Inguinal Hernia In Patients Research Articles

IMPRUVING HEMOSTASIS DURING ONESTAGE RETROPUBIC PROSTATECTOMY AND SIMULTANEUS PREPERITONEAL HERNIOPLASTIC IN PATIENTS WITH BENIGH PROSTATIC HYPERPLASIA AND INGUINAL HERNIAS

Summary. Inguinal hernia is found in 2-8% of patients with benign prostatic hyperplasia. The possibility of simultaneous elimination of prostatic obstruction and inguinal hernia requires improvement of the method of hemostasis during the performance of recumbent prostatectomy in order to reduce blood loss and time of surgery is a pressing issue for both abdominal surgery and urology.
 Purpose of research. Improve the method of hemostasis in the performance of one-stage prostatectomy and simultaneous preabdominal plastic of inguinal hernia in patients with benign prostatic hyperplasia and inguinal hernia to reduce blood loss and time of operation.
 Materials and methods of research. Preabdominal plastic of the inguinal hernia during a single-stage concurrent prostatectomy was performed for 32 patients with benign prostatic hyperplasia. The first 6 patients, preperitoneal gernioplasty was performed before retropubic prostatectomy, for the last 26 patients - after a prostatectomy because of the possibility of loosening of the applied sutures at stretching of a wound by hooks.
 Research and discussion of results. In order to reduce bleeding during prostate prostatectomy and time of surgery, we proposed to perform hemostatic U-shaped catgut sutures (No. 6) on the lateral surfaces of the prostate capsule on muscle pieces (pads) of the pyramidal abdominal muscle. Intraoperative blood loss during surgery was determined by weight. The application of the hemostasis technique in the performance of a single-stage concurrent prostatectomy and simultaneous preperitoneal plasticity of inguinal hernias for patients with benign prostatic hyperplasia and inguinal hernia allowed to reduce the duration of surgery by 10-15 minutes, and blood loss by 150-250 ml.
 Conclusions. The results of improvement of the method of hemostasis in the performance of a single-stage concurrent prostatectomy and simultaneous preperitoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia show a decrease in the duration of surgery and intraoperative blood loss. The use of mesh prosthesis in the performance of pre-abdominal plastics of inguinal hernias and one-time supraventricular prostatectomy allows one surgical pathology to be eliminated simultaneously with one access, to prevent recurrence of hernia, to improve the quality of life of the patient and to have economic justification.

Tension-free mesh repair of inguinal hernia in patients on continuous ambulatory peritoneal dialysis.

Peritoneal dialysis (PD) is the first-line renal replacement therapy for end-stage renal failure patients in Hong Kong. Abdominal wall hernia is a common mechanical complication of PD, and early surgical repair has been advocated to reduce complications. This study aims to review the outcomes of tension-free mesh repair of inguinal hernia in PD patients. All PD patients who underwent elective repair of inguinal hernia from 2009 to 2015 were identified from a single centre for retrospective analysis. Primary outcomes included surgical complications, perioperative dialysis technique and recurrence. Twenty-one patients with a total of 26 inguinal hernia repairs were included in this 7-year retrospective study. All were males, and the mean age was 68 ± 10 years. Diabetic nephropathy (n = 9, 42.9%) and glomerulonephritis (n = 7, 33.3%) were the two most common causes of renal failure. All hernias were detected after the initiation of PD, and the mean duration of PD to hernia detection was 16 months (range 1-65 months). Lichtenstein open mesh repair was performed in all patients. Complications included seroma (n = 3, 11.5%) and ischaemic orchitis (n = 1, 3.8%). There were no mesh infection or recurrence. Twenty patients (95.2%) received intermittent peritoneal dialysis post-operatively and returned to continuous ambulatory PD in 15 to 30 days. Only one patient (4.8%) required bridging haemodialysis due to Tenckhoff catheter blockage. Tension-free mesh repair is associated with low morbidity and low recurrence rates in PD patients. Timely management and close collaboration with renal physicians are essential to continue PD after repair.

Safety and effectiveness of inguinal hernia repair in patients with liver cirrhosis: a retrospective study and literature review.

Inguinal hernia is a common feature of decompensated liver cirrhosis and a frequent cause of life-threatening complications. The traditional treatment of inguinal hernia in patients with liver cirrhosis includes non-operative management; however, emerging data suggest elective surgical repair as a preferable approach. Therefore, we aimed to assess the outcomes of inguinal hernia repair in patients with liver cirrhosis and describe their clinical characteristics. In this retrospective study, we included a total of 28 consecutive patients with liver cirrhosis who underwent inguinal hernia repair between March 2000 and May 2019 at the First People's Hospital of Xiaoshan, Hangzhou, China. We also reviewed the literature on inguinal hernia repair in patients with liver cirrhosis. Emergency surgery for complicated hernia was performed in 17.9% of the study patients. Two patients developed major complications including wound hematoma in 1, who required reoperation, and gastrointestinal tract hemorrhage in the other patient, who required blood transfusion. Further, minor complications developed in 6 patients, including wound seroma in 1 and scrotal swelling in 5. Emergency hernia repair was found to be associated with a higher complication rate than elective surgery in patients with liver cirrhosis. Elective surgery for inguinal hernia repair in patients with liver cirrhosis appears to be successful and might be associated with a lower complication rate than emergency surgery. Inguinal hernia repair is recommended for patients with liver cirrhosis to prevent the development of life-threatening complications.

Inguinal hernia repair in patients with liver cirrhosis: Lichtenstein repair versus laparoscopic total extra-peritoneal approach

Background: The optimal surgical approach of inguinal hernia in patients with liver cirrhosis; laparoscopic or open; is still undefined. Whether laparoscopic inguinal hernia repair is safe and potentially affords superior outcomes in patients with liver disease is unknown. Aim of this study is to assess the outcomes of laparoscopic inguinal hernia repair compared to open procedures regarding postoperative complications and recurrence rate in patients with liver cirrhosis.Methods: This study involves data of ninety patients with primary unilateral inguinal hernia and liver cirrhosis. 48 of them had Lichtenstein repair and 42 patients had laparoscopic inguinal hernia repair with the total extra-peritoneal (TEP) approach.Results: The mean operation time was greater for the patients operated by TEP than that by Lichtenstein repair with a statistically significant difference (p=0.02). Wound infection, scrotal edema and hospital stay were greater for the patients operated by Lichtenstein repair (p=0.0001 for all). At a mean follow-up of 16.9 months (range: 2 –32 months); recurrence of hernia developed in 3 (3.1 %) with Lichtenstein repair but no recurrence of hernia occurred in the patients operated with TEP.Conclusions: Elective Laparoscopic inguinal hernia repair is feasible option in liver cirrhosis patients. However; despite of some better outcomes with TEP; there is insufficient evidence to conclude its greater effectiveness than Lichtenstein repair.

Transabdominal preperitoneal repair using barbed sutures for bilateral inguinal hernia in liver cirrhosis with ascites

The appropriate surgical treatment for inguinal hernia in patients with liver cirrhosis and ascites remains controversial. A 79-year-old male undergoing treatment for Child–Pugh B hepatitis C-induced liver cirrhosis and hepatocellular carcinoma complicated with bilateral inguinal hernia underwent transabdominal preperitoneal (TAPP) repair. During surgery, barbed sutures were used to facilitate appropriate peritoneal closure. His postoperative course was uneventful. Information on TAPP repair for inguinal hernia in patients with liver cirrhosis and ascites is limited. The International Guidelines for Inguinal Hernia Management recommend Lichtenstein repair for patients with ascites. TAPP repair requires peritonectomy via a posterior endoscopic approach; therefore, proper peritoneal closure is important to prevent the leakage of ascitic fluid. Herein, TAPP repair was safely and successfully completed using barbed sutures to achieve proper and strong peritoneal closure. TAPP repair using barbed sutures can be an effective treatment option for patients with liver cirrhosis and ascites.

Characteristics of Inguinal Hernias in Patients Aged 80 Years or Older and Treatment Strategy

高齢者鼠径部ヘルニアの特徴と治療方針に関して検討した．［方法］鼠径部ヘルニア873例を80歳以上の高齢群167例と80歳未満の非高齢群706例に分け，さらに高齢群のうち腸切除3例を除く164例を腹腔鏡手術（以下，TAPP）88例と鼠径部切開法76例に分け，臨床的特徴と手術成績を比較検討した．［結果］高齢群ではASA-PS分類のASA IIIが42％，嵌頓例が13％と高リスク例や嵌頓例が多かった．高齢群のTAPPでは鎮痛剤投与回数は0.4±0.7回，術後在院日数は3.0±2.3日と鼠径部切開法の1.4±1.2回と4.1±4.1日に比し低値であった．また，高齢者におけるTAPPの適応をASA III以下として経年的に手術適応を拡大したところ，重篤な合併症はなく安全に施行可能であった．［結語］高齢者鼠径部ヘルニアにおいて，ASA III以下で全身麻酔が可能であればTAPPは有用な選択肢である．

Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature.

Background:Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature.Methods:A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were (‘laparoscopic’ OR ‘laparoscopy’) AND (‘inguinal’ OR ‘groin’ OR ‘hernia’) AND ‘prostatectomy’.Results:The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85–4.97), conversion to open surgery (RR 3.91; 95% CI 0.85–18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39–4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05–18.64), due to an injury of the inferior epigastric vessels.Conclusions:Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.

Comparative study of local versus spinal anaesthesia in long standing open inguinal hernia in patients of south Karnataka

Comparative study of local versus spinal anaesthesia in long standing open inguinal hernia in patients of south Karnataka

Radiologic Reporting and Interpretation of Occult Inguinal Hernia

Inguinal hernias are common entities. Occult inguinal hernias are difficult to diagnose on examination and can cause groin and pelvic pain. Imaging is heavily relied on to help diagnose these hernias; as such, correct interpretation of imaging studies can prevent delay in treatment for a patient with pain. We evaluated the accuracy and reliability of radiologic reports for detection of occult inguinal hernias in patients with groin and pelvic pain. All CT and MRI studies ordered for groin or pelvic pain during a 5-year period were analyzed. Studies were included if the original radiologic reports were available for review, and if the patient underwent operative exploration. A blinded radiologist was asked to "over-read" the images. Operative findings were considered the gold standard with which radiologic reports were compared. Of 322 CT and MRI studies, 125 groins met criteria. Original radiologic reports were 35% accurate, with 97% positive predictive value (PPV) and 13% negative predictive value (NPV). Over-read radiologist reports were significantly different (p < 0.0001), with 79% accuracy, 97% PPV, and 30% NPV. Most radiologic reports issued for CT and MRI studies were incorrect for evaluation of occult inguinal hernia. Over-read radiologist reports were more than twice as accurate when evaluating the same images. The physician who is relying on radiologic reports to determine plan of care for a patient with groin or pelvic pain should inquire further into any negative study, especially if there is strong clinical suspicion for inguinal hernia.

Circulating matrix metalloproteinases and procollagen propeptides in inguinal hernia.

Degradation of collagen has been suggested involved in the pathogenesis of inguinal hernia. In this study, we aim to evaluate circulating biomarkers of procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propeptide (PIIINP), matrix metalloproteinases (MMP)-2, MMP-9, copper and zinc in primary and recurrent inguinal hernia patients. This study included 110 inguinal hernia patients: 45 patients had primary indirect inguinal hernia, 40 patients had primary direct inguinal hernia, 15 patients had recurrent indirect inguinal hernia and 10 patients had recurrent direct inguinal hernia. Additional 45 patients operated for reasons other than hernia were included as a control group. All blood samples were obtained preoperatively. Circulating PINP, PIIINP, MMP-2 and MMP-9 were investigated using enzyme-linked immunoabsorbent assay (ELISA) methods, and copper and zinc were measured using an air acetylene flame atomic absorption spectrometer. Serum MMP-2 levels in patients with direct and recurrent inguinal hernias were significantly higher than controls. The ratios of PINP/PIIINP decreased more apparent in recurrent indirect or direct inguinal hernia group than primary indirect or direct inguinal hernia group. Based on receiver operating characteristic curve analysis, PINP/PIIINP can effectively diagnose recurrent inguinal hernia from primary inguinal hernia with area under the curve (AUC) of 0.919 for recurrent indirect inguinal hernia and 0.808 for recurrent direct inguinal hernia, respectively. The ratio of serum PINP/PIIINP was lower in patients with recurrent inguinal hernia, demonstrating more serious damage of collagen metabolism in these patients. Serologic ratio of PINP/PIIINP may be used to identify the presence of recurrent inguinal hernia in patients.

The cumulative incidence and risk factors of postoperative inguinal hernia in patients undergoing radical prostatectomy

The aim of this study is to investigate the cumulative incidence and risk factors of postoperative inguinal hernia (PIH) in patients undergoing radical prostatectomy, i.e., laparoscopic prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RARP). This study included 1124 patients who had undergone radical prostatectomy or transurethral resection of bladder tumor from 2011-2016. We compared the cumulative incidence of PIH in the radical prostatectomy groups (460; LRP 341, RARP 119) and the control group (664; transurethral resection of bladder tumor), and we then analyzed the risk factors (age, operative methods, previous abdominal operative history, thickness and width of external oblique muscle and rectus muscle, thickness of abdominal subcutaneous fat layer at Hesselbach's triangle level, body mass index, prostate-specific antigen, operative time, specimen weight, Gleason score, and pathology T-stage) of PIH in the radical prostatectomy groups. The median follow-up period in this study was 39.6months. In Kaplan-Meier curve analysis, the cumulative incidence of PIH was 5.3, 4.2, and 0.5% for the LRP, RARP, and control groups, respectively (p<0.001). Multiple logistic regressions showed that thickness of external oblique muscle and width of rectus muscle were significant risk factors (p<0.001 and p=0.027). PIH is considered to be one of the complications of LRP and RARP. Moreover, we suggest that if the thickness of the muscle is <7.3mm, thoughtful surgical manipulation is needed for radical prostatectomy, and care should be taken to determine whether hernia occurs during follow-up.

For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed.

ObjectiveData on the prevalence of patent processus vaginalis (PPV) and hernia in patients with cryptorchidism are controversial. While some pediatric surgeons do not dissect the processus vaginalis (PV), most prefer to do so to prevent hernia formation and to achieve an effective orchiopexy outcome. This study was performed to evaluate the importance of dissection and high ligation of the PV during treatment of undescended testis (UT).MethodsThe clinical findings and surgical procedures of 55 patients with UT were retrospectively investigated.ResultsThe mean patient age was 2.5 (range 1.0–12.0) years. Non-palpable testis (NPT) was located on the right and left side in 39 and 16 patients, respectively. Ultrasonography revealed no testis in 10 patients and an atrophic testis in 7 patients. Seven patients had a parent with an inguinal hernia, and the silk sign or a PPV was detected during inguinoscrotal examination in 22 patients. Undescended testis repair was performed by an inguinal approach in all patients. The inguinal canal was opened in all patients; 42 patients had a wider-than-normal internal ring (>2.5 cm), and the posterior wall of the inguinal canal was consequently weakened. Two-stage orchiopexy was performed in 2 patients, and 15 underwent the Prentiss maneuver. In the remaining patients, the dissection was easily done, and the orchiopexy was performed without any difficulty. Scrotal edema and wound infection occurred in five and two patients, respectively. One patient presented with an atrophic testis, and three had recurrent UT. Inguinal hernia was not observed in any of the patients during the study period, and all procedures were performed on an outpatient basis.ConclusionHigh ligation of the PV is an effective method for successful orchiopexy and prevention of inguinal hernia in patients with NPT and UT.

Prevention Technique of Postoperative Inguinal Hernia in Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer.

To prevent inguinal hernia after retropubic radical prostatectomy, many urologists have utilized a prevention technique of inguinal hernia at the same time as retropubic radical prostatectomy. Here, we report the clinical benefit of the prevention technique of inguinal hernia as well as risk factors for the incidence of inguinal hernia. We investigated the medical records of 223 men who underwent retropubic radical prostatectomy for clinically localized prostate cancer between January 2007 and March 2013 at our medical center. We assessed the association between the postoperative inguinal hernia and variables such as age, body mass index, and previous abdominalsurgery. Inguinal hernia-free survival was analyzed to verify risk factors of postoperative inguinal hernia. Of 223 patients, 67 (30%) received prevention of inguinal hernia and 156 (70%) did not. The median follow-up period after retropubic radical prostatectomy was 36months (range, 3-58months). Thirty one (14%) patients developed unilateral or bilateral inguinal hernia after retropubic radical prostatectomy. The rate of postoperative inguinal hernia in prevented and non-prevented group was 3% (2 of 67) and 19% (29 of 156), respectively (P<0.01, Mann-Whitney U test). Moreover, postoperative inguinal hernia-free survival in the prevention group was significantly longer than that in the non-prevented group (P<0.01, log-rank test). In the prevention group, 1-, 2-, and 3-year inguinal hernia-free survival rates were 100%, 96%, and 96%, respectively. Other clinical factors including age, body mass index, previous abdominal surgery, and previous inguinal hernia were not associated with the incidence of inguinal hernia in our cohort. The prevention technique was simple and safe to perform, and it could increase inguinal hernia-free survival rates after retropubic radical prostatectomy.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jun 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.03.071AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : The accuracy of references in The Journal of Urology®. J Urol2016; 195: 1952. Abstract, Google Scholar 2 : Safety and efficacy of ureteral stent placement at the bedside using local anesthesia. J Urol2016; 195: 1886. Abstract, Google Scholar 3 : Validation of a genomic classifier for predicting post-prostatectomy recurrence in a community based health care setting. J Urol2016; 195: 1748. Link, Google Scholar 4 : Laparoscopic nephrectomy as outpatient surgery. J Urol2016; 195: 1671. Link, Google Scholar 5 : Preoperative International Prostate Symptom Score predictive of inguinal hernia in patients undergoing robotic prostatectomy. J Urol2016; 195: 1744. Link, Google Scholar 6 : Standardizing the definition of biochemical recurrence after radical prostatectomy—what prostate specific antigen cut point best predicts a durable increase and subsequent systemic progression?. J Urol2016; 195: 1754. Link, Google Scholar 7 : More favorable pathological outcomes in men with low risk prostate cancer diagnosed on repeat versus initial transrectal ultrasound guided prostate biopsy. J Urol2016; 195: 1767. Abstract, Google Scholar 8 : Critical analysis of early recurrence after laparoscopic radical cystectomy in a large cohort by the ESUT. J Urol2016; 195: 1710. Abstract, Google Scholar 9 : Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J Urol2016; 195: 1848. Abstract, Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 6June 2016Page: 1633-1635 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative International Prostate Symptom Score Predictive of Inguinal Hernia in Patients Undergoing Robotic Prostatectomy

Studies have shown that encountering an inguinal hernia during robotic radical prostatectomy is not uncommon. We reviewed our experience with simultaneous robotic prostatectomy and mesh hernia repair to identify variables predictive of a hernia. Our cohort consisted of 693 consecutive men who underwent robotic radical prostatectomy as performed by 1 surgeon. Hernias were repaired with mesh composed of equal parts of absorbable polyglecaprone-25 and nonabsorbable polypropylene monofilament. Preoperative variables potentially predictive of an inguinal hernia were evaluated. Inguinal hernias were encountered in 55 of 639 patients (8.6%), of which 22.3% were bilateral for a total of 68 hernia sides. Only 26 of 55 hernias (47.2%) were evident preoperatively. Men with a preoperative I-PSS (International Prostate Symptom Score) of 15 or greater had a 22.4% chance (30 of 134) of requiring a hernia repair compared with 5% in those without such a score (OR5.54, 95% CI 3.13-9.81, p <0.0001). There were no differences between the hernia and nonhernia groups in prostate size, body mass index, age, blood loss, transfusions, operative time, length of stay or any Clavien grade II-V complication. In 47 patients there was 1 recurrence at a median followup of 27.9months. There were no cases of mesh associated pain or erosion. Independent of prostate size, men with preoperative lower urinary tract dysfunction were at 5 times the risk of a hernia at robotic radical prostatectomy (22.4% vs 5%). Given that half of the hernias were subclinical, patients with an I-PSS of 15 or greater should be counseled about the potential need for hernia repair at robotic radical prostatectomy.

Impact of pelvic osteotomy on the incidence of inguinal hernias in classic bladder exstrophy

Background/purposeThe high prevalence of inguinal hernias in the bladder exstrophy population is well documented. The authors' aim is to determine whether pelvic osteotomy reduces the incidence of primary and recurrent inguinal hernias in patients with classic bladder exstrophy. MethodsUsing an institutionally-approved database, patients who underwent immediate or delayed primary bladder closure between 1974 and 2012 were identified and stratified by the use of pelvic osteotomy at the time of closure. Data were analyzed using Fisher's exact test and multivariate logistic regression analysis. ResultsOne hundred thirty-six patients were identified with a median follow up of 8years. The incidence of inguinal hernias following closure was 25% in the osteotomy group versus 46% in the non-osteotomy group (p=0.017). Osteotomy was associated with a significant decrease in recurrence of inguinal hernias amongst patients who underwent previous repair (17% versus 47%, osteotomy versus non-osteotomy, p=0.027) and the development of primary inguinal hernias in whom initial groin exploration was negative (20% versus 39%, p=0.029). Osteotomy and female sex were associated with a decreased rate of inguinal hernia development after bladder closure while age at closure was not. ConclusionsPelvic osteotomy at the time of exstrophy closure decreases the likelihood of primary or recurrent inguinal hernia development.

Laparoscopic Inguinal Hernia Repair by Intraperitoneal Onlay Mesh (IPOM) Technique in Specific Cases as an Alternative Method

Purpose: Despite advancements in surgery, laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia in patients with previous lower abdominal surgeries has been a burden to surgeons. This study was conducted in order to assess the feasibility of laparoscopic intraperitoneal onlay m esh (IPOM) hernia repair as an alternative method for these cases. Methods: From May 2006 to November 2010, 48 IPOM repairs were performed in 43 patients. All medical records were reviewed retrospectively. Results: Mean age of patients was 61 years old and male to female ratio was 37:6. Five were direct and 43 were indirect hernias. There were 15 recurrent inguinal hernias after either open or laparoscopic hernia repair, and five of 15 were recurrent cases more than two times. Mean operative time was 44.5 minutes, and mean postoperative hospital stay was 1.41 days. There were two cases of postoperative swelling at the groin area and two patients complained of pain that required oral pain-killers during out-patient follow-ups. Recurrence developed in one case. Conclusion: Even though laparoscopic IPOM repair is not a preferred m ethod for inguinal hernia, it can be applied as an alternative method in specific cases involving difficulties in approaching the usual plane of repair.

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy

We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair. Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group). All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups. Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.

Inguinal hernias in patients of 50 years and above. Pattern and outcome

to evaluate a one year experience with inguinal hernia repair, in patients of > 50 years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. a prospective descriptive study of patients (n=57) > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. the most representative age group was 61-70 years, and all patients were male. 52 (91.22%) patients had unilateral inguinal hernias, while five (8.77%) had bilateral hernias. In 50 (87.71%) patients, the hernia was uncomplicated, while seven (12.28%) patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71%) patients while seven (12.28%) patients were operated in emergency. Postoperatively, 50 (87.7%) patients had uneventful recovery, while seven (12.28%) patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA. A total of 18,331 men aged 65-76 years had ultrasound screening for AAA in the Central Region of Denmark from 2008 to 2010. The Danish National Patient Registry was interrogated, and screened men registered with an inguinal hernia from 1977 to 2011 were identified. The association between inguinal hernia and AAA was assessed by multiple logistic regression analysis. The prevalence of AAA was 3.3 per cent (601 of 18,331). A total of 2936 (16.0 per cent) of the 18,331 patients were registered with a diagnosis of inguinal hernia or hernia repair. Inguinal hernia was not associated with AAA: crude odds ratio (OR) 0.86 (95 per cent confidence interval 0.68 to 1.09) and adjusted OR 0.94 (0.75 to 1.20). In contrast to smaller patient-based studies, this large population-based study found no association between inguinal hernia and AAA.