Indirect Hernia Research Articles

Safety of hernia sac resection in inguinal herniorrhaphy for patients on peritoneal dialysis: a case series.

Peritoneal dialysis (PD) is a risk factor for inguinal hernia, and herniorrhaphy on PD might be complicated by PD fluid.Although sac resection should contribute to preventing indirect hernia recurrence, the safety on PD has not beendescribed. This case series describes the detailed surgical procedures and long-term outcomes of 16 cases ofinguinal herniorrhaphy on PD. Results are shown as median (range). The age was 67.5 (53-83) years. Beginning atthe 6th case, we omitted interim hemodialysis and performed the Lichtenstein procedure. We performed sac excisionin the 14 patients. No complication related to PD was found. The follow-up period was 41.5 (4-124) months. Norecurrence occurred. They could continue PD for 21.5 (4-103) months after surgery. The total PD duration was 38.5(18-152) months. In conclusion, inguinal herniorrhaphy with sac resection may not compromise safety even forpatients on PD and achieve the expected PD duration without recurrence.

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty.

The totally preperitoneal (TPP) approach is a new concept that was recently introduced. Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages, there is little evidence reflecting the characteristics and feasibility of either approach. To analyze the potential applications of single-incision laparoscopic TPP (SIL-TPP) inguinal hernia hernioplasty for the treatment of inguinal hernias. A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022. A single-port, named Iconport, and standard laparoscopic instruments were used during the operation. Demographic data, intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed. The demographic data of 152 patients underwent SIL-TPP were shown in Table 1. The average age was 49.5 years (range from 21 to 81 years). The average body mass index was 27.7 kg/m2 (range from 17.7 kg/m2 to 35.6 kg/m2). SIL-TPP were conducted successfully in 147 patients. Three patients were converted to the SIL-transabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience. In 2 patients with incisional hernias, an auxiliary operation hole was added during the SIL-TPP procedure, as required for surgery. The mean operative time was 64.5 minutes (range: 36.0-110.0 minutes) for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias (range: 40.0-150.0 minutes). The mean postoperative hospital stay was 3.4 days. SIL-TPP is feasible and has advantages for inguinal hernia repair. SIL-TPP has potential benefits for patients with various abdominal wall hernias. Consequently, doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Cord lipoma in minimally invasive surgical repairs of inguinal hernias: a prospective study.

Cord lipomas are frequent findings in laparoscopic inguinal hernia surgeries in male patients. The symptoms of lipoma and the potential benefits of removing them are often overlooked because the focus is on the primary pathology of the hernia itself. Current recommendations are to reduce this fatty content, when present. When inguinal cord lipomas are left untreated in inguinal hernia surgery they can potentially cause symptoms and be detected in follow-up imaging exams. The objective of this study was to study incidence of cord lipomas in a cohort operated on by a single group specializing in abdominal wall surgery, as well as to analyze the possible relationship of this finding with the patient's symptoms, the characteristics of the operated hernia and postoperative outcome. This is a prospective study of male patients operated on for inguinal hernia laparoscopically or robotically in a single reference center. Of the total of 141 hernias, the distribution according to European Hernia Society classification showed that 45.4% were lateral, 19.1% medial and 35.5% mixed, highlighting a variety in the presentation of hernias. Analysis of the size of the hernias revealed that the majority (35.5%) were ≤ 1.5cm. Inguinal cord lipoma was present in 64.5% of the samples, with no statistically significant association between the presence of the lipoma and an indirect hernia sac or obesity. The incidence of surgical site occurrences (SSO) was 9,2%, with seroma and hematoma. No recurrences were observed during follow-up, indicating a successful approach. There were no statistically significant relationships between SSO, the presence of lipoma and indirect hernial sac.

A Busoga Hernia: A Rare Case Report in India

Inguinal hernia stands as a prevalent surgical concern, often addressed either through elective procedures or as emergencies by surgeons. The indirect hernia has high propensity to bowel obstruction due to narrow constrictive ring. Direct hernia is comparatively safe from complications owing to the larger defect. Busoga hernia (BH), alternatively referred to as Gill-Ogilvie hernia, represents a seldom-seen variation of direct inguinal hernia affecting the conjoint tendon. This hernia type arises due to a weakness in the conjoint tendon and tends to manifest more frequently among young athletes. Some authors described herniation in the weakened conjoint tendon secondary to rigorous training, kicking, running and sharp turn. Busoga hernia (BH) represents an uncommon subtype of direct inguinal hernia, characterized by a heightened risk of strangulation of its contents. This risk is attributed to an exceptionally narrow neck under constant tension within a resilient fascial sling. BH may migrate into labia majora in female and rarely migrate to the scrotum in male. We encountered a case involving a male patient aged 64 years who arrived with a small painful inflammation in his right groin. Surgical exploration under general anesthesia, revealed a 1cm defect in the medial aspect of the conjoint tendon. Subsequent procedures included herniotomy and herniorrhaphy, wherein the hernial contents consisted of pre-vesical fats and a portion of the urinary bladder. Surgeons must possess a thorough understanding of the anatomy of the inguinal region to effectively manage situations with confidence. The postoperative recovery period progressed satisfactorily with good outcomes. Patient is under regular follow up.

Tailored treatment of female indirect inguinal hernias by using single-port laparoscopic percutaneous internal ring suture: a comparison between children and adults

PurposeTo compare the outcome of indirect inguinal hernias repaired by using single-port laparoscopic percutaneous internal ring suture (SPIRS) between the pediatric and adult females.MethodsThe medical records of females who were clinically assessed to have inguinal hernia from Oct. 2016 to May 2022 were reviewed. Patients who received laparoscopy for the diagnosis of the hernia type and customized treatment according to their hernia type were included, while those who chose other operation methods initially were excluded. The patients were divided into the adult and pediatric groups based on their age. The demographic characteristics, hernia types, operation durations, and outcomes were analyzed between these two groups.ResultsA total of 65 adults and 60 children were included in this study. The median age was 38 years. (range: 23–88) for group A and 3 years (range: 0.1–16) for group P. Indirect hernias were present in 85% of adults and 100% of children. All the indirect hernias were repaired by SPIRS uneventfully. Incidence of contralateral patent processus vaginalis was 24% in adults and 50% in children (p = 0.016). The average operation time was 22/46 min (one/two sides) for the adults and 9/15 min (one/two sides) for the pediatrics (p < 0.010 for both). The overall complication rates were 5.4% and 3.3% for the adult and pediatric group respectively (p = 0.106). No recurrence was observed in the pediatric group, but two adults experienced recurrence and another had chronic postoperative inguinal pain, necessitating reoperation. The mean follow-up period was 38.6 ± 15.4 months for adults and 42.8 ± 18.9 months for children (p = 0.198).ConclusionOur results support that the pathogenesis of indirect inguinal hernia for the female adults is due to the non-obliteration of a congenital processus vaginalis. Tailored treatment of the female IIH by using single-port laparoscopic percutaneous internal ring suture may be an alternative for the management of female IHs.

Laparoscopic inguinal hernia repair in children: true herniotomy is more reliable than herniorrhaphy

BACKGROUND: The optimal laparoscopic technique for pediatric inguinal hernia continues to be discussed with a view to its further refinement. AIM: This study aimed to ascertain the outcomes of two laparoscopic fully intra-corporeal techniques employed in our practice: herniorrhaphy and true herniotomy. METHODS: A retrospective comparative review of patient outcomes was conducted following laparoscopic groin hernia repair: herniorrhaphy — 1st series and true herniotomy — 2nd series. Patient data was analysed using non-parametric statistics with Mann-Whitney test. RESULTS: In total there were 328 patients, aged between 2 months and 17 years, with 402 groin hernia defects including metachronous and rare defects. The herniorrhaphy was performed for indirect hernia defects (n=186) and herniotomy — for indirect (n=206) as well as for direct (n=6) and femoral (n=2) defects. Technically, there were no intraoperative complications in any case in either series. Conversion to open procedure was required in one patient of 1st series (0,5%) with giant hernia because of the impossibility to maintain due pneumoperitoneum. The postoperative recovery was prompt and uneventful with restoration of mobility and oral intake within 3–6 hours in all patients with no difference between the series. Adverse postoperative events were noted in 10 patients after herniorrhaphy — hydrocele (n=6; 3.2%) and hernia recurrence (n=4; 2.2%) whereas after herniotomy there was only one case (n=1; 0.5%) of hydrocele and none of recurrence. The overall rate of these complications was significantly lower in the herniotomy series vs herniorrhaphy (p=0.004). CONCLUSION: Laparoscopic intracorporeal techniques both herniorrhaphy and true herniotomy are safe and effective for pediatric hernia repair. True herniotomy appears to be a more robust technique to minimise incidence of postoperative hydrocele and recurrence.

TPP (totally preperitoneal) making single incision laparoscopic inguinal hernia repair more feasible: a comparison with single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP)

BackgroundTotally preperitoneal hernioplasty (TPP) is a concept which was introduced for distinguishing with totally extraperitoneal (TEP). There is few evidence reflecting the single incision laparoscopic totally preperitoneal (SIL-TPP) characteristic. The aim of study is to demonstrate the feasibility of single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) and compare the outcomes with the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) technique.MethodsDuring August 2018 and July 2022, 200 inguinal hernia patients received SIL-TPP and 56 patients received SIL-TEP in the First hospital of Ningbo university. The demographics, clinical characteristics, intraoperative and postoperative parameters were retrospectively analysed.ResultsSIL-TPP and SIL-TEP hernia repair were successfully conducted in all patients. There was no conversation happened in two group. Patients’ demographics were comparable when compared between the two groups adding the comparison initial 52 cases analysis (P > 0.05). The mean unilateral hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (unilateral: 81.38 ± 25.32 vs. 95.96 ± 28.54, P: 0.001). Further study of unilateral hernia operative time revealed the mean indirect hernia operative time was significant shorter in the SIL-TPP group than SIL-TEP group (indirect: 81.38 ± 25.33 vs. 95.87 ± 28.54, P: 0.001). The unilateral hernia operation time trend of initial 52 cases of two group analysis revealed the operation time of SIL-TPP reduced faster than SIL-TEP along with treating number increasing (Figs. 2 and 3). The comparison of initial equal quantity unilateral hernia patient mean operative time revealed the SIL-TPP group was significant shorter than SIL-TEP group (85.77 ± 22.76 vs. 95.87 ± 28.54, P: 0.049). The rate of peritoneum tearing of SIL-TPP group was significant high than SIL-TEP (P = 0.005).ConclusionSIL-TPP hernia repair is a superior procedure and possess its own distinguished advantages. We recommend it rather than SIL-TEP for treating inguinal hernia, especially for indirect hernia. However, large-scale randomized controlled trials comparing SIL-TPP and SIL-TEP are needed to confirm these results.

Diagnostic impact of using the semi-erect position in the evaluation of inguinal hernia with superficial sonography.

&lt;b&gt;Introduction:&lt;/b&gt; The main cause of groin pain is inguinal hernia (IH). The most commonly used imaging test for diagnosis is sonography, which is also useful in distinguishing between indirect and direct hernias.&lt;b&gt;Aim:&lt;/b&gt; In this study, measurements were made with sonography in the semi-erect position (45) in addition to the supine position and the effectiveness of this position in detecting the defect was investigated.&lt;b&gt;Material and methods:&lt;/b&gt; The IH cases diagnosed by ultrasound between March 2019 and October 2023 were evaluated retrospectively. According to the diameter of the defect in the supine position, the cases were divided into three groups: Group A (≤1.5 cm), Group B (1.5-3 cm), and Group C (≥3 cm). A total of 252 patients with unilateral IH were identified.&lt;b&gt;Results:&lt;/b&gt; For Group A, the mean value was 1.09 0.23 (0.64-1.48) cm in the supine position and 1.28 0.26 (0.67) cm in the semi- -erect position (p&lt;0.001). For Group B, the mean value was 2.29 0.29 (1.57-2.82) cm in the supine position and 2.41 0.31 (1.65-2.94) cm in the semi-erect position (p&lt;0.001). For Group C, the mean value was 3.57 0.23 (3.28-4.05) cm in the supine position and 3.62 0.24 (3.32-4.10) cm in the semi-erect position (p&lt;0.05).&lt;b&gt;Conclusions:&lt;/b&gt; Superficial ultrasound, which provides reliable results in the diagnosis of IH, is an easily accessible modality. Unlike previous studies, this study was the first to examine the semi-erect position in IH patients. It showed that it is effective in determining the optimal diameter of the defect.

Ultra-micro instrument in laparoscopic transabdominal preperitoneal (TAPP) hernioplasty.

This study aimed to explore the feasibility of ultra-micro instruments in the laparoscopic repair of inguinal indirect hernia. This retrospective study included 83 patients with an indirect inguinal hernia who underwent elective surgery from January 2020 to December 2021. All patients were divided into the traditional laparoscopic group and ultra-micro laparoscopic group. The data on operation time, blood loss, ventilation time, hospital stays, complication, postoperative pain degree was collected and compared between the two groups. Of these 83 patients, 25 assigned to the ultra-micro group used ultra-micro instruments while 58 were assigned to the traditional group. The traditional group had a lower mean operation time (57.07min) than the ultra-micro group (69.60min) p < 0.05, while ultra-micro group patients had a shorter hospital stay (2days) than the traditional group (3days) p < 0.05. The ultra-micro group experienced significantly less pain for 6h, 1day, and 2days postoperatively (2, 1, 0 points) compared to the traditional group (4, 2, 1 points) p < 0.05. There was no significant difference in blood loss, ventilation time, or complication between the two groups. Using ultra-micro instruments is safe and feasible. Patients have less postoperative pain and a smaller incision than the traditional laparoscopic instrument. It is worthy of clinical promotion.

An Unusual Case of a Strangulated Right Inguinal Hernia Containing the Caecum Managed with Desarda’s Repair

Groin hernias are most common hernias in abdominal wall hernias (75%). 95% of groin hernias, are from inguinal canal and remaining area femoral hernias. Two-thirds of the inguinal hernias are indirect and remaining are direct inguinal hernia. An indirect inguinal hernia is the most common, regardless of gender and in men, indirect hernias predominate over direct hernias at a ratio of 2:1. Direct hernias are uncommon. Strangulated external hernia is a relatively common serious surgical emergency. In these approximately 50% of cases involves small bowel obstruction and accounts for most of the deaths from this condition. Presenting a case of 64-year gentleman diagnosed with strangulated right inguinal hernia, managed with urgent surgery and underwent right hemicolectomy with Desarda’s repair in view of gangrenous caecum. This case report underscores the clinical presentation and prompt surgical management of an unusual case of a strangulated right inguinal hernia containing the cecum, entailing both hernia repair and right hemicolectomy. The Desarda’s technique was chosen as the hernia repair method which focuses on autologous tissue repair. Keywords: Strangulated hernia, Desarda’s repair, right hemicolectomy, ileo-transverse anastomosis, small bowel obstruction.

Laparoscopic Totally Extraperitoneal Repair Using Self-gripping Polyester Mesh (ProGrip™) in Inguinal Hernia: A Retrospective Study in a Tertiary Care Hospital

Abstract Introduction: Surgical management of inguinal hernia (IH) is advanced with laparoscopy surgery, and total laparoscopic totally extraperitoneal (TEP) repair is gaining popularity. The use of self-gripping mesh (ProGrip™) further provided substantial advancements with improved postoperative outcomes and early recovery. Objectives: The objective of our study was to determine the short-term outcomes, complications, postoperative hernia recurrence, and chronic inguinal pain in laparoscopic IH. Furthermore, we assessed the factors associated with longer operative time. Subjects and Methods: We retrospectively analyzed the data of adult IH patients who had undergone TEP repair with ProGrip™ mesh. Data on demographics, hernia characteristics, operating time, surgical details, and postoperative outcomes such as infection, hernia recurrences, chronic pain, and other complications were collected and analyzed. P &lt;0.05 was considered statistically significant. Results: During January 2020 to January 2022, we collected the data of 208 patients and analyzed them. The mean age of the patients was 59.7 ± 13.1 years and 96.2% were males. Hernia was bilateral in 26% of cases and 78.8% were indirect hernias. The mean duration of surgery was 60.4 ± 8.6 min. Hernia size ≥2.5 cm was associated with significantly longer operative time. After a median follow-up of approximately 1 year, there were no postoperative complications, recurrence of hernia, or chronic inguinal pain. Conclusion: In experienced hands, laparoscopic TEP repair of IH using ProGrip™ mesh is effective and safe without significant complications or recurrences.

Outcome Of Totally Extra-Peritoneal (TEP) Mesh Repair Among Patients With Unilateral Primary Inguinal Hernia: A Single Center Experience

Introduction: Inguinal hernias were conventionally treated with open methods like hernioplasty and herniorrhaphy. However, with the development in minimal access surgery, the trends have changed and surgeons are also performing the TEP and TAPP laparoscopic hernia repair routinely. Hence, a retrospective study was performed to assess the safety, feasibility, and associated complications of the TEP laparoscopic hernia repair. Methods: A single institution, single unit retrospective study of all TEP hernia repair was performed at the department of surgery from May 2020 to April 2021. Data of all patients undergoing TEP were obtained from a proforma attached to the case file during patients’ admission and was analyzed. Results: A total number of 30 patients underwent the TEP laparoscopic hernia repair during the study period. Age group ranged from 25 years to 80 years and a male preponderance was noted with all patients being male. Per operative findings of indirect hernia was noted in 27, and direct hernia in 3 patients. The mean operating time was 76.23 ± 13.53 minutes. Complications encountered in the post-operative period were seroma in one patient, and wound erythema in two patients. The mean hospital stay was 1.6 ± 0.72 days. Conclusion: Totally Extra-peritoneal (TEP) laparoscopic repair can be performed and has all the established benefits of minimal access surgery among patients with primary unilateral inguinal hernia.

Current Surgical Management of the Inguinal Hernias

Definition: Inguinal hernias are characterized by the protrusion of tissues through a weakness in the abdominal wall in the inguinal region. They are divided into direct and indirect hernias, with anatomical differences influencing the choice of surgical technique. Types of Hernias and Surgical Management: The surgical approach is based on individual and symptomatic considerations. Asymptomatic hernias may be observed, while symptomatic ones usually require intervention. Mesh repair is a common technique, with both open and laparoscopic repair options. The choice is based on the patient's anatomy and the surgeon's experience. Complications: Despite progress, recurrences remain a concern. Careful selection of technique and attention to mesh placement can reduce this rate. Postoperative complications, such as infections and chronic pain, are also concerns to consider. Discussion: The discussion focuses on the choice between open and laparoscopic repair techniques. Adaptation to the patient's individual conditions, such as age and comorbidities, is essential. Research and innovation continue to play a crucial role in improving outcomes and preventing complications. Conclusions: The surgical management of inguinal hernias is a balance between tradition and innovation. Collaboration between surgeons and constant research are critical to advancing the field. The individualized approach and continuous improvement of techniques and materials will continue to provide patients with a better quality of life and more positive outcomes in the future.

Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.

Local Anesthesia Versus Spinal Anaesthesia for Inguinal Hernia Repair: A Comparison

Background: Repair of an inguinal hernia is among the most common surgical procedures done today. Local anesthesia has surpassed spinal and general anesthesia as the method of choice for hernia operations performed on the same day. Advantages include less suffering after surgery, getting up and moving around sooner, spending less time in the hospital, and saving money. Methods: This prospective study was carried out in Department of General Surgery, Malla Reddy Medical College for Women, Hyderabad, Telangana, India, from September 2021 to August 2022, and it included 26 cases of inguinal hernia. Following admission to the hospital, a full history was gathered, as well as a thorough clinical examination. Results: The ages of the patients in the current study varied from 22 to 77 in group A, and from 18 to 76 in group B. Group A patients had a mean age of 46.216.64, whereas Group B patients had a mean age of 42.5616.71; both groups consisted primarily of males. Two groups, A and B, were created from the 26 patients. Participants' ages ranged from 19 to 70 in Group A, and from 43 to 77 in Group B. In Group A, there were 4 cases of direct inguinal hernia and 9 cases of indirect hernia, whereas in Group B, there were 3 cases of direct inguinal hernia and 10 cases of indirect hernia. Conclusion: Although effective and inexpensive, the method has substantial economic benefits because to the low morbidity, low recurrence rate, and speedy return to ordinary activities. The patient can be discharged sooner, and complications from the anesthesia are less likely to arise. If successful, it may one day replace open surgery as the go-to method for fixing groin hernias.

Body Mass Index Within Multifactor Predictors of Ventral Hernia Recurrence: A Retrospective Cohort Study.

Background A ventral hernia is a protrusion of the peritoneum through the defective abdominal wall. Several risk factors increase the likelihood of hernial recurrence. One of the most common risk factors is obesity, defined by the World Health Organization (WHO) as increased body mass index (BMI). Few studies have explored the effects of BMIand other factors on hernia recurrence. Hence, we aimed to investigate the role of increased BMI in hernia recurrence in conjunction with various risk factors such as age, sex, type of hernia, the time elapsed between the occurrence and recurrence, complications of hernia, and procedure. Methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH). All the patients were admitted between 2015-2022. A total of 1676 medical records were obtained from all patients who underwent hernia repair more than once or were diagnosed with a recurrent hernia during the study period. Results Our study revealed an insignificant correlation between a BMI of more than 25 kg/m2 and the recurrence of inguinal hernias, predominantly indirect hernias. Furthermore, overweight and obese patients experience a longer interval between the first and second hernia repairs. Interestingly, all the patients with inguinal and umbilical hernias had the same diagnosis at the second presentation. However, the findings also included a significant increase in umbilical hernias in individuals with a high BMI and higher recurrence rates among male patients with inguinal hernias. Conclusion BMI higher than25 kg/m2increases recurrence rates for umbilical hernias but decreases the recurrence of inguinal hernias.

Analysis of the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia

ObjectiveInguinal hernias are a common disease that may present at all ages. Adolescents are a unique patient population between children and adults. The etiology and the surgical treatment strategies of adolescent indirect hernias are not clear. Specifically, whether these kinds of hernias should be treated by high ligation or mesh repair remains controversial. We aimed to evaluate the efficacy of laparoscopic high hernia sac ligation in adolescent indirect hernia.MethodsThe data of adolescent patients who underwent laparoscopic high hernia sac ligation at the The First People’s Hospital of Foshan,China, from January 2012 to December 2019 were analyzed retrospectively. Data collected included their age, gender, weight, surgical method, hernia ring diameter, operation time, postoperative recurrence rate and postoperative complications.ResultsA total of 70 patients were enrolled, including 61 males (87.14%) and 9 females (12.86%),all patients were aged 13–18 years old (mean 14.87 ± 1.56years), weighed 28-92 kg (mean 53.04 ± 10.60 kg). All 70 patients underwent laparoscopic surgery except 2 patients with irreducible hernias who converted to laparotomy.The hernia ring diameter ranged from 0.5 to 3 cm (mean 1.39 ± 0.49 cm), and was ≤ 2 cm in 68 cases (97.14%).The operative length ranged from 12 to 105 min (average 24.96 ± 12.61 min), There were 37(52.9%) right-sided hernias, 32 (45.7%) left-sided hernias, 1 (1.4%) bilateral hernia.There were 67(95.7%)reducible hernias,2(2.9%)irreducible hernias ,and 1(1.4%)incarcerated hernia.Hospital stays ranged from 1 to 5 days (mean 2.37 ± 1.05 days). Follow-ups were performed from 30-119months (mean 74.27 ± 28.14months). There were no cases of recurrence, howere, incision infection occured in 1 patient, who underwent a second operation 6 months after surgery, and 4 (5.7%) patients had complaints of intermittent pain around the ligation incision site, mostly during exercise .ConclusionLaparoscopic high hernia sac ligation is feasible for treatment of adolescent indirect hernias with a hernia ring diameter of ≤ 2 cm.

Role of Scrotal Support to Prevent Scrotal Edema After Inguinal Hernioplasty

Inguinal hernia is a quite common condition that is often seen in the elderly as compared to younger patients. Objective: To find out the prevalence of patients developing scrotal edema after inguinal hernioplasty and evaluate the role of scrotal support in avoiding it in our setting. Methods: We conducted a cross-sectional study at K.V.S.S. Site Hospital, Karachi for the period of January 2021 to December 2022. All the data that were collected and analyzed on the latest version of SPSS. The frequencies calculated for the categorical data while the mean found for the numerical data. The chi-square test was run to find out the effectiveness of scrotal support in reducing the frequency of scrotal swelling. A p-value of less than 0.05 was considered significant. Results: 50(55.6%) patients were in the age group of 50-70 years. The majority were smokers (66.7%) and had a BMI&gt;30 (83.3%). 40(44.4%) patients had a significant surgical history. The majority of the patients in our study had diabetes (66.7%). 59% of the patients in our study had an indirect hernia. 25(27.8%) patients who were not given scrotal support developed scrotal edema however only 1(1.1%) who were provided scrotal support immediately after the surgery developed scrotal edema. The association between scrotal support and scrotal edema was statistically significant (p&lt;0.01). Conclusions: Scrotal support has a positive role in preventing scrotal edema in our study.

P-052 RISK FACTORS FOR PERITONEAL TEARS DURING LAPAROSCOPIC EXTRAPERITONEAL HERNIA REPAIR

Abstract Background Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (TEP) repair of groin hernias. There are several mechanisms involved in the occurence of PTs during the course of the operation. There are many studies about the causes of peritoneal tears. Detection of independent risk factors in peritoneal tear formation may identify patients who will benefit from elective inguinal hernia repair in laparoscopic extraperitoneal hernia surgery. Methods Between April 2018 and december 2022, 518 consecutive patients undergoing 575 TEP repair surgery were recruited by the retrospective study. They were divided into two groups as with and without peritoneal tear. Patient characteristics, operative data, and postoperative outcomes were compared between patients with and without peritoneal tear. Risk factors for peritoneal tear were evaluated by univariate and multivariate analyses. Results The overall incidence of peritoenal tear was 19.7% (n=97). The median age was 45 years (18 to 83) and body mass index was 25.7 kg/m2 (15.67 to 35.20). Significant clinical factors associated with peritoneal tear included such as hernia type, previous hernia surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for peritoneal tear as indirect hernia type and previous hernia surgery. Conclusion Peritoneal tears is a major complication seen during TEP repair surgery and its incidence varies depending on many factors. Previous hernia surgery and indirect inguinal hernia the risk for peritoneal tears from during TEP repair.

P-075 CHRONIC INGUINAL SEROMA AFTER LAPAROSCOPIC SURGERY

Abstract Aim Chronic inguinal seroma is rare, with 80% being totally reabsorbed 3 months after surgery. Inguinal seroma after laparoscopic indirect hernia repair is presented in 3,7–70% of cases. Material and Methods Description of a clinical case. Results Male, 74 years-old. Prior bilateral inguinal herniorrhaphy. Diagnosed with recurrent right inguinal hernia, ultrasound confirmed. The patient underwent TAPP and a L2R right inguinal hernia was observed (EHS classification). The patient was discharged on day 1. One month after, the patient presented an irreducible tumefaction on right inguinal zone. Ultrasound describes a hydric collection measuring 5.8×5.4×4.1cm, suggesting a seroma, and excluded hernia relapse. 50mL of pure serous fluid was aspirated with clear reduction of the mass. Negative microbiology. Five months post-operatively, the tumefaction was present and 35mL of a fluid, with the same characteristics, was aspirated again. One month later, seroma was still found, and 35mL of a fluid was aspirated. After that, 100mg of Doxycycline was injected. Two years after surgery, tumefaction was present. He was proposed for surgical intervention and underwent unroofing and scarification of the seroma. Three-month follow-up without complications. Conclusions Chronic seroma that needs intervention is extremely rare. It is estimated that only 0,24% need percutaneous drainage and 0,2% reoperation. Therefore, this case is relevant and should inform us for this infrequent form of presentation of a common complication of inguinal hernia.