematic review and meta-analysis found a lower SSI for the MIS repair but did not find differences regarding recurrence, SSO, and postoperative pain. More studies are required to provide a more accurate conclusion about this topic.

Primary abandon-of-the-sac technique in laparoscopic inguinoscrotal hernia repair: A retrospective comparative study

Abstract BACKGROUND: Laparoscopic inguinoscrotal hernia repair is a challenging procedure. The surgeon must perform large dissections to reduce the hernial sac, although he has the alternative technique of leaving the sac at the deep inguinal orifice level from the beginning. OBJECTIVE: We aimed to determine the postoperative morbidity of laparoscopic inguinoscrotal hernia repair with the primary abandon-of-the-sac (PAS) technique and to compare it with complete dissection and reduction (CD). Operative times were compared as a secondary outcome. METHODS: A retrospective analysis was conducted between January 2021 and May 2022. The minimum follow-up was 3 months. Postoperative morbidity and operative times in the PAS group were analyzed and compared with those in the CD group. RESULTS: Seventy-eight patients were evaluated. The mean follow-up was 5 months (range, 3–18 months). PAS was performed in 15 patients, while the remaining 63 patients underwent CD. There were no significant differences in demographic and hernia characteristics. An overall morbidity of 30.7% was recorded. No statistical differences were observed in postoperative morbidity between the PAS group and the CD group (33.3% vs. 30.1%; P = 0.81). No statistical differences were found in terms of seromas (13.3% vs. 9.5%; P = 0.662), hematomas (6.6% vs. 9.5%; P = 0.727), or hydrocele (13.3% vs. 11.1%; P = 0.808). No recurrence or chronic pain was observed during the study period. Finally, a significantly shorter median operative time was recorded in the PAS group (50 vs. 80 min; P = 0.0026). CONCLUSION: The PAS technique is safe and feasible for the management of inguinoscrotal hernias. In our series, comparable morbidity rates were found when comparing it with CD. The benefit of the PAS technique is a significant reduction in operative time, despite the fact that it requires more postoperative ultrasounds.

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children.

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Choice of hernioplasty method based on the degree of intra-abdominal hypertension

Aim. To study the variability of intra-abdominal pressure and the choice of hernioplasty method for large and giant abdominal hernias.Material and Methods. This study analyzed the outcomes of various hernial orifice repair methods in 134 patients with large and giant hernias of the anterior and lateral abdominal walls. The majority of cases involved incisional hernias (n=52), while 47 patients presented with recurrent hernias, and 35 cases involved primary hernias. In 84.3% of cases, the hernias were localized in the anterior abdominal wall, and concomitant comorbidities were identified in 82 patients. Preoperative evaluations included clinical examination, imaging studies, and assessment of intra-abdominal pressure. Research results. In 31 (29.2%) observations, hernia repair was performed using the inlay method due to high intra-abdominal pressure. Anterior and posterior component separation with prosthetic reinforcement using the sub lay technique was carried out in 21 patients (7.5%). Additionally, the placement of a mesh prosthesis using the on lay method was performed in 54 patients (20.7%). The overall mortality rate was 2.2% (n=3), while 11 patients experienced recurrence in the late postoperative period, resulting in a recurrence rate of 8.2%.Conclusion. The increasing frequency of abdominal and retroperitoneal surgeries has led to a rise in the incidence of abdominal hernias. Traditional hernia repair techniques continue to evolve, and new, minimally invasive approaches are being developed to enhance patient outcomes. Despite ongoing advancements in surgical techniques for large and giant abdominal hernias, several challenges remain unresolved, necessitating further research and innovation in this field.

Inguinal Hernia Repair: Comparative Study between TEP versus Extended Totally Extraperitoneal.

Inguinal hernia repair is a common surgical procedure, with laparoscopic techniques offering advantages over open surgery. The extended Totally Extraperitoneal (eTEP) technique provides a larger working space compared to the traditional Totally Extraperitoneal (TEP) approach, potentially improving outcomes. A prospective study was conducted comparing eTEP and TEP techniques for inguinal hernia repair at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. Forty patients (20 in each group) aged 15-65 with uncomplicated inguinal hernias were included. Surgical procedures were performed based on patient preference. Data on surgical duration, pain scores, hospital stay, and complications were collected and analyzed using statistical methods. eTEP surgery had a significantly shorter mean duration (48.70 ± 7.505 minutes) compared to TEP surgery (74.20 ± 7.78 minutes; P = 0.00). Patients undergoing eTEP experienced lower mean pain scores (3.75 ± 0.55) compared to those undergoing TEP (5.15 ± 0.745; P = 0.00). Hospital stay following eTEP surgery was shorter (1.70 ± 0.657 days) than following TEP surgery (3.65 ± 1.137 days; P = 0.00). eTEP had lower incidences of hematoma and surgical emphysema but higher seroma complications. TEP surgeries were associated with more post-operative complications and a higher likelihood of requiring conversion to open surgery. The eTEP technique offers several advantages over TEP, including shorter surgical duration, less post-operative pain, and shorter hospital stays. However, TEP had more complications related to seroma. Individual patient factors and surgeon experience should guide the choice of technique. The eTEP technique appears to be a promising option for inguinal hernia repair, offering advantages over TEP in terms of surgical outcomes. However, further studies are needed to evaluate long-term outcomes and complication rates comprehensively.

Minimally Invasive Pauli Parastomal Hernia Repair.

Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the available evidence. A literature search in Pubmed, Embase, and Web of Science was undertaken to include all articles reporting on minimally invasive repair of parastomal hernias using the Pauli technique. Data regarding a total of 75 patients across 11 articles published between 2019 and 2023 were included. Patients received surgery either by a laparoscopic (27%) or robotic (73%) approach. A transabdominal route was chosen in 62 patients (83%), while an extraperitoneal technique was employed in the remaining 13 patients. The rate of postoperative morbidity was 34%, with 10% being the incidence of grade >II complications. The reported overall rate of recurrence was 7% at a median follow-up of 1 to 43 months. The available evidence derived from a growing number of centers suggests that minimally invasive Pauli repair is a viable option to treat parastomal hernias. Despite robust, high-level data still lacking, preliminary experiences indicate promising results.

Pneumaturia and Colonic Bleeding Post-Inguinal Herniorrhaphy: A Case Report

Introduction: A 51-year-old male was seen complaining of pneumaturia and bowel complaints, including blood per rectum. The patient related a history of an open left inguinal hernia repair utilizing a Kugel mesh ten years before. Case Presentation: Cystoscopy and colonoscopy demonstrated a hemorrhagic mass due to a prosthetic mesh protruding into the bladder and colon. Following colonoscopy and cystoscopy, a large inflammatory mass involving both the colon and urinary bladder was resected, which contained a rolled-up “tubular” mesh structure. After primary repair of the urinary bladder and placement of a Foley catheter, the sigmoid colon and mesh were resected, and the colonic anastomosis was completed. Outcome: Postoperatively, the patient progressed well with normal colon and bladder function after the removal of the Foley catheter. Discussion: Historically, the patient demonstrated the risk of major multiorgan surgical complications of a newer inguinal hernia repair technique, which may occur even a decade or more after the initial surgical correction and is, therefore, presented.

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

Tumescent Technique for Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) versus Conventional TAPP

Abstract Background Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications reported from laparoscopic procedure. But also, laparoscopic approach has its benefits as rapid recovery, quicker return to work, less acute pain complication, better quality of life outcomes. Objective To compare between the conventional and tumescent technique in TAPP inguinal hernia repair as regards operative technique, intra &amp; post-operative complications, early post-operative pain, hospital stay, restriction of physical activity, incidence of recurrence and post-operative chronic groin pain. Methods This was a prospective, randomized, comparative study, that was conducted at El-Demerdash hospital over one and a half years (October/2021 - March/2023). The 60 patients who were included divided into two groups, 30 for each. Group A; tumescent technique, Group B; conventional technique. Results Follow up started from the first day after operation and then visits at surgery outpatient clinic were arranged as follows, two weeks postoperative, then after one month. Interpretation of results revealed that there was significant difference between the two groups in operative time and early post-operative pain which decreased in tumescent group. There was no significant difference between the two groups as regards postoperative complications, the most reported complications were post- operative urinary retention and seroma formation. No reported cases of hernia recurrence and chronic groin pain in both groups. Conclusion Tumescent TAPP inguinal hernia repair appears to offer technical and clinical improvements to conventional TAPP, with small learning curve makes it easy procedure for unexperienced surgeons to use it for hernia repair and to learn it quickly. In general, TAPP inguinal hernia repair is considered both safe and effective for surgeons skilled in laparoscopic surgery; as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention, also the short-term treatment results were satisfactory.

Comparative analysis of robotic and laparoscopic techniques in hiatal hernia and crural repair: a review of current evidence and outcomes.

The purpose of this narrative review is to evaluate the implementation of robotic surgery in hiatal hernia and crural repair, based on the existing literature and to compare this approach to other established techniques. We performed a non- systematic literature search of PubMed and MEDLINE on February 25, 2024 for papers published to date focusing on the surgical repair of hiatal hernias using the robotic platform. After eliminating publications based on eligibility criteria, 13 studies were selected for analysis. Robotic surgery is increasingly utilized in hiatal hernia repair due to its enhanced ergonomics and superior visualization capabilities. Operative times vary, with some studies indicating longer durations for robotic surgery (e.g., Giovannetti et al. demonstrated median operative time of 196min for robotic compared to 145min for laparoscopic) while others report shorter times (e.g., Lang F et al. demonstrated 88min for robotic versus 102min for laparoscopic). Recurrence rates between robotic and laparoscopic repairs are comparable, with reported recurrence rates of 1.8% for robotic and 1.2% for laparoscopic approaches by Benedix et al. Robotic surgery offers potential advantages, including reduced intraoperative blood loss (e.g., Giovannetti et al. mentioned median blood loss of 20ml for robotic versus 50ml for laparoscopic). The length of hospital stay and postoperative complication rates also vary, with some studies suggesting shorter stays and fewer complications for robotic surgery as surgeons become more proficient. Soliman et al. reported a statistically significant reduction in complication rates with robotic surgery (6.3% versus 19.2%). Robotic surgery presents promising results regarding the length of hospital stay, conversion rate to open surgery and postoperative complication rates when compared to laparoscopy based on the existing literature. Despite the lack of striking differences, robotic hiatal hernia repair is a valid and evolving approach.

"Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias".

The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach. An observational prospective data-collected and quality of life study is performed in selected patients with less than 10cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score. A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score. Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

Risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia

Background: Inguinal hernia occurs in 1 to 5% of the general population. The development of laparoscopic inguinal hernia repair techniques as an alternative to conventional open surgery has improved results such as less postoperative pain, shorter hospital stays, and faster recovery. This study was conducted to assess the risk factors of conversion of laparoscopic totally extraperitoneal repair of inguinal hernia. Method: A total of 200 patients who were scheduled to undergo TEP were enrolled. Complete demographic and clinical details of all the patients was obtained. A Performa was made and detailed intraoperative findings were evaluated. Baseline hemodynamic and biochemical profile was evaluated. Separate assessment of patients was done who were converted to open surgery. Comparison of patients was done among those with and without conversion. Various risk factors were evaluated which were responsible for conversion. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients was 49.2 years. 60.5 percent of the patients were of rural residence. Mean BMI of the patients was 24.8 Kg/m2. Incidence of conversion was 6.5 percent. Geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear and previous hernia surgery history was found to be significant risk factors for conversion. Conclusion: Laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia is an effective technique, but conversion to open surgery occurs in 6.5% of cases. Significant risk factors for conversion include geriatric age, obesity, higher ASA grade, larger hernial defects, larger peritoneal tear, and previous hernia surgery history. Identifying these risk factors can help optimize patient selection and improve outcomes for TEP repair.

Clinical and computed tomography outcomes after mesh-enforced hiatoplasty and anterior hemi-fundoplication in large hiatal hernia repair.

The surgical technique in large hiatal hernia (HH) repair is controversially discussed and the outcome measures and follow-up schemes are highly heterogeneous. The aim of this study is to assess the true recurrence rate using computed tomography (CT) in patients with standardized large HH repair. Prospective single-center study investigating the outcome after dorsal, mesh-enforced large HH repair with anterior fundoplication. Endoscopy was performed after 3months and clinical follow-up and CT after 12months. Between 2012 and 2021, 100 consecutive patients with large HH were operated in the same technique. There were two reoperations within the first 90days for cephalad migration of the fundoplication. Endoscopic follow-up showed a correct position of the fundoplication and no relevant other pathologies in 99% of patients. Follow-up CT was performed in 100% of patients and revealed 6% of patients with a cephalad slippage, defined as migration of less than 3cm of the wrap, and 7% of patients with a recurrent hernia. One patient of each group underwent subsequent reoperation due to symptoms. There was no statistical correlation between abnormal radiological findings and clinical outcomes with 69.2% of patients being asymptomatic. Multivariate logistic regression did not show any prognostic factor for an unfavorable radiologic outcome. Ninety-four percent of patients rated their outcomes as excellent or good. Radiological follow-up after large HH repair using CT allows to detect slippage of the fundoplication wrap and small recurrences. Patients with unfavorable radiological outcomes rarely require operative revision but should be considered for further follow-up.

The DySLOH Study: Comparative Evaluation of the Results between the ProFlor and Lichtenstein Techniques for Open Inguinal Hernia Repair-A Randomized Controlled Trial.

Background: The Lichtenstein open anterior approach with static flat meshes, the most popular inguinal hernia repair technique, has raised concerns regarding mesh fixation, defect patency, and poor quality biological response. To address these issues, the 3D dynamic ProFlor scaffold promoting a fixation-free hernia defect obliteration has been developed as an alternative. Methods: The results of open inguinal hernia repair with the ProFlor approach compared with those of the Lichtenstein repair were evaluated. Results: In a time frame of 24 months, two cohorts of patients were enrolled, 95 in the ProFlor group and 93 in the Lichtenstein group. ProFlor demonstrated superior outcomes compared to the Lichtenstein technique, with shorter procedure times, decreased intraoperative complications, and lower rates of postoperative complications. Additionally, ProFlor provided enhanced postoperative pain relief, a faster return to daily activities, and no long-term discomfort. No chronic pain was reported in the ProFlor group and 11.8% reported chronic pain in the Lichtenstein group. Conclusions: The results highlight the need to reevaluate the conventional Lichtenstein approach and align it with recent scientific progress. Further consideration of the evolving understanding of inguinal pathophysiology and groin protrusion genesis is crucial for advancing surgical techniques.

Comparison of early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty

Background &amp; Objective: Inguinal hernia is a frequently encountered issue in surgical practice. Surgical techniques for hernia repair have significantly advanced and improved. The study objective was to compare early postoperative pain in mesh fixation versus without fixation in open Lichtenstein mesh hernioplasty regarding early postoperative pain. Methods: A randomized control trial was done at the Department of Surgery of the Federal Government Services Hospital, Islamabad from April to December 2023. Total 60 patients meeting the inclusion criteria and were presented with inguinal hernia. Randomly patients were divided into two groups, each consisting of 30 patients and were managed with Lichtenstein repair followed by either suture fixation for mesh or non-fixation of mesh. Patients from both groups were observed for 24-hours and early postoperative pain was recorded using visual analog scale (VAS). The data underwent analysis utilizing SPSS v 25. Results: The mean age of the patients was 46.0±9.2 years. Among 60 patients, 36 (60%) men and 24 (40%) women. The average BMI was 26.34±4.27 kg/m2. No significant difference was observed in postoperative pain between two groups (p ≥ 0.05). A t-test was utilized to compare the VAS score between two groups and it was observed the results insignificant except in patients with BMI less than 25 (p ≤ 0.05). Conclusion: There is no difference in occurrence of postoperative pain in fixed versus non-fixed mesh.

COMPARAÇÃO ENTRE ABORDAGENS CIRÚRGICAS PARA REPARO DE HÉRNIA ABDOMINAL

This systematic review aims to compare open, laparoscopic, and robotic surgical techniques for abdominal hernia repair, evaluating their efficacy, benefits, and drawbacks. A comprehensive search of PubMed and ScienceDirect was conducted using terms related to "abdominal hernia repair" and "surgical techniques". The review included studies published from 2020 to 2024, focusing on randomized controlled trials, meta-analyses, and systematic reviews. The analysis revealed that laparoscopic and robotic repairs generally offer reduced recovery times, less postoperative pain, and lower complication rates compared to open surgery. However, robotic repairs, while offering precision and ergonomic advantages, come with higher costs and longer setup times. Open repairs, though associated with higher complication rates and longer recovery periods, are still preferred in certain complex cases due to their straightforward execution. This review highlights that laparoscopic and robotictechniques present notable advantages over traditional open surgery, particularly in terms of postoperative outcomes and patient recovery. The findings support the use of minimally invasive approaches where feasible but also underscore the importance of considering individual patient circumstances and the complexity of the hernia when selecting the most appropriate surgical technique.