Indirect Hernia Research Articles

Laparoscopic Versus Open Mesh Repair in Treatment of Inguinal Hernia

Hernia, in the definition means to actually protrude. Inguinal Hernia is more common among all the hernias. Hernia repair is the most common surgery performed in all medical institutions. Inguinal Hernia (repair) is the most common performed surgery operatio. The contents of Ithe nguinal canal are, Spermatic cord and Ilioinguinal nerve Inguinaln Hernia presents in two types Indirect and direct hernia. Indirect type is the most common. The prevalence of Inguinal Hernia specifically is more common in males which is 25% and in females is 2%. As known till date, Treatment of hernia is a definitive surgery. 10-15% of hernias are direct. 50% of direct hernias that occur are of bilateral origin. And 35% of Inguinal hernias are direct. Etiology of hernia is-Chronic cough Smoking Straining Constipation Heavy work and Previous appendicectomy When in late 1984, Author Lichtenstein coined the term Tension-free hernioplasty, it changed the conventional surgrical technique by making mesh hernia repair more common. When in 1990 laparoscopic tension free technique which was introduced it was being promoted that it causes less pain shorter recovery period. There are multiple repair techniques for Inguinal hernia. This is a most common occurrence in men which does not have a particular effective surgical technique. This study is to determine wheather which technique is comparitivly more effective and useful in the future which will be effective as well as economical. This specific study required a meta analysis of randomised control trials. There are multifactorial reasons for deciding which srugical technique is best.

Periosteal Rotation Flap Technique in Management of Tibialis Anterior Muscle Hernia: A Case Series

Introduction: Traumatic herniation of the leg muscle is not an uncommon condition. This may be a direct traumatic hernia caused by open injury to the leg, or an indirect traumatic hernia following blow to a contracted muscle causing rupture of the fascia and its consequent herniation. Tibialis anterior muscle herniation has been reported to be the most common form of muscle hernia of the lower extremities. Materials and Methods: We report on 3 cases of traumatic herniation of the tibialis anterior muscle who were treated using a periosteal rotation flap raised from the anteromedial aspect of the tibia and used to close the fascial defect. Conclusions: We have found this to be a safe surgical procedure in the adult and adolescent age group with satisfying results and reduced recurrence rate and postoperative complications.

A comparative study of Desarda’s mesh free inguinal hernia repair with modified Bassini’s repair

Objective. This is a prospective study of 50 cases of inguinal hernias which were treated through open inguinal hernia repair techniques. The study was conducted with the objective of comparing the effectiveness of these procedures and complications. Materials and Methods. A number of 50 cases of inguinal hernias admitted to Dr. BR Ambedkar Medical College and Hospital were selected on the basis of the non-probability (purposive) sampling method. All the patients with direct and indirect uncomplicated hernias treated by means of an open approach were included. After the preoperative preparation, they were randomly chosen either for Desarda’s or Modified Bassini’s repair techniques. Results. In the postoperative period, moderate pain was experienced by 19 patients included in the Desarda group and 17 patients included in the Modified Bassini’s repair group on day 1. The postoperative wound infection developed in 2 cases of Desarda and 3 cases of Modified Bassini’s, erythema was observed in 2 cases of Desarda and 3 cases of Modified Bassini’s, 3 cases reported the occurrence of seroma in the Desarda group and 4 cases of seroma were recorded in the Modified Bassini’s group. Conclusions. The patients who underwent Desarda repair complained of a higher intensity of pain, which could probably be attributed to the extensive dissection involved. The duration of Desarda repair was longer due to the learning curve of the surgeons in our hospital. The return to normal gait and normal activities was significantly lower in the Desarda group. The duration of hospital stays and the postoperative complications was not significantly different in the two groups. There were no recurrences in either of the groups until the current study.

Clinical profile of patients with inguinal hernia at a tertiary care hospital

Background: Around 80% of inguinal hernia cases are caused by indirect hernia. Various studies have reported that hernia accidents are more common in the elderly, who are often unaware of their diagnosis and have not sought surgical treatment. Aim: This study was conducted to evaluate the various inguinal hernia aspects and its presentations among adult population. Materials and Methods: This study was conducted in Department of surgery in tertiary health care center during February 2018 to February 2019 in outpatient department. 50 patients were included in the study. Results: Highest number of patients were in the age group of >51 years (50%), males were 76% and females were 24% in the study, the majority of patients (66 percent) had an indirect hernia, while only 34% had a direct hernia, the majority of patients had a left side hernia (40%) followed by a right side hernia (36%) and both in 24 percent of cases, symptoms of pain when coughing, exercising was observed in majority of patients i.e. 32%, followed by burning sensation (28%), the occupation of most of the patients were farmer (54%), followed by labourer (18%), shopkeeper (16%) and student (12%). Conclusion: The bulk of the patients in this study were in their eighties and nineties, with males accounting for the majority of the patients. The majority of the patients had an indirect hernia, with a left hernia being the most common. The majority of the patients felt pain when coughing, exercising, or leaning over.

Comparison of laparoscopic transabdominal preperitoneal hernioplasty and laparoscopic iliopubic tract repair for Nyhus type II hernia in women.

Indirect inguinal hernia with a dilated internal ring but an intact posterior inguinal wall is classified as Nyhus type II. Females have a higher incidence of indirect hernia than direct hernia. The purpose of this study was to evaluate the efficacy of laparoscopic iliopubic tract repair (IPTR) compared with laparoscopic transabdominal preperitoneal (TAPP) hernioplasty in treating women with Nyhus type II hernia. This retrospective study included 318 women aged ≥ 20years who were treated for Nyhus type II hernia from January 2013 to December 2018. The patients were categorized into two groups in accordance with the operative technique: the TAPP group (33 patients) and the IPTR group (285 patients). In the IPTR group, intraabdominal suturing of the iliopubic tract and transversalis fascia arch was performed without mesh implantation. The mean operation time was shorter in the IPTR group (17.2 ± 3.9min) than the TAPP group (20.5 ± 8.1min, p = 0.028). The postoperative complication rate was higher in the TAPP group than the IPTR group [6.1% (2/33) vs. 0.4% (1/285), respectively; p = 0.001]. Inguinodynia occurred in one patient in the TAPP group and no patients in the IPTR group. The hospital stay did not significantly differ between the two groups. The numeral rating scale pain scores at 1day and 1week postoperatively did not significantly differ between the two groups. There was no recurrence in either group. Laparoscopic IPTR was safe and feasible for treating Nyhus type II hernia in women.

Surgical sequale of transabdominal preperitoneal approach versus Lichtenstein open repair in a rural setting

Background: The objective was to compare the outcomes perioperative outcomes of transabdominal preperitoneal approach (TAPP) versus Lichtenstein tension (open) free repair for adult unilateral uncomplicated inguinal hernia patients (including both direct and indirect hernias).Methods: The prospective study was conducted between July 2018 to August 2020. A total of 60 patients, 30 in the Lichtenstein tension free repair group and 30 in the TAPP repair group data were collected and analysed.Results: The mean age was 55 in our study. On comparing open versus TAPP, significant difference of p value ≤0.05 was observed in terms of surgical site infections, time to discharge, time to return to work and mesh related pain in TAPP. Operative time was shorter in open group.Conclusions: Laparoscopic transabdominal preperitoneal repair is a valid alternative to open traditional method with lesser morbidity to the patients.

Application of membrane anatomy theory in totally extraperitoneal inguinal hernia repair

Trocar placement and camera-dissection in the midline is the most commonly applied method for total extraperitoneal inguinal hernia repair (TEP), for which the theory of membrane anatomy has guiding significance. We hereby applies the theories and concepts, such as "fascia lining", "multi-layer", "inter-fascial planes", "combined inter-fascial plane" and "plane transition", to elucidate the key steps of TEP, for instance, space creation, hernia sac dissection, mesh flattening. Camera-dissection is performed along the posterior sheath of the rectus abdominis. Firstly, the camera enters retro-rectus space locating between the rectus abdominis and the transversalis fascia (TF). There are inferior epigastric vessels and their branches in the retro-rectus space, thus over-dissection should be avoided. Secondly, the camera goes downward through the TF into the pre-peritoneal space. The pre-peritoneal space is divided into the parietal plane and visceral plane by pre-peritoneal fascia (PPF). Both bladder and spermatic cord components locate on the visceral plane. Dissection of the median area should be implemented on the parietal plane, namely "surgical space", to protect the bladder. The parietal plane is the "holy plane" of TEP. Dissection of the indirect hernia area should be implemented on the visceral plane, namely "anatomical space", to protect the spermatic cord components. The reduction of direct hernia could be understood as the easy separation of TF and PPF. The reduction of indirect hernia is relatively difficult separation of peritoneum and spermatic cord components. During the transition of parietal and visceral planes, PPF (especially the pre-peritoneal loop) should be dissected for complete parietalization, in order to flatten the mesh.

Management of Inguinal Hernia in a Tertiary Center, a two-year Retrospective Study.

Background: Inguinal hernia repair remains the most common surgery performed by general surgeons worldwide. There is a lot of published data on the surgical management of inguinal hernias in our country. This study aims to describe our experiences in the surgical management of inguinal hernias and compare our results with those reported in the literature. Material and Method: A descriptive retrospective study was conducted at the University Hospital of Trauma in Albania. From April 2016 - March 2018 were recorded all the data for patients who presented to our hospital and underwent inguinal hernia repair in our hospital, under the conditions of elective surgery. Statistical data analysis was done using SPSS software version 17.0. Results: In this period had a total of 542 patients with inguinal hernias were enrolled in the study. The median age of patients was 46,12 years (range 14 to 92 years old). Males outnumbered females by a ratio of 18.3:1. This gender difference was statistically significant (p = 0.004). Most patients 130 (23.9%) presented late (more than one year of onset of hernia). At presentation, 208 (38.4%) patients had a reducible hernia, 101(18.6%) had an irreducible hernia. The majority of patients 303(55.9 %) had a right-sided inguinal hernia, and 156(28.7 %) had left-sided inguinal hernia with a right-to-left ratio of 1.94: 1. Eighty-three 83(15.3%) patients had bilateral inguinal hernias. 319 (58.8%) patients had an indirect hernia, Conclusion: Inguinal hernias continue to be a source of morbidity and mortality in our center. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem.

Risk of Inguinal Hernia Formation after Radical Prostatectomy: A Consequence or Coincidence?

The Post-operation complication is one of the causes of inguinal hernias, but the primary aetiology is still unknown. One of the hypotheses for inguinal hernias is after radical prostatectomy. Inguinal hernia is one of the most common causes of surgery. There are several techniques to repair this problem. However, nowadays there are a variety of articles to explain laparoscopic repair. This disease could be divided into direct and indirect. Indirect hernias usually have a congenital aetiology by open process vaginalis. However, direct hernias are from the inguinal canal’s floor.

Short-term comparative study of three-dimensional and two-dimensional laparoscopic surgery for total extraperitoneal primary inguinal hernia repair.

PurposeThe aim of this study was to compare the short-term outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic surgery for total extraperitoneal (TEP) primary inguinal hernia repair.MethodsThis was a single-center, retrospective, observational database study of 38 patients who underwent laparoscopic TEP inguinal hernia repair from March 1, 2019 to August 30, 2019 at Kyung Hee University Hospital at Gangdong in Seoul, Korea.ResultsThere was no significant difference in sex ratio, age, or body mass index between the two groups. The 2D group had two patients with direct hernia and 18 patients with indirect hernia. The 3D group had five patients with direct hernia, 11 patients with indirect hernia, and two patients with femoral hernia. The mean operation time was 38.2 minutes in the 2D group compared with 37.2 minutes in the 3D group. There was no severe intraoperative bleeding in either group. During the operation, peritoneal tearing occurred in 12 out of 20 patients in the 2D group compared with five out of 18 patients in the 3D group (p = 0.02). The average length of hospital stay was 1.3 days in both groups. The numeric rating scale score was 3.3 and 3 in the 2D group and the 3D group, respectively. In the 2D group, two patients revisited the outpatient clinic because of the postoperative occurrence of seroma and varicocele.ConclusionA 3D laparoscopic surgery is feasible and safe for inguinal hernia repair and showed less peritoneal tearing compared with 2D laparoscopic surgery for primary inguinal hernia repair.

The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature.

The aim of this study is to investigate the current management strategy of indirect hernia sac during laparoscopic inguinal hernia repair. The aim was to evaluate the various indirect hernia sac management strategies when performing laparoscopic inguinal hernia repair. Major databases (PubMed, Embase, Springer, and Cochrane Library). MeSH and free-text searching include "laparoscopic inguinal hernia" "TAPP," "TEP," "inguinal hernia," "indirect inguinal hernia sac," "distal sac," "sac transection," "sac ligation," and "sac reduction." The present study enrolled 7 trials, 4 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (odds ratio=2.74, 95% confidence interval: 1.41-4.31), and there was no statistical difference in the incidence of postoperative pain, operative time, hernia recurrence, and time to return to normal activity between the sac transection and sac reduction groups. Two studies reported the application of adjuncts in the management of distal sac during laparoscopic large inguinoscrotal hernia repair. The seroma formation could be reduced by adjuncts of fixing the distal hernia sac to posterior abdominal wall with either suture or tacks. Indirect sac transection during laparoscopic indirect inguinal hernia repair is associated with a higher incidence of postoperative seroma. Additional adjuncts to the divided distal hernia sac, including distal sac fixation with either suture or tacks, are effective methods to prevent postoperative seroma.

Totally Extraperitoneal Herniorrhaphy (TEP): Lessons Learned from Anatomical Observations.

Background Totally extraperitoneal herniorrhaphy (TEP) is a therapeutic challenge because of its complex anatomical location in inguinal region. The aim of this study was to describe the related surgical anatomy through laparoscopic observation and share the lessons learned from a review of 250 primary inguinal hernia repair procedures performed at our hospital from January 2013 to November 2019. Patients and Methods. There were 245 men and 5 women (median age: 63.2 years). Right hernia (60.2%) was the most common site. Indirect hernia (60.5%) was the most common abnormality. The classification of type II (65.0%) was the most common form. Surgical techniques comprised retromuscular approach using cauterized dissection, management of variations of arcuate line, Retzius space and Bogros space dissection, hernia sac reduction, and mesh positioning. Results The incidence of peritoneum injury was in 27 (10.1%). No epigastric vessels were injured. There were 8 (3%) hematoma and 18 (6.8%) seroma. No mesh infection, chronic pain, and recurrence were found after follow-up of an average of 35 months. Conclusion A good understanding of the anatomically complex nature in the inguinal region can make it easier and safer to learn the TEP approach. Early and midterm outcomes after TEP are satisfactory.

Comparison of Open Repair and Laparoscopic Percutaneous Internal Ring Suturing Method in Repairing Inguinal Hernia in Children.

IntroductionAn inguinal indirect hernia is one of the most frequent surgical conditions in children. In this study the experience with laparoscopic percutaneous internal ring suturing (PIRS) and open inguinal hernia surgery and their relations evaluated.MethodsAll children over 90 days of age and without having prior inguinal region surgery with a diagnosis of indirect inguinal hernia underwent surgical repair with open or laparoscopic PIRS technique. Patients' gender, age at surgery, inguinal hernias side, surgery duration, recurrence, complications, and follow-ups were collected.ResultsA total of 488 inguinal hernias of 405 patients were repaired. The diagnoses were unilateral inguinal hernia in 360 (88.9%) and it was bilateral in 33 (8.1%) patients. The operative technique was laparoscopic PIRS for 227 and open inguinal hernia surgery for 178 patients. In the PIRS group, a contralateral hernia was found in 48 of 205 children (23.4%). The surgery times were 23.3 (PIRS) and 33.7 (open) min for unilateral and 28 (PIRS) and 53.1 (open) min on average for bilateral inguinal hernia surgery. Mean follow-up was 30.4 months for PIRS and 24.4 months for open technique. Recurrence was observed in seven (3%) patients in PIRS and one (0.5%) in the open group and postoperative complications in three (1.3%) in PIRS and four (2.2%) in the open group.ConclusionPIRS method has the advantage to evaluate contralateral hernia at the same session, minimal scar related to surgery, and preserve the spermatic cord from manipulation. PIRS is an alternative feasible method and easy to perform to repair the inguinal hernia with/without communicating hydrocele in children.

Outcomes of obese compared to non-obese veterans undergoing open inguinal hernia repair: a case–control study

The optimal approach for inguinal hernia repair in the obese remains elusive. Minimally invasive techniques show equivocal results compared to the open method. None of the current analyses include a non-obese control group because the differences in factors leading to complications vary widely between these two cohorts. In the present study, we matched (1:1) obese to non-obese patients undergoing an open inguinal hernia repair. Matching was performed by age, hernia type (bilateral, inguinal, femoral, recurrent, primary, direct, pantaloon, and scrotal component), type of repair (tissue repair vs. mesh), concurrent umbilical hernia repair, current smoking, ASA Class, a history of DM and COPD. Demographics in the unmatched cohorts demonstrated significantly (p < 0.05) wide differences between obese (n = 319) and non-obese (n = 1137) veterans: age (58.0- vs. 63.4-year-old), indirect hernia (37.7% vs. 45.5%), scrotal component (14.4% vs. 9.9%), current smoking (23.5% vs. 34.4%), DM (20.8% vs. 13.1%), OSA (13.2% vs. 3.6%), COPD (12.2% vs. 18.5%), and BPH (16.9% vs. 23.3). After matching, there were 300 obese and 300 non-obese patients available for analysis. There was no difference in 30-day morbidity between obese and non-obese patients in the unmatched (11.0% vs. 7.9%; p = 0.09) and matched (10.7% vs. 8.1%, p = 0.27) cohorts. Similarly, no differences in inguinodynia and recurrence were observed in either matched or unmatched cohorts. Obese patients pose no further risk in outcomes compared to non-obese veterans undergoing open inguinal hernia repair. The best technique for an inguinal hernia repair in obese patients should rest on the comfort and the experience of the surgeon.

A concealed inguinal presentation of a gastrointestinal stromal tumor (GIST): a case report and literature review

BackgroundGastrointestinal stromal tumor (GIST) can arise anyplace along the gastrointestinal (GI) tract. The uncommon tumor location in groin area is rarely reported.Case presentationWe herein reported a metastasized case presented as GI hemorrhage complicated with indirect hernia, and underwent tumor cytoreduction, herniorrhaphy and chemotherapy for jejunal GIST. The case was described consecutively based on the process of surgical management, with a good follow-up result. A literature review by searching similar case reports from two national medical databases was performed to summarize clinical features of such unusual presentation of GIST, which included hernia characteristics, short- and long-term outcomes of this disease. It showed GIST presenting as groin hernia was rarely reported and all available 11 cases suggested a primary tumor and required both tumor resection and hernia repair. The long-term results indicated 64.3% overall survival at 5 years after the incidental diagnosis.ConclusionsInguinal hernia is an extremely rare presentation of GIST, with limited case reports available in the literature. A radical involving tumor resection plus hernia repair is an optimal surgical approach for such uncommon condition. An adjuvant medication mounting on mutated KIT gene should be strictly followed for high risk cases.

A Novel Technique Using Mesh to Repair a Recurrent Large Indirect Inguinoscrotal Hernia

Background: The positioning of a slit mesh around cord structures during laparoscopic transabdominal preperitoneal (TAPP) hernia repair rests the mesh better without kinks, thereby minimizing recurrences. However, studies also suggest that insufficient closure of the mesh slit may lead to recurrences. Aim: This report describes a novel technique using AbsorbaTacks (Covidien) to close the mesh slit and refashion an artificial ‘deep ring’ to minimize recurrence. Technique: We report the case of a fit 82-year-old Caucasian male presenting with a recurrent large right indirect inguinoscrotal hernia (8 x 8 × 7 cm with 4 × 4 cm deep inguinal ring). The patient underwent a TAPP repair with a background of unsuccessful open repair by another surgeon previously. Following mesh deployment, the mesh was lifted up by the cord structures, which was under tension due to a large defect. A slit was made in the inferomedial aspect of the mesh. This allowed it to be wrapped around the cord structures. The overlapped trouser flaps were then stapled together encircling the cord, by AbsorbaTacks to create a secure artificial ‘deep ring’. Edges of the mesh were also standardly affixed by AbsorbaTacks to the pectineal ligament and posterior abdominal wall. This creates a secure four-point fixation of the mesh scaffold to prevent ‘windsock’ effect, which happens when the mesh is pushed into the widened deep inguinal ring, leading to early recurrences. The peritoneal incision was also closed with AbsorbaTacks. Conclusion: No complications were registered during the early postoperative period. The patient had an uneventful recovery and was discharged within 20 hours with simple analgesia. No recurrence was reported during the 6 months follow-up period. Clinical significance: The anchoring of a slit mesh with tackers around the cord structures can be used to repair large recurrent inguinal hernias laparoscopically following an open repair. This technique potentially minimizes further recurrences. © Jaypee Brothers Medical Publishers. 2021.

Case Report A Rare Case Report: Supernumerary Testis

Introduction: Poly-orchidism is a rare congenital anomaly with less than 100 cases reported in the world literature. As many theories have an etiology regarding poly-orchidism but still exact etiology is not clear. But majority patient presents with painless scrotal/groin swelling. In rare presentation it may present with an indirect hernia, varicocele, hydrocele, epididymitis, mal-descended testis. The majority have tri-orchidism and the supernumerary testis is most frequently found on the left side.Aims: This is a study of rare case report of tri-orchidism of 3 yr. male child present with absent left side testis. On exploration found that two testes were with the vas having distally 2 limbs draining both testis in the 'Y' fashion.Result: In case of this tri-orchidism ideally plan of management is various. If investigation vise testis found atrophied or non-functional then plan of management should be orchidectomy. In this case as clinically both the testis appeared normal both the testis was placed in the left scrotum and orchidopexy was done Conclusion: Poly-orchidism may be a rare genitourinary abnormality and its management is still controversial. The management will depend upon the location, size and anatomical organization of the testicular drainage system and the age of the patient.

Management of strangulated inguinal hernia with Resection and Anastomosis in a primary health care setting during COVID -19 crisis

Introduction: Longstanding reducible hernia should be intervened timely so as to prevent the risk of strangulated hernia and resection and anastomosis of gut. Strangulated hernia is a surgical emergency and only timely surgical intervention can prevent from further deterioration of patient’s health condition.&#x0D; Case Report&#x0D; There was a case of 75 years male from rural area of Eastern Nepal at Charikot Hospital emergency department, with the complaint of severe pain and swelling over right inguinal region, associated with abdominal distension, vomiting, not passing stool for 3 days. He had history of swelling of right inguinoscrotal region for last 5 years. Intraoperative finding showed that there was indirect hernia and the content was jejunum and omentum which was gangrenous, resection and anastomosis along with bassini's repair was done.&#x0D; Conclusion: Hernia should be managed as soon as the diagnosis is confirmed before emergency visit due to serious risk of obstruction and strangulation. So, we should repair any inguinal hernia on an elective basis in any age group.

Drainage decreases the seroma incidence in laparoscopic transabdominal preperitoneal (TAPP) hernia repair for large inguinoscrotal hernias

BackgroundSeroma is a common and inevitable postoperative complication in transabdominal preperitoneal (TAPP) hernia repair, especially in patients with large inguinoscrotal hernias. However, studies have rarely reported drainage in TAPP for large inguinoscrotal hernias. MethodsSixty-five patients with 78 large indirect inguinoscrotal hernias who underwent TAPP procedure with drainage between September 2016 and December 2019 were enrolled in this study. 181 patients with Type Ⅲ indirect inguinal hernias (European Hernia Society (EHS) classification, hernia defect >3 cm) who underwent TAPP without drainage (no-drainage group) between January 2019 and December 2019 were included for a comparison. In the drainage group, a 12-Fr drainage tube was inserted into the distal hernia sac via the preperitoneal space to decrease the incidence of seroma. ResultsThere was no conversion to open procedures in all the patients. The operative time (56.5 ± 8.4 VS 54.8 ± 9.6 min, unilateral; 95.8 ± 10.4 VS 92.1 ± 13.9 min, bilateral), blood loss (5.9 ± 1.9 VS 5.6 ± 1.7 mL), visual analogue scale score on postoperative day 1 (2.3 ± 0.5 VS 2.2 ± 0.5) and postoperative hospital stay (1.1 ± 0.3 VS 1.0 ± 0.2 days) in the drainage group were equivalent to those in the no-drainage group (p > 0.05). The mean length of drainage was 5.2 ± 1.3 days. The drainage group had a significantly lower incidence of seroma than the no-drainage group (1.5% VS 9.4%, p = 0.037). The postoperative complications including haematoma, recurrence and chronic pain were comparable in the two groups. ConclusionDrainage with appropriate duration is a feasible, safe and effective measure to decrease the incidence of seroma in TAPP for patients with large inguinoscrotal hernias.

Groin Hernias: a Pictorial Essay Outlining Basic Anatomy with Illustration of Interesting Cases on Computed Tomography

The goal of this project is to illustrate the imaging findings of interesting cases of groin hernias while providing a basic overview of the anatomy of the inguinal region. This anatomical overview will provide a basic approach to interpreting CT scans of inguinal and femoral hernias with respect to the myopectineal orifice. A literature review was performed to evaluate the management and anatomical definitions of inguinal and femoral hernias. Several diagrams were created to illustrate the important anatomical concepts of inguinal and femoral hernias. Interesting cases of groin hernias were selected by staff radiologists, to review the anatomy of inguinal and femoral hernias. Eight interesting cases of groin hernias were identified: a bilateral indirect inguinal hernia, an indirect hernia containing a ureter, an indirect hernia containing bladder, an incarcerated femoral hernia, a mixed or “pantaloon” hernia, an appendicitis containing femoral hernia, a direct Amyand hernia, and an indirect Amyand hernia. Direct inguinal, indirect inguinal, and femoral hernias can be classified according to their exit point with respect to the quadrangular myopectineal orifice.