Management Of Inguinal Hernia Research Articles

A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century

Background: In the 21st century, the management of groin hernias (GHs) has evolved from watchful waiting (WW) to robotic hernia repair (RHR). The present study interrogates the status of robotics in the context of current repairs and provides one author’s perspectives. Methods: A systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies comparing open (OHR) to robotic hernia repair (RHR); RHR to laparoscopic hernia repair (LHR); or OHR vs. LHR vs. RHR. The historical context was extracted from previous reviews. Results: Fifty-four studies were included in the analysis. Three techniques have withstood the test of time: OHR (tissue and mesh repairs), laparo-endoscopic (TEP and TAPP), and RHR. The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this technique. While the number of overall complications with RHR is similar to OHR, in a minority of cases, complications are more consequential with the robotic platform. Conclusions: RHR has emerged as an unequivocally powerful technique for the management of GHs. OHR remains the technique of choice for local/regional anesthesia, posterior recurrences, and in centers that lack other platforms. In low- and middle-income countries, OHR is the most utilized technique. Centers of excellence should offer all techniques of repair including WW.

A Comprehensive Review of Inguinal Hernia Management with Saudi Arabia’s Clinical Landscape

This comprehensive review explores the management of inguinal hernia (IHN) in Saudi Arabia, focusing on region-specific strategies and clinical approaches. IHNs are prevalent in the male population and are a frequent cause for surgical intervention, often diagnosed through patient history and physical examination. The clinical presentation of IHNs ranges from asymptomatic to severe, life-threatening complications, with mild to moderate pain being the most common symptom. Diagnosis is typically confirmed through physical examination and the Valsalva maneuver, with imaging techniques used, when necessary, particularly in women and recurrent cases. Various repair techniques are discussed, including sutures and mesh, with both open and laparoscopic approaches recommended based on international guidelines. The choice of surgical procedure is influenced by factors such as surgeon expertise, patient characteristics, and resource availability. Recent advances in Saudi Arabia include the increasing use of robotic-assisted surgeries, which offer enhanced precision and minimally invasive options. Additionally, artificial intelligence is being explored for its potential to improve surgical outcomes through advanced data analysis and machine learning. This review underscores the need for tailored strategies to improve IHN management in Saudi Arabia, considering both clinical advancements and socio-economic factors.

Management Of Inguinal Hernias In Adults In Mulongo: A Local Anesthesia Approach

Introduction: Inguinal hernia, passage through the transversalis fascia of a peritoneal diverticulum, is a common condition often requiring surgical intervention. It represents one of the most frequent reasons for consultation in surgery, with a worldwide incidence estimated at 4.6% of the population. Objective: Describe the epidemiological, clinical aspects and therapeutic modalities of sublocal hernia repair of inguinal hernias in adults in the territory of Mulongo. Materials and Methods: This descriptive cross-sectional and prospective study was conducted during a campaign of free general surgery operations in Mulongo, Haut-Lomami, DRC, between June 1, 2021 and December 31, 2021. Local anesthesia with xylocaine was used. The parameters evaluated were frequency, age, sex, anatomoclinical type, type of anesthesia and postoperative evolution. Results :A total of 162 patients were included. The mean age was 41.5 years (range: 18-70). There were 90.7% men, the sex ratio was 9.8. The hernia was simple in 95.6% of cases and located on the right in 50% of cases. In 4.4% of cases the hernia was operated on urgently (strangulated and engorged and painful). Postoperative pain was the most common postoperative complication found in 54.9% of cases. Conclusion: The management of inguinal hernias in adults in Mulongo is often carried out under local anesthesia, due to the high prevalence of this pathology in the professional context of patients. Inguinal hernia thus remains a significant problem in this region, justifying adapted approaches such as local anesthesia

When and why Desarda repair: Evaluation of the efficacy of Desarda technique in the management of inguinal hernia

When and why Desarda repair: Evaluation of the efficacy of Desarda technique in the management of inguinal hernia

Inguinal hernias in children: Update on management guidelines.

Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics. Currently available moderate-to-low quality evidence recommends postponing hernia repair in premature infants until after discharge, to reduce the risk of respiratory difficulties and recurrence. Laparoscopic repair provides similar outcomes to open but may shorten operative time in bilateral cases. No clear recommendation can be made for contralateral exploration, therefore should be evaluated case by case. In preterm infants, consideration of regional anaesthesia may reduce post-operative apnoea and pain, with no difference in neurodevelopment outcomes.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.

Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.

There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability. A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively. Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory. This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.

Study to Assess the Effectiveness of Live Demonstration on Knowledge Regarding Surgical Management of Inguinal Hernia Repair among Nursing Students in Selected College of Nursing, Hubli

Introduction: Teaching skills are essential for learning needs of the students, the teaching is aided by the various technique of teaching. Live demonstration is a technique of educating students in actual scenario with demonstration of the content of topic, here the teacher performs the in presence of the students the topic of discussion. In the present study the technique of live demonstration practiced to improve the knowledge of nursing students in surgical management of inguinal hernia repair included pre, intra and post operative management of surgery. Objectives: the study designed to assess the effectiveness of live demonstration on knowledge regarding surgical management of inguinal hernia among nursing students. Methodology: one group pretest posttest design used for 156 nursing students selected by simple random sampling technique, a structured knowledge questionnaire was designed having content validity of 0.89 and reliability of 0.92 used to collect and assess knowledge of nursing students on surgical management of inguinal hernia repair, pretest was conducted following which a live demonstration on periopertive management of inguinal hernia repair was demonstration in class room and by live video visuals from operation theater while performing surgery following which the post operative care was demonstrated till the stabilization of the patient. The posttest was conducted to assess the gained knowledge using same questionnaire used in pretest. The collected data was analyzed using SPSS 16.0 version statistical analysis and the findings were tabulated and computed. Results: The findings of the study revealed that, the pretest knowledge of the nursing students regarding surgical management of inguinal hernia repair was inadequate, out of 156 nursing students, assessed 145 students had inadequate knowledge, and following live demonstration the knowledge, improved to adequate to almost all the students signifying that live demonstration is effective method of teaching learning activity. The t value was 69.56 for 0.05 level of significance. Conclusion: teaching is an art, which include the colors of various techniques to make classroom live and living. Live demonstration is the best method, which bring in the actual experience and spot learning of the students and the retention of the content discussed in live demonstration is high along with ability to compare, judge and reason the care and outcome of the learning. The study recommends that the nursing education should be equipped with live in demonstration, which brings students out of imagination of content and picture memorization from books and articles. Live demonstration should be included in teaching learning activity of the student’s class learning.

Tacker Fixation versus Suturing of Mesh in Laparoscopic Inguinal Hernia Repair

Abstract Background Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications which reported from laparoscopic procedure is due to learning curve lead to operative complications. Objective To compare the outcome results of the fixation of mesh by intracorporeal sutures and by tackers in TAPP hernia repair. Patients and Methods In our study, 30 patients were included divided on two groups, 15 for each. Group A; fixation mesh with tackers, Group B; fixation mesh with intracorporeal sutures. Both groups were compared in terms of operative technique, operative time, mesh device fixation cost, intra & post operative complications, early post operative pain within two weeks and in first month, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain. Results We found that using Intracorporeal sutures for fixation mesh is available, cheaper and more handle than using the Tackers which are expensive and less available so it makes a laparoscopic hernia more practical and decrease need for open surgery so we avoid the complication of open surgery. Both techniques are considered safe and effective with similar rates of recurrence and chronic pain although further wider scale studies are recommended. Conclusion TAPP hernia is considered safe as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention. Mesh fixation technique did not affect long-term persistent pain. A large number of patients reported persistent pain regardless of mesh fixation technique, which emphasizes the need for preoperative information. Preoperative pain was a risk factor for persistent pain. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilateral or bilateral, primary or recurrent status, strangulation and type of anesthesia, occupation, and leisure activities. Both techniques are effective in the management of inguinal hernia and were associated with same recurrence rate. However, due to small sample size and short follow up duration, longer- term studies are also recommended.

Prosthetic Management of Inguinal Hernias Using the Lichtenstein Technique in 100 Cases

Introduction: There has always been a plethora of hernia repairs in the absence of consensus. Techniques described as ancient, such as the Bassini, Mac Vay or Shouldice procedures, are still widely practised. Aponeurotic plasty has proved its worth in our practice. Prosthetic plasty, which has reduced recurrence by half, has become the gold standard. The aim of this study was to report on the feasibility of prosthetic management of inguinal hernias using the Lichtenstein technique. Material and method: This was a prospective fifteen (15)-month study: from July 1, 2022 to September 30, 2023. Study variables were sociodemographic, clinical and therapeutic. Results: During the study period, 173 patients underwent surgery for inguinal hernia. We noted one hundred (100) patients operated on according to the Lichtenstein procedure, i.e. 58% of all patients operated on for inguinal hernias in the department. We noted 98 men and 02 women. The mean age was 48.8 years (extremes: 20-91). The category of heavy laborer (laborer, farmer, etc....) accounted for % of cases. The hernia was exclusively right in 9 cases, left in 21 and bilateral in 10. A strangulated hernia was present in 9 patients. NYHUS classification was dominated by type IIIA (38.9%). Therapeutically, spinal anesthesia was the most common treatment: 8 cases. 40% of patients were pain-free in the immediate post-operative period, according to the analogue pain scale. The main complications were chronic pain in 10 patients and seroma in 02. After a minimum follow-up of three months for each patient, we noted no recurrence. Conclusion. The Lichtenstein technique is a relatively new procedure in our practice. Today, it is the technique of choice, with little postoperative morbidity.

Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Connecting Coding and Policy: Inguinal Hernias in Children

The June 2023 American Academy of Pediatrics clinical report, “Assessment and Management of Inguinal Hernias in Children” (https://doi.org/10.1542/peds.2023-062510), notes that inguinal hernia repair is one of the most commonly performed surgical procedures in children. In addition to the procedural considerations included in the clinical report, it is important that physicians who repair inguinal hernias and their coding and billing staff know the correct codes for reporting these procedures. This article reviews the following topics: Evaluation and management with decision for surgery Diagnosis codes for inguinal hernia Laparoscopic inguinal hernia repair Open inguinal hernia repair

Management of Inguinal Hernias in the Surgical Department of the Anaim De Kamsar Hospital

Management of Inguinal Hernias in the Surgical Department of the Anaim De Kamsar Hospital

Laparoscopic Management of Inguinal Hernia: A Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials.

Various surgical approaches for inguinal hernia repair have been outlined in medical literature. In most cases, these lesions are repaired by general surgeons. A variety of surgical techniques for the treatment of inguinal hernias have been documented in the medical literature. In 2018, the European Hernia Society (EHS) recommended laparo-endoscopic repair as a preferred approach for adults. This method involves a combination of laparoscopic and endoscopic techniques for hernia repair. The goal of this systematic review is to conduct a thorough examination of the total extraperitoneal vs. transabdominal preperitoneal comparison in inguinal hernia repair, with an emphasis on randomized controlled trials (RCTs). It also intends to conduct a trial sequential analysis (TSA)in order to determine whether more trials and investigations are required or whether there is sufficient evidence to draw a firm conclusion. The study's systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used the PubMed and Google Scholar databases to conduct a thorough web search for articles published between January 2019 and December 2023. The meta-analysis was carried out using Resource Manager Revmanversion 5.4.1 (Revman International, Inc., New York City, New York). After a review of the studies was done, ten studies were selected to be used in conducting the systematic review and meta-analysis. The recurrence rate of TEP treatment was found to be slightly lower than transabdominal preperitoneal (TAPP). The two techniques did not differ in terms of postoperative complications; however, TEP had a marginally lower rate of postoperative pain. Further, the study revealed that there was a decreased risk of wound infections, seromas, and hematomas with total extraperitoneal (TEP) as opposed to transabdominal preperitoneal (TAPP). TEPalso reduced the amount of recovery time needed. After conducting successful hernia treatments, total extraperitoneal and transabdominal preperitoneal both had low rates of complications and recurrence. Based on the information obtained from the study analysis, this meta-analysis provides evidence for the efficacy of TAPPand TEP techniques in the management of inguinal hernias. Though there was a statistically significant difference while applying both methods in the treatment of hernia (p=0.001), TEPs have been shown to have a lower recurrence rate than TAPPs. Similarly, the TEP method has been revealed to have a slight reduction in postoperative pain compared to transabdominal preperitoneal. However, the two techniques have been shown to have no significant difference in postoperative complications. Further, laparoscopic procedures have proved to be a little bit safer and more effective than open procedures. This has been shown by reduced risk of wound infection, hematoma, seroma, and decreased sensibility while using this method. It accelerated the healing process as well. Thus, depending on the needs of the patients and the experience level of the surgeons responsible for the treatments, inguinal hernias can be repaired using either transabdominal preperitonealor total extraperitoneal techniques since both treatment techniques have generally minimal chance of complications or recurrence as both have proved to safer method.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia.

Women have a 3% lifetime chance of developing an inguinal hernia, which is not as common in men. Due to its cosmetic benefits, single-incision laparoscopic transabdominal preperitoneal (SIL-TAPP) inguinal hernia repair is becoming increasingly popular in the management of inguinal hernia in women. However, there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal (CL-TAPP) inguinal hernia repair for the treatment of inguinal hernia in women. To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients. We retrospectively compared the clinical information and follow-up data of female inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hospital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts. This study included 123 patients, with 71 undergoing SIL-TAPP repair and 52 undergoing CL-TAPP repair. The two cohorts of patients and inguinal hernia characteristics were similar, with no statistically meaningful difference. The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort (0, 0%) than in patients in the CL-TAPP cohort (4, 7.7%) and was significantly different (P < 0.05). In addition, the median [interquartile range (IQR)] total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort [$3287 (3218-3325)] than in patients in the CL-TAPP cohort [$3511 (3491-3599)]. Postoperatively, the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort (0, 0%) than in the CL-TAPP cohort (4, 7.7%), and the median (IQR) cosmetic score was significantly higher in the SIL-TAPP cohort [10 (10-10)] than in the CL-TAPP cohort [9 (9-10)]. SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female inguinal hernia patients. Moreover, female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who underwent CL-TAPP repair. In addition, female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision. Therefore, SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Laparoscopic Sac Excision as a Definitive Technique for Inguinal Hernia Management in Pediatric Females: A Prospective Study.

The utilization of laparoscopic techniques in the management of inguinal hernias among pediatric patients has seen a rising trend. We aimed to assess the efficacy of laparoscopic excision of the hernial sac as a suitable approach for managing inguinal hernias specifically in female patients and conducted a prospective study to investigate this hypothesis. Over a comprehensive four-year period, a total of 99 hernias in 69 female patients were surgically addressed using laparoscopic methods. The surgical procedure primarily involved the laparoscopic inversion and excision of the hernial sac without subsequent distal suturing. During the initial phase of the study, two cases encountered recurrences within 48 hours post-operation, potentially attributed to incomplete excision. However, in the subsequent period, no further recurrences were recorded. Our study findings support the contention that laparoscopic excision of the sac, without adjunctive closure of the peritoneum, suffices as an effective approach for managing inguinal hernias in female pediatric patients.

Efficacy and safety of artificial intelligence-based large language models for decision making support in herniology: evaluation by experts and general surgeons

To evaluate the quality of recommendations provided by ChatGPT regarding inguinal hernia repair. ChatGPT was asked 5 questions about surgical management of inguinal hernias. The chat-bot was assigned the role of expert in herniology and requested to search only specialized medical databases and provide information about references and evidence. Herniology experts and surgeons (non-experts) rated the quality of recommendations generated by ChatGPT using 4-point scale (from 0 to 3 points). Statistical correlations were explored between participants' ratings and their stance regarding artificial intelligence. Experts scored the quality of ChatGPT responses lower than non-experts (2 (1-2) vs. 2 (2-3), p<0.001). The chat-bot failed to provide valid references and actual evidence, as well as falsified half of references. Respondents were optimistic about the future of neural networks for clinical decision-making support. Most of them were against restricting their use in healthcare. We would not recommend non-specialized large language models as a single or primary source of information for clinical decision making or virtual searching assistant.

Appropriateness of Online Chat-Based Artificial Intelligence (ChatGPT) Answers to Common Questions on Inguinal Hernia Repair.

ChatGPT is a conversational AI model developed by OpenAI designed to generate human-like text based on the input it receives. ChatGPT has become increasingly popular, and the general public may use this tool to ask questions about different medical conditions. There is a lack of data showing if ChatGPT is able to provide reliable information on medical conditions to the general public. The aim of our study is to assess the accuracy and appropriateness of ChatGPT answers to questions on inguinal hernia management.

Inguinal Hernia: Diagnosis and Management

The inguinal hernia is the subcutaneous part of the peritoneum containing the abdominal viscera that exits through the inguinal canal or directly through the abdominal wall. Most patients do not realize they have an inguinal hernia until swelling arises in the thigh fold area or pain in the groin area. The purpose of this literature review is to provide an update regarding the diagnosis and management of inguinal hernias. The diagnosis of an inguinal hernia is largely based on the history and physical examination, whereas imaging is rarely performed unless there is a certain suspicion. Surgical management can be performed on patients with symptoms, while asymptomatic patients can be subjected to conservative therapy.&#x0D;

A Cross Sectional Study on Types, Clinical Assessment and Management of Inguinal Hernia

A Cross Sectional Study on Types, Clinical Assessment and Management of Inguinal Hernia