Hernioplasty For Inguinal Hernia Research Articles

Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia

Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia

Laparoscopic TAPP Single Access Hernioplasty with Simultaneous Appendectomy for Chronic Appendicitis

Aim. To investigate the technological features and immediate results of simultaneous laparoscopic hernioplasty of inguinal hernia and appendectomy in chronic appendicitis.Methods. Was performed the analysis of the initial data, complications, duration of surgery and hospitalization in patients after simultaneous appendectomy and TAPP inguinal hernia repair in comparison with isolated TAPP.Results. Simultaneous appendectomy during laparoscopic hernioplasty does not significantly affect the performance of TAPP inguinal hernia repair, but it increases the duration of the intervention due to additional manipulations. This does not affect the incidence of complications and the length of hospital stay.Conclusions. Simultaneous laparoscopic appendectomy for TAPP hernioplasty is advisable in patients with chronic appendicitis and inguinal hernias.

Laparoscopic totally extraperitoneal hernioplasty: Theodor Bilharz Research Institute preliminary experience

Background The two standard methods for inguinal hernioplasty is open and minimal access laparoscopic technique. Most laparoscopic surgeons use a transabdominal preperitoneal approach but totally extraperitoneal (TEP) approach potentially offers several advantages. Objective The aim in this study was to assess the learning curve, cost value, safety, and feasibility of TEP approach. Patients and methods Prospectively collected data on 185 consecutive patients submitted to laparoscopic TEP hernioplasty for inguinal hernia from 2016 to 2018 in Theodor Bilharz Research Institute Hospital. This study involved repair of primary, recurrent inguinal hernia and femoral hernia. The prolene mesh was used for groin hernia repair in all cases with and without fixation. Results All 185 cases started with the laparoscopic TEP technique with only four cases converted to transabdominal preperitoneal technique (2.1%). In 110 (60.7%) cases the mesh was placed without fixation. In 71 cases the mesh was fixed by Tackers or Histoacryl. In unilateral hernia, the mean operating time was 45 min, while in bilateral hernia it was 61 min. Intraoperative complications included three cases of inferior epigastric vessel injury which were managed by metallic clips of 5 mm. The mean pain score was 7.5, while the mean satisfaction score was 5.4. The mean hospital stay was 16.4 h. Regarding postoperative complications, 10 (5.5%) patients developed a postoperative seroma, four (2.1%) patients developed a hematoma, two (1.1%) patients developed a hydrocele, and five (2.7%) patients experienced neuropathic pain. There were three (1.1%) recurrent cases; all these cases were managed by open hernioplasty. Conclusion In this study, the laparoscopic TEP approach is found to be an effective, and safe technique regarding primary, recurrent open inguinal and femoral hernias with good learning curve to laparoscopic surgeon who started with transabdominal preperitoneal technique technique.

Posterior rectus canal: not a single anatomical entity & morphology - a laparoscopic study during TEP hernioplasty.

Posterior rectus canal assumed immense importance with newer laparoscopic technique of total extra-peritoneal pre-peritoneal (TEPP/TEP) hernioplasty for inguinal hernia. However, scientific study of live surgical anatomy of posterior rectus canal is almost totally lacking in the English literature, and hence the present study was conducted. 3-midline-port technique through posterior rectus sheath approach; Initial telescopic dissection under direct CO2 insufflation followed by instrument dissection. 68 TEPP hernioplasties were successful in 60 patients with mean age of 50.1 ± 17.2 years (range 18-80) and mean BMI of 22.6 ± 2.0 kg/m2 (range 19.5-31.2). Rectusial fascia was a definite anatomical entity, dividing traditional posterior rectus canal into two channels, namely, true retromuscular space and true posterior rectus canal (T-PRC). Rectusial fascia was variable, i.e., thick diaphanous (n= 47), thick membranous (n= 13), thin membranous (n= 3) and thin flimsy (n= 5). Posterior rectus sheath (PRS) was also variable, incomplete (n= 54) and complete (n= 14). Incomplete PRS showed seven variations in both extent and/or morphology. Complete PRS show five morphological variations. Transversalis fascia demonstrated three morphological variations, namely, single diaphanous (n= 41), single membranous (= 10) and thin flimsy (n= 3). TEPP hernioplasty was readily feasible through avascular true posterior rectus canal. Posterior rectus canal is divided by 'rectusial fascia' into two channels, namely, true retromuscular space and true posterior rectus canal, latter being proper avascular plane of dissection for TEPP hernioplasty. Rectusial fascia, posterior rectus sheath and transversalis fascia showed morphological variations. Timely recognition of variable real-time anatomy is recommended to perform adequate proper surgical dissection for seamless TEPP hernioplasty with ease, rapidity and safety.

A clinical study of post operative complications of Lichtenstein’s hernioplasty for inguinal hernia

Background: Lichtenstein’s hernioplasty is the commonly done surgery for inguinal hernias. The study was done with the objective to evaluate the postoperative complications, and the recurrence rate associated with Lichtenstein’s hernioplasty.Methods: This was a prospective clinical study conducted at Sapthagiri Institute of Medical Science and Research Centre, Bangalore during the period from May 2015 to April 2016. A total of 50 patients with inguinal hernia were included in the study. All the patients underwent Lichtenstein’s hernioplasty. Outcome of the surgery was evaluated by the incidence of postoperative complications and recurrence rate of hernia after 1 year follow up.Results: Intraoperative complications were observed in 3 (6%) patients. Immediate postoperative complication was seen in 6 (12%) cases. Stiffness in lower abdomen was noticed in 13 (26%) cases. The average post-operative hospital stay was 4.06±1.43 days and the average post-operative ambulation time was 1.52±0.64 days. The average time taken to return to work post-operatively was 8.68±2.63 days. Long term complications included are foreign body sensation and chronic pain at operated site. After 1 year follow up the prevalence of both the complications was decreased to 4% and 6% respectively. No recurrence of hernia (0%) was noticed after 1 year follow up.Conclusions: Lichtenstein’s hernioplasty was considered as the best surgical procedure for inguinal hernia repair because of low recurrence rate (0%) and postoperative complications.

Effect of neurectomy versus ilioinguinal nerve preservation in the Lichtenstein tension-free hernioplasty of inguinal hernia

Objectives The aim of this study was to evaluate the effect iveness of ilioinguinal neurectomy on postoperative pain in the Lichtenstein tension-free hernioplasty of inguinal hernia. Background Chronic pain following tension-free inguinal hernioplasty is a significant clinical problem that can interfere with normal daily activities. Moreover, the condition can sometimes be debilitating, and treatment is often difficult and challenging. Contrary to the previous belief, division of the ilioinguinal nerve prophylactically during mesh repair has been practiced to reduce the incidence and intensity of persistent postoperative pain after hernia repair. Patients and methods Between April 2015 and October 2016, this prospective, randomized, controlled study included 40 male patients above 18 years of age with unilateral inguinal hernia who were undergoing the Lichtenstein hernia repair. Patients were randomized into two groups – the ilioinguinal neurectomy group and the ilioinguinal nerve preservation group. Twenty patients were included in each group. Patients were followed-up for inguinal postoperative pain at 1 and 6 months using a four-point categorical scale. Groin numbness was also assessed at 1 and 6 months using a self-administered questionnaire. Results There were no statistically significant differences between the two groups with regard to postoperative pain after 1 and 6 months at rest; however, after coughing 10 times, walking up three flights of stairs, and cycling for 10 min, there were statistically significant differences – postoperative pain in group A was 5% and in group B 30% (P Conclusion Ilioinguinal neurectomy should be considered a routine surgical step during the Lichtenstein tension-free hernioplasty.

Curative effect of preperitoneal tension-free hernioplasty for inguinal hernia in the treatment of patients with incarcerated hernia and(or) strangulated hernia

Objective To explore the clinical curative effect of preperitoneal tension-free hernioplasty for inguinal hernia in the treatment of patients with incarcerated hernia and(or) strangulated hernia. Methods 76 patients with incarcerated hernia and(or) strangulated hernia were selected as the research subjects, and they were divided into two groups according to the random number table, with 38 cases in each group.The observation group was treated with tension-free inguinal hernia repair, while the control group was given surgical treatment.The intraoperative blood loss, surgical time and hospital stay were recorded.The postoperative visual pain scores(VAS) and the number of postoperative infection were statistically analyzed.Patients were followed up for 1 month after discharge, and the return to work time, the number of masses in surgical site and the recurrence cases were recorded. Results The intraoperative blood loss[(16.23±8.64)mL vs.(28.19±7.93)mL], operation time[(57.13±14.58)min vs.(74.29±15.01)min], hospital stay[(4.27±1.87)d vs.(7.09±1.43)d] and postoperative infection rate(2.6% vs.28.9%) in the observation group were shorter (less) than those in the control group, the differences were statistically significant(t=6.287, 5.055, 7.384, χ2=9.896, all P 0.05], while the postoperative 48h score in the observation group was significantly lower than that in the control group[(4.28±1.78)points vs.(6.19±0.97)points, t=5.808, P<0.05].1 month after discharge, the number of masses in surgical site(2 cases vs.8 cases), the recurrence cases(0 case vs.4 cases) and the return to work time[(5.34±1.36)d vs.(9.27±1.54)d]of the observation group were less than those in the control group(χ2=4.146, 4.222, t=11.791, all P<0.05). Conclusion Preperitoneal tension-free hernioplasty for inguinal hernia has remarkable curative effect in the treatment of incarcerated hernia and(or) inguinal hernia, which is suitable for clinical promotion. Key words: Hernia, inguinal; Surgical procedures, operative; Treatment outcome

Technical features of laparoscopic prosthetic hernioplasty of inguinal hernia

OBJECTIVE. The authors investigated different methods of hernioplasty. MATERIAL AND METHODS. Endovideosur gical inguinal hernioplasty was performed in 3900 patients at the period from 1994 to 2016. The article described the developed and implemented techniques, strategy of surgical treatment, the choice of the type and size of prostheses in patients with different variants and complex forms of inguinal hernias. RESULTS. Specific postoperative complications were analyzed and suggested the methods of their prevention. CONCLUSIONS. The analysis of results was made. The authors gave recommendations concerning the technique of operative intervention.

Inguinal hernia in hemodialysis versus peritoneal dialysis patients: a case-control study

Inguinal hernia is common in dialysis patients, especially peritoneal dialysis (PD) patients; however, no previous reports have assessed the incidence, type, treatments, and risk factors of inguinal hernia in hemodialysis (HD) patients. We retrospectively evaluated the differences in these factors between HD and PD patients. A total of 2287 HD and 410 PD patients treated between March 2006 and December 2013 were enrolled. The incidence, type (indirect, direct, or combined), and hernioplasty of inguinal hernia as well as demographic characteristics of HD and PD patients were compared. The incidence of inguinal hernia was lower in HD (0.7 %) than in PD patients (5.9 %) (P < 0.001), and these incidences were higher among men (P = 0.007 and P < 0.001, respectively). Of the 16 HD and 24 PD patients with inguinal hernia, 14 and 21 (both 88 %) underwent hernioplasty. Among them, PD patients demonstrated a higher proportion of indirect hernia (91 %) than HD (47 %) patients (P = 0.003). No recurrence was observed in either group. In a multivariate logistic regression model, PD and male sex were risk factors for inguinal hernia (both P < 0.001). In this study, indirect inguinal hernia was more frequent in PD patients than in HD patients. Male sex and PD are risk factors for inguinal hernia in dialysis patients. Tension-free hernioplasty for inguinal hernia was effective in both HD and PD patients. Our findings can help inform clinicians when selecting the dialysis modality (HD or PD) prior to the initiation of dialysis therapy and guide clinical management practices for inguinal hernias in dialysis patients.

Clinical experience of tension-free hernioplasty for inguinal hernia

Objective To summarize the effect of tension-free hernioplasty for inguinal hernia .Methods Retrospective analysis of 619 cases of adult inguinal hernia underwent tension-free hernioplasty clinical data , curative effect and complications were observed .Results Patients could all get up 1 day after operation .Incisional pain was disappeared within 1-2days.Postoperative scrotal hematoma was found with 3 cases,no postoperative incision infec-tion,rejection.574 cases were followed up for 3 months to 4 years, there was no recurrence .Conclusion Adopting the method of Tension-free herniorrhaphy in treatment for inguinal hernia has the advantages of less trauma , faster postoperative recovery ,less complications and low recurrence rate etc . Key words: Hernia,inguinal; Patch repair; Tension-free mesh herniorrhaphy

Complete posterior rectus sheath and total extra-peritoneal hernioplasty

Introduction: Variations in rectus sheath formation have been reported with little realization of its importance to the laparoscopic surgeons doing total extra-peritoneal preperitoneal (TEPP) hernioplasty. Observation of complete rectus sheath during laparoscopic mesh hernioplasty for inguinal hernia through TEP approach and its surgical implication are presented here. Materials and Methods: Setting - Elective. Location for the study - J. N. Medical College and Hospital, A. M. U., Aligarh. Study design - Prospective with effective from April 2010 to August 2013. Study population - Adults (≥18 years). Data collection - Instant documentation and video recording. Method of analysis - All data were computed through on-line calculators (www.graphpad.com/quickcalcs/and http://epitools.ausvet.com.au/). Results: Thirty-five TEPP hernioplasties were carried out in a period of 3 years. All patients were males, with an overall mean age of 48.7 ± 13.4 years. Posterior rectus sheath (PRS) was found complete in four patients with a mean age of 47.28 ± 09.74, and was associated with significantly increased surgical difficulties during the procedure. On Visual Analog Score, endoscopic vision was 4.3 ± 0.6 (4.0-5.5), and the ease of the procedure was 4.5 ± 0.8 (4.0-6.0) that is, both were less than satisfactory. Operating time was 3.1 ± 0.7 h (3.25-4.0). Out of four patients, peritoneal injury occurred in three patients, surgical emphysema in one patient, and postoperative seroma in one patient. Conclusions: PRS was complete in 11.43% of cases studied that was associated with an increased level of surgical difficulties and a higher rate of complications.

RESULTS OF MESH PLUNG TECHNIQUE FOR INGUINAL HERNIA IN ADULTS AND COMPARISON WITH OTHER OPERATIVE METHODS

Hernioplasty with the use of a mesh prosthesis for inguinal hernia in adults had become popular in Japan. Since April 1992, various operative methods using mesh grafts have been performed at our department, and the results of 160 plug repairs were compared with those of other methods. Two hundreds and sixty-nine adult cases with hernioplasty for inguinal hernia, from January 1991 to December 1996, were investigated. The case breakdown was; Bassini 143, McVay 12, Lichtenstein's tension free hernioplasty 50, Stoppa 13, laparoscopic hernioplasty 5 (TAPP 3 and TEPP 2), preperitoneal approach with laparotomy for gastrectomy and plug repair 160. Plug repair, especially in 137cases with PerFix mesh plug in contrast to other methods, yielded good results, such that the mean operative time was 32.2±12.2minutes, the recurrent rate was 1.3% and complications were continuous pain in 2 and hematoma in 1 case. According to our experience, plug repair can be recommended as the standard operative technique for inguinal hernia in adults.