Adult Inguinal Hernia Research Articles

Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults

ObjectiveWe aimed to evaluate the causes of complications following surgery for inguinal and femoral hernia, using surgical site infection (SSI) and recurrence rate as indicators of outcomes to consider appropriate treatments. MethodsWe retrospectively assessed the medical histories of 1,098 patients with adult inguinal and femoral hernias who underwent herniorrhaphy between July 2010 and March 2019. Using SSI and recurrence rate as indicators of outcomes, we statistically assessed the influence of preoperative and operative conditions on surgical outcomes. ResultsThe occurrence of postoperative SSI was significantly more frequent in patients who experienced a long surgical duration, excessive blood loss, and incarceration; underwent emergency surgery and bowel resection; and in whom no mesh sheet insertion was performed. There was no correlation between mesh use and SSI in cases that did not require emergency incarceration repair. For cases involving hernia incarceration, the use of a mesh sheet was avoided to prevent potential infection, which could explain the high incidence of SSI in cases where mesh was not used. The hernia may have recurred due to technical issues during the procedure, as well as failure to ligate the hernia sac. ConclusionsSelecting the appropriate surgical method for hernia repair may reduce the incidence of SSI. If manual reduction of inguinal hernias is not possible, an appropriate surgical procedure should be determined based on laparoscopic findings in facilities where laparoscopic hernia surgeries are frequently performed. Moreover, in cases without infection and bowel resection, mesh use may be beneficial. Recurrence can be prevented by ligating the hernia sac during surgery and solving relevant technical problems.

A study of the effectiveness of the bilateral and contralateral occult inguinal hernia repair by total extraperitoneal repair with intraperitoneal examination.

Of the various methods used, the laparoscopic surgical repair of inguinal hernias is widely performed. We aimed to estimate the incidence of bilateral and contralateral occult inguinal hernias in our surgical population and to compare the results of total extraperitoneal repair (TEP) for bilateral and unilateral inguinal hernias, occult and non-occult hernias. We retrospectively reviewed data of patients who underwent TEP for the repair of adult inguinal hernias from January 2012 to November 2018 in our hospital. Of the data of 259 patients included, 134 (51.7%) and 125 (48.3%) had unilateral and bilateral inguinal hernias, respectively, while 70 patients (27%) were found to have a contralateral occult inguinal hernia, intraoperatively. The mean operative time was 129 ± 48 minutes (range, 43-300 minutes) and 167 ± 55 minutes (range, 85-390 minutes) for the unilateral and bilateral groups, respectively, indicating a significantly longer duration of surgery for the bilateral group (P < .05). Recurrence occurred in 1.5% (5/134) and 0.4% (1/250) of the operated hernias in the unilateral and the bilateral groups, respectively, indicating a significantly lower rate of recurrence in the latter group (P < .05). The two groups showed no statistically significant differences with respect to the remaining perioperative data. The incidence of postoperative complications in occult hernias was not significantly different from that in non-occult hernias. Our TEP method, involving a laparoscopic exploration from the intraperitoneal side, can be safely and effectively utilized for the repair of both bilateral and contralateral occult inguinal hernias.

Matrix Metalloproteinase-2, COL1A1, and COL3A1 mRNA Expression in Aponeurosis Musculus obliquus Externus Abdominis of Adult Inguinal Hernias

BACKGROUND: The ratio change of type I and type III collagen in the peritoneal tissue can be associated with defects in collagen synthesis caused by the extracellular matrix’s degradation. Matrix metalloproteinase-2 (MMP-2) is an enzyme that contributes primarily to the degradation of this extra cell. AIM: This study aimed to analyze the differences in expression of COL1A1, COL3A1, and MMP-2 mRNA and the relationship between these expressions in adult inguinal hernias and the expression ratio between the COL1A1/COL3A1 genes. METHODS: This study was an observational study with a cross-sectional comparative study design, where the sample was adult inguinal hernia patients who were taken from the aponeurosis tissue m. external obliquus performed at the time of surgery, while control was a non-herniated patient. The sample RNA was isolated, followed by cDNA synthesis, and examined by real-time polymerase chain reaction. RESULTS: The mean values of expression for COL1A1, COL3A1, and MMP-2 in the case group were 40.02 ± 181.38 copy number, 33.70 ± 143.62 copy number, and 31.78 ± 84.47 copy number. Meanwhile, the expression values for COL1A1, COL3A1, and MMP-2 in the control group were 40.247 ± 162.837 copy number, 13.35 ± 37.43 copy number, and 20.58 ± 48.95 copy number. CONCLUSIONS: Our study showed a difference in COL3A1 expression between the hernia and non-hernia groups, and no difference was found in the expression of COL1A1 and MMP2 between the hernia and non-hernia groups.

All in one procedure Versus classical procedure for Hernioplasty in Patients With Inguinal Hernia

Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair. Objective: we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Patients and Methods: . A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis .According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications. Results: all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. Conclusion: This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications. Keywords: Hernia ;Open mesh inguinal hernia; patients

Asymptomatic patent processus vaginalis is a risk for developing external inguinal hernia in adults: A prospective cohort study

BackgroundInguinal hernia repair is common for children and adults across the world, but the mechanism behind hernia onset still requires elucidation. This prospective study aims to determine whether patent processus vaginalis (PPV) is a factor in the development of external inguinal hernias. MethodWe enrolled 1008 patients who underwent laparoscopic surgery and in whom the inguinal region was observed. If processus vaginalis existed, we measured the diameter and length. Patients were followed for three years after surgery to investigate the incidence of external inguinal hernias. ResultNo significant differences were found between age groups. Furthermore, no difference could be recognized in length or opening diameter of the PPVs between age groups. Three-year follow up was possible for 765 of 1008 patients enrolled in this study (76%), eight of whom, all male, developed external inguinal hernia during this period. Multivariate analysis for onset of inguinal hernia onset in male patients showed that PPV and length of the right PPV were independent risk factors for development of external inguinal hernia. ConclusionThe patency rate, length, and diameter of the processus vaginalis do not differ according to age. The patency of the processus vaginalis in male patients is an independent risk factor for development of external inguinal hernia in adults.

Evaluation of Trans Rectus Sheath Extra-Peritoneal Mesh Repair:Our Early Results

Background:An inguinal hernia is a protrusion of the content of the abdominal cavity or preperitoneal fat through a hernia defect in the inguinal area.Inguinal hernia repair is considered one of the most common surgical procedures done all over the world. The Lichtenstein technique, introduced in 1984, is the best evaluated and the most common open tensionless mesh repair of different open mesh techniques with low morbidity and low recurrence rates (≤4%) in the long-term follow-up. Objectives:Evaluation of our results ofTrans Rectus Sheath Extra-Peritoneal Procedure (TREPP)considering the data available from the literature of the standard Lichtenstein method for the treatment of primary adult inguinal hernia. Patients and Methods: A clinical study was conducted at Qena University Hospital over 6 months period, between 1/9/2019 to 1/3/2020 for patients with hernia visiting the outpatient clinic. We operated on 52 patients using the TREPP technique with a follow-up period at 6 months duration post-operative. Results:We operated on 52 patients using the TREPP technique; all of them were males with a mean age of 33.3±10.2years. Intra-operative complications occurred in 1.9% of cases. No cases showed recurrence during the first 6 months post-operative. No cases had CPIP (chronic post-operative pain). Conclusion: The TREPP technique is a good alternative to the standard Lichtenstein tension-free mesh repair with a low recurrence rate as in Lichtenstein repair, but with a less incidence of CPIP and scrotal edema with shorter operation time.

Inguinal Hernias in Adults: Epidemiological, Clinical and Therapeutic Aspects in the City of Douala

Background: Inguinal hernia is defined as the subcutaneous passage of a portion of the peritoneum containing abdominal viscera through the inguinal canal or directly through the abdominal wall. Its diagnosis is essentially clinical and strangulation is the most important of complications. Many surgical techniques have been described update. The aim of the present study was to highlight the epidemiological, clinical and therapeutic aspects of inguinal hernias in adults in Douala city. Methodology: we conducted a retrospective study from January 01, 2010 to December 31, 2019. The study concerned medical records of patients aged from 18 and above, who were followed and or operated for inguinal hernia in the surgical wards of five hospitals in Douala city. Files with no content of: age, sex, type of hernia and the therapeutic method used have been excluded in the study. Variables were recorded on data collection sheets. Data were analysed using the software Sphinx plus² version 5.0. Results: One thousand and twenty-four cases answered the inclusion criteria (925 males and 99 females). The mean age was 45.6 years (in-between: 18-94). Labourers category were about 56.4% of the cases (n = 578). 84.0% of cases (n=865) were simple hernia, 7.0% of cases (n=74) were recurrences and 16.0% of cases (n=159) were complications. Strangulation with 85.5% of cases (n=136) was the most common complication. The factors in relation to these complications were the length progression of the hernia and patients professions. The predominant site of the hernia was the right side with 53.9% of cases of simple hernia and 65.2% of cases of complicated hernia. The diagnosis was clinical in 99.0% of cases and ultrasound (10 cases) was the only imaging test used for cases with doubtful diagnosis. Therapeutically the most widely used non-prosthetic treatment was that of Bassini in 47.8% of cases with simple hernias and in 46.7% of cases with complicated hernias. Lichtenstein technique was the most used prosthetic treatment with 90.5% of cases of simple hernias and 100% of cases of complicated hernias. The hernia was mainly through the external oblique in 66.0% of simple hernias and 76.9% of complicated hernias. Bowel resection and anastomosis were performed in 43 (27.0%) patients with intestinal necrosis. Recurrent hernia was mostly treated by the Shouldice technique in 25 cases (33.8%). The mean length of hospital stay was 3 to 4 days. The mortality and morbidity rate were respectively null and 1.4 (n=12) for simple hernias and 6.2 (n=10) for complicated hernias. The factors identified in relation to this morbidity were sex and the length of hospital stay. Conclusion: inguinal hernia was the most common hernia of the abdominal wall (85.4%). It was predominant in the male sex (90.0%) and mostly present on the right side. Bassini surgical repair was the most used operating technique. Prosthetic cures (gold standard of the surgical management) were little or not well practiced in our setting and could be a tool to improve needed results.

Đánh giá kết quả phẫu thuật TAPP điều trị thoát vị bẹn có biến chứng ở người lớn tại Bệnh viện Trung ương Huế - Cơ sơ 2

Abstract Introduction: Laparoscopic approaches for inguinal hernia, including transabdominal preperitoneal repair (TAPP) and the totally extraperitoneal approach (TEP), are effective and widely accepted in elective inguinal hernioplasty. The choice an procedure for complicated inguinal hernia repair still controversial. Since the TAPP approach has advantages in assessing hernia content and decreasing incision infection rate and early recovery after surgery. Materials and Methods: Study participants included 17 patients of complicated inguinal hernia treated by TAPP technique at the Hue Central Hospital - Base 2 from 6/2019 though 6/2020. Descriptive and prospective follow-up study. Results: The mean age was 67,4 ± 14,85. Strangulated hernia and incarcerated hernia respectively accounted for 41,2% and 58.8% among cases. 94,1% cases were indirect hernia. 12 cases (70,6%) were right sided and 5 cases (29,4%) were left sided hernias. The content was small bowel in 58,8% cases, omentum in 23,5% cases and both in 11,8% cases, colon in 5,9%. 7 patients of strangulated hernia with recovery bowel and non resection. The mean durations of unilateral inguinal hernia repair were 77,2 ± 19.3 mins. Mean duration of postoperative stay was 4.2 ± 2.1 days. Postoperativer complications were 5,9% seroma formation. At 6-months evaluation, 1 case was reported with sensation disorder of inguinal area and there was no recurrence. Conclusions: TAPP is a safe and effective surgical technique for incarcerated inguinal hernia repair. Keywords: Strangulated inguinal hernia, incarcerated, TAPP, laparoscopic, mesh. Tóm tắt Đặt vấn đề: Phẫu thuật nội soi điều trị thoát vị bẹn ngày càng phổ biến rộng rãi với hai phương pháp TEP (totally extraperitoneal) và TAPP (transabdominal preperitoneal). Những trường hợp thoát vị bẹn có biến chứng việc lựa chọn phương pháp điều trị vẫn còn nhiều quan điểm khác nhau. Với cách tiếp cận bên trong khoang phúc mạc phương pháp TAPP có lợi thế trong việc đánh giá tạng thoát vị, giảm tỉ lệ nhiễm trùng và hồi phục nhanh sau phẫu thuật. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 17 người bệnh thoát vị bẹn có biến chứng được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ 06/2019 đến 06/2020. Kết quả: Tuổi trung bình 67,4 ± 14,85 tuổi. Thoát vị bẹn nghẹt 7 người bệnh (41,2%); thoát vị bẹn cầm tù 58,8%. 94,1% thoát vị thể gián tiếp. Bên phải có 12 người bệnh chiếm 70,6%, bên trái 29,4%. Tạng thoát vị được giải phóng 58,8% ruột non; 29,4% mạc nối; 11,8% ruột non và mạc nối và 5,9% là đại tràng. 7 người bệnh thoát vị nghẹt có sự hồi phục ruột non không phải cắt bỏ. Thời gian phẫu thuật trung bình 77,2 ± 19,3 phút. Thời gian nằm viện sau mổ trung bình 4,2 ± 2,1 ngày. Biến chứng sớm sau phẫu thuật 5,9% tụ dịch bẹn bìu. Sau 6 tháng có 1 trường hợp rối loạn cảm giác vùng bẹn; không có trường hợp nào tái phát

Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial.

Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.

Uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia

Multiple researchers have given numerous guidelines in the clinical management of this disorder in the late nineteenth and twentieth centuries, after comprehensive works on the subject. As a result, a very wide variety of surgical procedures are now available to the surgeon to suit the requirement. There have been numerous advances in the management of inguinal hernia. Inguinal hernias can conveniently be repaired under all kinds of anaesthesia, namely general, spinal and local. Whereas the general anaesthesia requires the services of an experienced anaesthetist and new devices and spinal anaesthesia requires postoperative impairment while local anaesthesia is safe to prescribe, easy and efficient and does not cause postoperative complications. This work consisted of a study group of twenty-five adult patients of uncomplicated inguinal hernias, who after repair of hernias, which after repair of hernias were allowed early ambulation and had a short hospital, stay of one day post operatively. The second control group consisted of similar twenty-five patients who are subjected to conventional delayed ambulation and prolonged hospital stay. The results of repair in the two groups were compared; the available literature on the subject was reviewed. The implementation of ”shortstay surgery” not only relieves the waiting list in hospitals but also offers an economic boost and provides the patient with some social advantages.

A rare case of Amyand’s hernia with acute appendicitis in a 69-year-old woman: a case report

Introduction: Amyand’s hernia is an extremely rare and atypical hernia that is difficult to diagnose clinically characterized by the herniation of the appendix into the inguinal sac. The aim of this report is to describe a case of Amyand’s hernia and highlights the importance of early CT scanning in reaching the exact and early diagnosis of Amyand’s hernia. Case report: We present a rare case of a 69-year-old female patient with a history of intermittent pain in the right inguinal region is see at the emergency surgical clinic. The patient underwent a CT scan of the abdomen and a small pelvis, and an inflamed appendix was diagnosed. The inflamed appendix is herniated in the inguinal hernia sac. Computed tomography was the only modality to diagnose the hernia sac contents preoperatively. Discussion: The reported incidence of Amyand’s hernia is less than 1% of all adult inguinal hernia cases. Acute appendicitis in Amyand’s hernia is even less common, with 0,1% of all cases of acute appendicitis. This hernia may be present without symptoms until the inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation, or rupture. Early symptoms include tenderness and inguinal swelling. Conclusions: Computer tomography helps make an accurate and timely diagnosis of Amyand’s hernia, thus avoiding complications from delayed surgery.

Adherence to international guidelines for Groin Hernia Management: a retrospective cross-sectional study in a tertiary government training hospital.

This study aims to determine overall compliance of the Department of Surgery in a tertiary government training hospital to the latest International Guidelines for Groin Hernia Management from July to December 2018. Medical records of operations involving inguinal hernia in adults done from July to December 2018 (N = 150) were reviewed and compliance rates were determined based on selected ten parameters. Overall, the Department of Surgery was poorly compliant to the guidelines. All cases were only partially compliant. The highest over-all compliance was noted on the use of clinical examination alone in diagnosing primary inguinal hernias (N=147, 100%, recurrent hernias excluded), use of appropriate technique (N=147, 98%), and use of preoperative antibiotics (N=144, 96%). Poor compliance was noted on round ligament preservation in females (0%), use of intraoperative local anesthesia (N=5, 3%), and the use of European Hernia Society Classification in the final diagnosis (N=42, 28%). Strict education, implementation, and regular monitoring of these guidelines among both the resident and consultant staff are needed to ensure better compliance to the guidelines.

Comparative study between laparoscopic trans-abdominal preperitoneal and open mesh hernioplasty in repair of non-complicated inguinal hernia

Background: Inguinal mesh hernioplasty is one of the common procedures performed all over the world. It can be done either through open or laparoscopic techniques. The aim of this study was to compare the outcomes of Lichtenstein tension free hernioplasty versus laparoscopic transabdominal pre-peritoneal (TAPP) mesh repair considering, duration of the surgery, hospital stay, and duration to resume normal activity, degree of postoperative pain, wound infection, recurrence and complications.Methods: Adult patients presented to the general surgical OPD, with the diagnosis of inguinal hernia underwent either Lichtenstein repair or laparoscopic repair by TAPP.Results: Patients in Group A (open-repair) had significantly greater level of local pain during rest and during routine activities than those within Group B (laparoscopic group) during the postoperative period assessed on the visual-analogue scale. Mean operative time for open hernia repair was 43.7 minutes and for laparoscopic hernia repair was 59.03 minutes and the difference were statistically significant (p=0.0001). The mean duration of hospital stay for open hernia repair was 2.16 days and that for laparoscopic hernia repair was 1.08 days with a (p=0.00001) which was statistically significant. The time to resume routine activities was much shorter among Group B patients than patients in Group A. Only one recurrence (3.3%) was seen in Group B after 6 months follow up.Conclusions: It is concluded that laparoscopic TAPP repair of inguinal hernia in adults is safe and preferred operation as compared to open inguinal hernia repair.

Audit of Patient Outcomes after Lichtenstein Hernioplasty for the Repair of Adult Inguinal Hernia

Background: Inguinal hernia repair is one of the most commonly performed surgeries worldwide. While numerous surgical approaches exist to treat inguinal hernias, the Lichtenstein tension-free mesh repair remains the gold standard. This retrospective study is carried out to evaluate the short and long term outcomes of Lichtenstein hernioplasty in the hand of a general surgeon. Patients and Methods: A retrospective analysis of all adult inguinal hernia repair by Lichtenstein method between January .2003 and December 2009 was carried out. The outcome measures were early post-operative complications, incidence of chronic groin pain and recurrence rate. Results: A total of 526 procedures were carried out in 445 adult male patients during the study period. The median age of the patients was 49 years (range, 21-73 years). All patients underwent Lichtenstein hernioplasty under spinal anesthesia. Length of hospital stay was median 2.4 days (range, 1-4 days). Median time to the resumption of normal activities was 8 days (range, 5-1 0 days). Urinary retention was the most frequent early post-operative complication (5.1 6%). Rate of wound infection was acceptable (0.44%). Chronic groin pain was experienced by three patients (0.67%). There was no recurrence observed among the 291 (65.4% of the total) patients who were available after two years of the procedure. Conclusion: The Lichtenstein open tension-free mesh repair of adult inguinal hernia is a safe procedure with least post-operative morbidity and least chance for recurrence. It is a simple technique, quick and. easy to perform without compromising the patient's care and long-term outcome in the hand of an experienced general surgeon.&#x0D; Journal of Surgical Sciences (2012) Vol. 16 (2) : 54-58

Effectiveness of open pre-peritoneal approach in the treatment of inguinal hernia in adults

Background: Bassini (1844–1924) transformed inguinal hernia repair into a successful venture with minimal morbidity. The success of the Bassini repair over its predecessors ushered in an era of tissue-based repairs. Inguinal hernia repair underwent its most recent transformation. Laparoscopic inguinal hernia repair as the Trans Abdominal Pre Peritoneal (TAPP) repair, and the Totally Extra Peritoneal repair (TEP). The most significant advances to inguinal hernia have been repair through open pre-peritoneal approach. The most significant advances to inguinal hernia have been repair through open pre-peritoneal approach. The advantage of pre-peritoneal approach is that the prosthetics can be placed between hernial contents and hernial defects. The need for present study is to review the effectiveness and complications of open pre-peritoneal approach in inguinal hernia repair. Methods: A prospective observational study in patients who had undergone open pre-peritoneal mesh repair in Narayana medical college, Nellore. Sample size- a total of 50 patients are taken in this study. Results:In this present study 50 cases of inguinal hernia were taken and operated by open pre-peritoneal approach. Conclusion:In this present study the effectiveness of pre-peritoneal approach in Inguinal hernia was studied in terms of post-operative pain, wound complications, time to return to pre-operative physical activities and short term recurrence.There was no recurrence rate on follow-up, Post operative pain was low compared to other approaches from various studies, and time to return to normal activities was significantly less than the other repairs.

Can Desarda Technique Repair all Adult Inguinal Hernia?

Objectives: This paper focuses on reporting the results of the daily use of the Desarda technique for the treatment of adult inguinal hernias without selection of patients at national hospital of Niamey. Patients and Method: This was a prospective and descriptive study from December 2012 to August 2014. It included 76 patients aged over 15 years who underwent inguinal hernia repair by Desarda technique without any selection. The variables studied include the type of inguinal hernia, the Nyhus class of inguinal hernia, the operating time, the postoperative pain, and the hernia recurrences. Results: There were 74 men and 2 women. The average age of the patients was 43.6 years [± 17.6]. Inguinal hernia was found in 57.9% of patients. There were 76.31% simple hernias, 15.80% recurrent hernias, 2.63% intractable hernias by loss of domain, and 5.26% strangulated hernias. 90.79% of the patients were operated under spinal anesthesia. The most frequent types of inguinal hernia were Nyhus type 2 found in 35.52% of patients, followed by Nyhus type 3b found in 30.26% of patients. The mean operative time was 46.67 [± 11.5] minutes. The immediate operative follow-up was marked by the occurrence of a hematoma of the scrotum in two patients. There was no recurrence of chronic postoperative pain after a median follow up of 40 months. Conclusion: The Desarda technique could be a good alternative for the cure of all inguinal hernias of adults.

Timings and presentation profile of adult inguinal hernias at a district hospital set up in central India

Background: Present study outlines experiences related to inguinal hernia presentation at a district hospital set up with respect to duration of time, mode of presentation and an effort have been made to analyse factors influencing them.Methods: Descriptive, epidemiological, prospective type of study design was adopted. Adult patients above 20 years presenting with inguinal hernia at District Hospital Sehore, Madhya Pradesh, India, were included in study; considering inclusion and exclusion criteria. Time frame of present study was from April 2017 to April 2018. Under proper written consent relevant data was collected on a pro-forma. Variables obtained were statistically analysed and magnitude of problem estimated on the background of available literature.Results: 80 patients were enrolled in the study with mean age of 39.64±09.59 years. Majority were men (98.75%) and farming was main occupation (51.25%). Main complaint was lump above the inguinal crease with pain. Increased pain in lump was the main cause of presentation (100%). Predominance of right sided hernia was noted (60%). Almost 36 patients (45%) were admitted with features of obstruction. Lack of awareness of the disease (41.25%) was commonest reason for late presentation. The most common operative procedure done was Lichtenstein’s hernioplasty.Conclusions: There is a need for health education and awareness among common masses especially from rural sector regarding inguinal hernia as a treatable surgical entity which can become life threatning when entity becomes complicated. Counselling regarding government funded schemes like Ayushman Bharat to be done at grass root level. Primary and community health centres need up gradation with availability of full time surgical expertise.

Worldwide hernia repair: variations in the treatment of primary unilateral inguinal hernias in adults in the United Kingdom and in low- and middle-income countries.

In this invited commentary, we aim to quantify and explain the variation between, and also within, developed healthcare systems (using the UK as an example) and low- to middle-income countries (LMICs). Rather than including complex cases, we have looked only at 'uncomplicated' primary unilateral inguinal hernias, an area where limited variation may be identified. Data were obtained from Hospital Episode Statistics and structured surveys in the United Kingdom and in low- and middle-income countries. There is widespread variation in the repair of 'uncomplicated' primary inguinal hernias worldwide and within developed healthcare systems.

The use of prosthetic mesh in adult inguinal hernia repair

Background: An abdominal wall hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the wall of the abdominal cavity. Different approaches have been described in regards to management and repair of hernia. The present study aims at showing the rate of frequency to use the prosthetic mesh versus classical repair in adult inguinal hernia.Methods: A retrospective study lasted from October 2014 to July 2018 in Al-Karama Teaching Hospital. The study Samples consist of 315 patients with inguinal hernia, the age group (20-70) years old they were diagnosed according to clinical examination. There are 76 patients operated on using mesh technique (tension free).Results: All patients in our series were male, with age group (20-70) years. However, the inguinal hernia more frequent with increase age. In age groups; (40-49) was 25 patients (32.89%). The indirect inguinal hernias are most common in the young 65% whereas direct hernias are most common in the old. In our series sixty-one (80.26%) patients with indirect inguinal hernias, eleven (11.82%) patients with direct hernias and six (5.263%) patients with pantaloon type.Conclusions: The frequent uses of mesh in inguinal hernioplasty increasing with age. Tension –free hernioplasty is technically simple surgical operation, which can be used to repair any groin hernia. The use of mesh patch with or without plug is technically easier to work than the classical methods and far simple to secure to surrounding tissues.

Cyanoacrylate Glue Versus Suture Fixation of Mesh in Adult Inguinal Hernioplasty

Background: Tissue glues have been present for over twenty years and are used in surgery for a variety of indications. Use of N butyl- 2-cyanoacrylate based in inguinal hernia surgery were practiced for the first time in the mid-nineties. These non-suture techniques was aimed to decrease the chronic groin pain after hernioplasty without adversely affecting the outcomes Aim of the work: this study was designed to compare the operative outcomes of mesh fixation with glue versus that with suture. The primary objective was to compare pain in the immediate postoperative period and also to compare chronic postoperative pain. Patients and Methods: This prospective randomized study was performed Between January 2018 and January 2019 on 40 patients with unilateral inguinal hernia for whom open hernioplasty was done in the Department of surgery, Al-Azhar University Hospital, Damietta. Results: in the present study, there was significant difference in postoperative pain perception at 24 hours, at one week and at one month (p < 0.05) between glue group and suture group with lesser pain perception in the glue group. After the first month the difference between the two groups was non-significant. The mean operative time which was 44.35 min in the glue group and 57.33 min in suture group showed significant difference. As regard to the postoperative complications, the postoperative hematoma, infection and seroma were lesser in glue group but the difference was not significant. There was no recurrence in both groups. Conclusions: Cyanoacrylate glue for mesh fixation in Lichtenstein repair of adult inguinal hernia shows advantages over mesh fixation by sutures in terms of immediate and chronic post-operative pain, operative time, and postoperative complications.