Inguinal Hernia Mesh Research Articles

A prospective randomized comparison of testicular functions, sexual functions and quality of life following laparoscopic totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) inguinal hernia repairs.

There is very scant literature on the impact of inguinal hernia mesh repair on testicular functions and sexual functions following open and laparoscopic repair. The present randomized study compares TAPP and TEP repairs in terms of testicular functions, sexual functions, quality of life and chronic groin pain. This study was conducted from April 2012 to October 2014. A total of 160 patients with uncomplicated groin hernia were randomized to either trans-abdominal pre-peritoneal (TAPP) repair or totally extra-peritoneal (TEP) repair. Testicular functions were assessed by measuring testicular volume, testicular hormone levels preoperatively and at 3months postoperatively. Sexual functions were assessed using BMSFI, and quality of life was assessed using WHO-QOL BREF scale preoperatively and at 3 and 6months postoperatively. Chronic groin pain was evaluated using the VAS scale at 3months, 6months and at 1year. The median duration of follow-up was 13months (range 6-18months). The mean preoperative pain scores (p value 0.35) as well as the chronic groin pain were similar between TEP and TAPP repairs at 3months (p value 0.06) and 6months (p value 0.86). The testicular resistive index and testicular volume did not show any significant change at follow-up of 3months (p value 0.9) in the study population. No significant difference was observed in testicular resistive index and testicular volume when comparing TEP and TAPP groups at at follow-up of 3months (p value >0.05). There was a statistically significant improvement in the sexual drive score, erectile function and overall satisfaction over the follow-up period following laparoscopic inguinal hernia repair. However, sexual function improvement was similar in patients undergoing both TEP and TAPP repairs. All the domains of quality of life in the study population showed a significant improvement at a follow-up of 3 and 6months. Subgroup analysis of all the domains of quality of life in both TAPP and TEP groups showed a similar increment as in the study population (p value <0.001); however, the mean scores of all the domains were comparable between the two subgroups (p value >0.05), preoperatively and 3 and 6months follow-up. Laparoscopic groin hernia repair improves the testicular functions, sexual functions and quality of life, but TEP and TAPP repairs are comparable in terms of these long-term outcomes.

Positive Contrast MRI Techniques for Visualization of Iron-Loaded Hernia Mesh Implants in Patients.

ObjectIn MRI, implants and devices can be delineated via susceptibility artefacts. To discriminate susceptibility voids from proton-free structures, different positive contrast techniques were implemented. The purpose of this study was to evaluate a pulse sequence-based positive contrast technique (PCSI) and a post-processing susceptibility gradient mapping algorithm (SGM) for visualization of iron loaded mesh implants in patients.Material and MethodsFive patients with iron-loaded MR-visible inguinal hernia mesh implants were examined at 1.5 Tesla. A gradient echo sequence (GRE; parameters: TR: 8.3ms; TE: 4.3ms; NSA:2; FA:20°; FOV:350mm²) and a PCSI sequence (parameters: TR: 25ms; TE: 4.6ms; NSA:4; FA:20°; FOV:350mm²) with on-resonant proton suppression were performed. SGM maps were calculated using two algorithms. Image quality and mesh delineation were independently evaluated by three radiologists.ResultsOn GRE, the iron-loaded meshes generated distinct susceptibility-induced signal voids. PCSI exhibited susceptibility differences including the meshes as hyperintense signals. SGM exhibited susceptibility differences with positive contrast. Visually, the different algorithms presented no significant differences. Overall, the diagnostic value was rated best in GRE whereas PCSI and SGM were barely “sufficient”.ConclusionBoth “positive contrast” techniques depicted implanted meshes with hyperintense signal. SGM comes without additional acquisition time and can therefore be utilized in every patient.

A study about inguinal hernia mesh repairs: plug and patch versus lichtenstein mesh repair technique

Background: The study was conducted on 200 patients admitted with inguinal hernias, at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India. Methods: This study was conducted on the simple technique of mesh repair in inguinal hernia patients of type 1,2, and 3, according to Gilbert’s classification of groin hernias, in the form of randomized controlled trial of plug and patch versus Lichtenstein mesh repair technique in a group of randomly selected 100 cases of inguinal hernias each in relation to concurrent study of operating time, any intraoperative or postoperative complications, post-operative pain, length of hospital stay, recurrence rate and time taken to return to normal routine activities and work, under the regular follow up intervals of 1 week, 3 weeks and 6 month. Results: Most common in 4th decade especially in patients doing strenuous activity. Right indirect hernia was most common and between both the groups it was seen that post-operative stay was similar. Conclusions: Both the techniques, lichtenstein and plug and patch inguinal hernia repair, are equally good in terms of negligible intra-operative, post-operative complications and overall outcome with good patient compliance and satisfaction.

A randomised control study on neurosensory outcomes of ilioingunal neurectomy in Lichtenstein's hernia repair

Background: Chronic groin pain is a major cause of post-operative morbidity in open inguinal mesh hernia repair. Neurectomy is a well-established treatment modality. This study was performed to evaluate the neurosensory outcomes of prophylactic neurectomy in open mesh hernia repair. Aim: To assess the incidence of inguinodynia in patients undergoing open mesh hernia repair And to study, the neurosensory outcomes of sacrificing the ilioinguinal nerve in comparison to the group in which a nerve is identified and preserved. Materials and methods: A prospective double-blinded study was performed at Kasturba Medical College, Manipal from September 2008 to December 2009. The ilioinguinal nerve was either preserved or sacrificed according to the surgeon’s choosing. Pain and hyposthesia were studied at defined timed intervals by a single observer. Results: 105 inguinal hernia mesh repairs were enrolled into the study. Nerve excision was done in 44 patients and preserved in 61 patients. Ninety patients were followed till six months. At post-operative day 1, all patients in both the groups had pain and 15.2% had numbness. Chronic post surgical inguinodynia was seen in 16.7% of the population in the study group and numbness in 5.6% of the study population at six months. Conclusion: The severity of pain in the neurectomy group was less than the control group. There were no significant differences in the neurosensory outcomes of prophylactic ilioinguinal neurectomies in open mesh hernia repair compared to nerve preservation and hence prophylactic neurectomy is presently the choice of most surgeons.

Efficacy comparison of laparoscopic versus open tension-free hernia repair using biologic mesh for inguinal strangulated hernia

To compare the efficacy of laparoscopic versus open tension-free mesh repair using biologic mesh for inguinal strangulated hernia. Clinical data of 27 patients with inguinal strangulated hernia in the Shanxi Provincial People's Hospital between January 2012 and April 2014 were analyzed retrospectively. All the patients underwent one-stage tension-free repair using biological mesh, including laparoscopic(n=13) and open procedures(n=14). As compared with the open group, the laparoscopic group had shorter operative time [(90.8±11.6) min vs. (130.8±32.5) min, P<0.01], lower rates of hematoma/seroma and wound infection[(7.7% vs. 42.9%) and (0 vs. 28.6%) respectively, both P<0.05], faster recovery of bowel function [(2.5±0.3) d vs. (3.8±1.4) d, P<0.01], and shorter hospital stay [(6.3±1.8) d vs. (9.8±3.2) d, P<0.01]. The mean follow-up was 5.7 months (ranged from 2 to 12 months), and no recurrence or serious complications occurred. Laparoscopic tension-free hernia repair using biological mesh for inguinal strangulated hernia has significant advantage versus open operation.

Pilot study of unsupervised use of laparoscopic box trainers in a cohort of core surgical trainees

s / International Journal of Surgery 23 (2015) S15eS134 S17 open hernia repair G3 or control G4 (surgical text on open hernia repair). The outcomemeasures were cognitive knowledge and overall global rating assessed by a checklist interview. Results: No differences in the baseline characteristics in trainees randomised to G1, G3 or G4 with mean similar ages, naivety for procedure and pre-intervention multiple-choice questionnaire. G1 trainees achieved significantly higher cognitive analysis performance scores for step-by-step knowledge of an open inguinal hernia mesh repair comparedwith trainees in G3 (p < 0.05) and G4 (p < 0.05). A similar significant finding was found for the general performance scores compared with trainees in G3 (p < 0.05) and G4 (p < 0.05). Conclusion: The interactive simulator of the open hernia facilitates clear thought processes and improves surgical trainees' knowledge of the hernia procedure step-by-step compared to other more traditional ways methods. 0154: REVIEW OF SHAPE OF TRAINING (GREENAWAY) REPORT: THE WEST OF SCOTLAND SURGICAL TRAINEES' VIEWPOINT A. Di Carlo , G. Nicholson , J.R. McGregor . University of Glasgow, UK; West of Scotland Surgical Association, UK; University Hospital

Robotic Excision of Migrated Inguinal Hernia Mesh into the Paravesical Space

Robotic Excision of Migrated Inguinal Hernia Mesh into the Paravesical Space

Postoperative analgesia after low-frequency electroacupuncture as adjunctive treatment in inguinal hernia surgery with abdominal wall mesh reconstruction.

To determine whether an electroacupuncture (EA) technique that was developed for a surgical population under general anaesthesia reduces pain after mesh inguinal hernia open repair. A total of 54 patients with right or left inguinal hernia were randomised to group I (preoperative, intraoperative, postoperative EA), group II (preoperative, postoperative EA), or a sham control group (group III; preoperative and postoperative placement of needles, but without skin penetration). The Visual Analogue Scale (VAS) (primary outcome) and the State-Trait Anxiety Spielberger Inventory were evaluated preoperatively and at 30 min, 90 min, 10 h and 24 h after surgery. Pain threshold and tolerance were evaluated using an algometer at these same time points and preoperatively before and after EA. Levels of the stress hormones cortisol, corticotrophin and prolactin were determined at 30 min, 90 min and 10 h after surgery and preoperatively before and after EA. The results showed significant differences between the true EA and control groups. The true EA groups (I and II) showed statistically significantly greater improvements in the primary (VAS pain, p<0.05) and secondary outcome measures (Anxiety scale; algometer measurements, p<0.05 and stress hormones, p<0.01) compared to the control group. There were no statistically significant differences between groups I and II. Electroacupuncture reduces postoperative pain after mesh inguinal hernia repair and decreases stress hormone levels and anxiety during the postoperative period. ClinicalTrials.gov identifier NCT01722253.

Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair.

Some patients develop chronic groin pain after a Lichtenstein hernia repair. Previous studies have demonstrated beneficial effects of removal of entrapped inguinal nerves or a meshectomy in patients with chronic pain after open inguinal hernia mesh repair. Factors determining success following this remedial surgery are unknown. The aim of the study was to identify potential patient- or surgery-related factors predicting the surgical efficacy for inguinodynia following Lichtenstein repair. Consecutive adult patients with a history of persistent pain following Lichtenstein repair who underwent remedial surgery were analysed using univariate analysis. Significant confounders (p < 0.05) were combined in a multivariate logistic regression model using a backward stepwise regression method. A total of 136 groin pain operations were available for analysis. Factors contributing to success were removal of a meshoma (OR 4.66) or a neuroma (OR 5.60) and the use of spinal anaesthesia (OR 4.38). In contrast, female gender (OR 0.30) and preoperative opioid use (OR 0.38) were significantly associated with a less favourable outcome. Using a multivariate analysis model, surgery under spinal anaesthesia (OR 4.04), preoperative use of opioids (OR 0.37), and meshoma removal (OR 5.31) greatly determined surgical outcome. Pain reduction after remedial surgery for chronic groin pain after Lichtenstein repair is more successful if surgery is performed under spinal anaesthesia compared to general anaesthesia. Removal of a meshoma must be considered as success rates are optimized following these measures. Patients using opioids preoperatively have less favourable outcomes.

Inguinal hernia repair with Parietex ProGrip mesh causes minimal discomfort and allows early return to normal activities

BackgroundThe type of inguinal hernia repair used depends on many factors but predominantly the surgeon’s training, interpretation of the literature, and personal preference. This prospective cohort study describes a consecutive series of open mesh inguinal hernia repairs (modified Lichtenstein technique) performed as an outpatient procedure using 2 different mesh types. MethodsAnalysis was undertaken on 540 consecutive patients who underwent inguinal hernia repair between January 2007 and December 2012. Short-term outcomes were compared between those repaired with conventional polypropylene mesh and those with Parietex ProGrip mesh. ResultsMost patients were male (89%) and the mean age was 63 years. The median operative time was 50 minutes for unilateral hernias and 90 minutes for bilateral hernias. The use of Parietex ProGrip mesh reduced the operative time to 40 minutes for unilateral hernias (P < .01) and 75 minutes for bilateral hernias (P < .01). After unilateral hernia repair, 88% of the patients were discharged home within 4 hours of operation. There was no mortality and the overall complication rate was 7.4%. One patient developed a pulmonary embolus but the remainder of the complications were minor. Twenty-four hours postoperatively, 74% of the patients were either totally pain free or had minimal discomfort. At 4 weeks, 97% of the patients were either pain free or had minimal discomfort. Patients who underwent unilateral inguinal hernia repair with Parietex ProGrip mesh had the most rapid return to normal activities (10 vs 14 days, P < .04). ConclusionsOpen anterior inlay mesh repair is safe and results in minimal postoperative pain and early return to normal activities. ProGrip mesh resulted in a shorter operative time and more rapid return to normal activities compared with polypropylene mesh (10 vs 14 days).

Endoscopic and histological evaluations of a newly designed inguinal hernia mesh implant: Experimental studies on porcine animal model and human cadaver.

PurposeConventional prostheses used for inguinal hernia repair are static and passive. This feasibility-study shows the features of a new 3D tension-free prosthesis in an experimental model.MethodsThis study was divided into two-phases: 1) aimed to test the physics intrinsic features and the anatomical adaptability of a new 3D designed mesh, and 2) aimed to evaluate the inflammatory reaction associated with different materials used. On phase-1 implantations were performed in pigs. During the first trial phase, the prostheses were also implanted on human cadavers. On phase-2, implantation was carried out on large swine. Follow-up was of 60-days, after which the animals were anaesthetized for laparoscopic assessment, and for sample collection of mesh implantation site for histological analysis.ResultsAll animals showed good 3D mesh tolerance, and the follow-up period was uneventful. The laparoscopy showed no inflammatory lesions on the internal surface of the peritoneum. Macroscopic observation of implantation site revealed some local fibrosis and reorganization of tissue, no signs of infection, and no changes on original implant positioning. Histological analysis on phase-1 showed in most sample segments the deferent duct maintaining its central position and surrounded by vascular and nervous structures. On phase-2 differences in inflammatory lesion score could be found between subjects.ConclusionsThis new 3D mesh can be placed appropriately and from this preliminary animal study no untoward complications were noted over a 60 day period.

Testicular Infarction Post Inguinal Hernia Repair: Would a laparoscopic approach have helped reduce the risk?

Testicular infarction is a rare consequence of inguinal hernia repairs. Ischaemic orchitis leading to testicular atrophy occurs in 0.2-1.1% of all inguinal hernia repairs. This case report describes a 52 year old male patient who developed testicular infarction three days post-open inguinal hernia mesh repair. Commonly, ischaemic orchitis is caused by damage to the pampiniform plexus which leads to venous congestion and acute thrombosis. The risk factors for developing testicular ischaemia include large or recurrent hernias. It is thought that open approaches have a higher risk of causing ischaemic orchitis compared to the laparoscopic approach due to the need for greater manipulation of the spermatic cord. However, some studies suggest that both approaches do not reduce testicular perfusion post-operatively. Nevertheless, larger studies need to be conducted to evaluate this further and patients should always be informed about this risk regardless of its rarity.

A New Open Minimal Access Approach for Mesh Repair of Inguinal Hernia

Mesh repair of inguinal hernia by open surgery is traditionally done with an oblique inguinal incision of 4-5 cm and by opening the inguinal canal by incising external oblique aponeurosis. We are presenting a new technique for mesh repair of inguinal hernia with two mini incisions, one over the superficial, and another over deep inguinal ring and without incising the external oblique aponeurosis. Methods: The study group comprised of 104 males patients undergoing surgery for inguinal hernia during the period January 2010- January 2015. Data regarding patient demographics, type of anesthesia given, operation performed, and complications were recorded. The operation was carried out under spinal or epidural anesthesia. With a transverse incision of size 1-1.5 cm at the superficial inguinal ring, the cord structures were reached and lifted up with the finger,. By passing an artery forceps with the tip upwards under neath the external oblique aponeurosis, another incision of 1-1.5cm was made at the deep inguinal ring and the cord was lifted up by mobilizing. The indirect sac was dissected, ligated and mesh was sutured to the inguinal ligament by interrupted sutures and on the other side to conjoined tendon by retracting wound. The patients were followed up in the post-operative period. Results: There were 104 men with an age range of 20-64 years (mean35.6). On examination, 84 patients had indirect inguinal hernia and 20 patients had direct hernia. The incision size at superficial ring and deep rings measured at the end of the operation was1.4cm, (range1.2 -2cm).Through the incision at the deep inguinal ring, the indirect sac could be identified, transfixation, ligation and excision of sac was done without difficulty. The mesh could be easily passed underneath the external oblique, spread and sutured. 3- sutures could be applied by retracting the external oblique. No drain was required in any repair. The mean operation rime was 54 minutes (range50-62 minutes).There was no post-operative hematoma or scrotal edema in any of the patients.. During a mean follow-up period of 48 months (range 12-60 months,), there was no recurrence and one patient had chronic pain. Conclusion: Inguinal hernia mesh repair with two mini incisions, one over the superficial inguinal ring and one over the deep inguinal ring and without incising the external oblique aponeurosis gives adequate exposure to place the mesh and repair the hernia. Follow- up did not show any recurrence or or significant chronic pain.

Antisperm antibodies and testicular blood flow after inguinal hernia mesh repair.

Testicular flow studies after hernia mesh repair mostly showed different outcomes. The reason of infertility in some men after hernia repair is immunological factors. Aim of the study was to investigate the influence of mesh hernia repair on antisperm antibodies production and testicular blood flow and a connection among these parameters. A prospective interventional longitudinal cohort study was made on 82 male patients without exclusion criteria who had an inguinal hernia. Patients underwent laparoscopic TAPP or open tension-free hernia repair. Vascular ultrasound and antisperm antibodies were measured in the preoperative and postoperative periods. Main outcome measures were resistive index (RI), peak systolic velocity (PSV) cm/s, and end-diastolic velocity (EDV) cm/s in testicular blood flow measurement and the quantitative value of antisperm antibodies (ASA) in serum (IU/ml). ASA significantly increased postoperatively only in patients who underwent open tension-free hernia repair (p < 0.001). ASA stayed in normal range in all patients except the one with postoperative complication. Friedman analysis showed significant change of the RI only on intratesticular (p < 0.001) and capsular artery level (0.02) in patients who underwent laparoscopic technique. PSV significantly changed on intratesticular (p < 0.001) and capsular artery level (p = 0.015) in the laparoscopic hernia repair. PSV showed significant change on intratesticular (p < 0.001) and testicular artery levels (p < 0.001) in the open tension-free hernia repair. EDV showed significant change only on testicular artery level (p = 0.032) in the patients who had open tension-free hernia repair. These blood flow parameters significantly increased in the early postoperative period and returned on basal value in the late postoperative period. Parameters of flow did not show any significant correlation with ASA. Mesh hernia repairs without complication caused only a transitory change in testicular blood flow and no clinical significant autoimmune reaction.

Feasibility and outcomes regarding open and laparoscopic radical prostatectomy in patients with previous synthetic mesh inguinal hernia repair: meta-analysis and systematic review of 7,497 patients.

The purpose of this article is to contribute information to the interpretation of the feasibility and outcomes regarding open, laparoscopic and robotic strategies of radical prostatectomy in patients with previous synthetic mesh inguinal hernia repair. A bibliographic search covering the period from January 1980 to September 2012 was conducted in PubMed, MEDLINE and EMBASE. Database searches yielded 28 references. This analysis is based on the eleven studies that fulfilled the predefined criteria. A total of 7,497 patients were included. In the study group, there were 462 patients. The surgical prostatectomy techniques were open in five studies, laparoscopic in three and robotic in the remaining three. The control group consisted in 7,035 patients. The comparison of the open procedure performed in patients with a previous mesh herniorrhaphy and controls shows that the number of lymph nodes removed resulted significantly lower and hospital stay with catheterization time results statistically longer. The comparison of the laparoscopic procedure does not evidence a statistically significant difference in terms of blood loss, operative time and catheterization time, while the comparison with the robotic group could not be performed for the lack of data. All patients need an adequate informed consent regarding the multitude of aspects which may be influenced by the mesh such as the possibility of hernia recurrence, mesh infection, need for mesh explantation, possibility of mesh erosion into the bowel or bladder, bladder neck contractures or postoperative urinary incontinence and a compromised nodal staging.

Comparative study between Laparoscopic Trasabdominal Preperitoneal (TAPP) inguinal hernia repair and open mesh repair in Medical city.

Background: Inguinal hernias are a common medical problem that can significantly decrease the quality of life.Repair of inguinal hernia is one of the commonest surgical procedures worldwide irrespective of the country, race, or socioeconomic state. The inguinal hernia repair has been a controversial area in surgical practice from the time it has been conceived. Laparoscopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition.Objectives: To compare the outcome of laparoscopic versus open inguinal hernia mesh repair in terms of operative time , analgesics requirement , postoperative complication , hospital stay and return to daily activities and work.Patients and methods: A prospective study of 80 patients with inguinal hernia repair, carried out during the period from January 2010 till January 2013, Baghdad Teaching Hospital\Medical City, Iraq, to compare the effectiveness and safety of laparoscopic and conventional open mesh techniques. Those patients were divided into 2 groups (each group of 40 patients); 1st group treated by laparoscopic (TAPP) repair and the 2nd one by open technique (mesh repair).Results: The mean operating time in laparoscopic repair was 55 minutes (45-120) while in open repair it was 38 minutes (30-110) .The laparoscopic repair was superior to open repair in regard to ; less analgesic requirement post operatively , short hospital stay , and faster return to daily activities and workThere was no statistically significant difference between the two groups regarding complications.Conclusion: Laparoscopic hernia repair is equally safe and can provide less postoperative morbidity in experienced hands Therefore laparoscopic hernia repair can be safely recommended for most cases of inguinal hernia unless laparoscopy itself is contraindicated.

Comparison of inguinal hernia repair under local anesthesia versus spinal anesthesia.

Background. Inguinal hernia is one of the most common diseases in the males. Treatment of this pathology is exclusively surgical . While in the past hernia surgery was carried out mainly under general and spinal anesthesia, in recent years there has been growing emphasis on the role of local anesthesia. Local anesthesia for inguinal hernia repair is cost-effective, but fear of intra-operative pain may hinder its widespread use. Objectives.To evaluate the safety and effectiveness of inguinal hernia repair under local anaesthesia. To compare the inguinal hernia repair under local anaesthesia versus spinal anaesthesia in relation with post operative pain, complications and hospital stay. Material and Methods; This prospective study comprised of 50 cases of inguinal hernia which were randomly divided into two groups of 25 each named group A and group B. Inguinal hernia mesh repair was done under local anaesthesia in group A and under spinal anaesthesia in group B. All the parameters were recorded intra and postoperatively in both groups. Data was compiled and subjected to statistical analysis by using paired student t test. conclusion: Tension-free mesh repair under local anaesthesia is simple, safe, cost effective, very low rates of complications and a speedy discharge.

A Comparative Study of Cost effectiveness of Net Mesh Vs Proline Mesh Inguinal Hernia Repair - An Experience at Rural Area of U.P.

A Comparative Study of Cost effectiveness of Net Mesh Vs Proline Mesh Inguinal Hernia Repair - An Experience at Rural Area of U.P.

Percutaneous suprapubic tube bladder drainage after robot‐assisted radical prostatectomy: a step‐by‐step guide

To describe our technique of maintaining bladder drainage after robot-assisted radical prostatectomy (RARP) using a percutaneous suprapubic tube (PST) in place of a urethral catheter. A watertight anastomosis permits placement of the PST. Contraindications include morbid obesity, concomitant inguinal hernia mesh repair, anticoagulation therapy, limited hand dexterity in the patient, bladder neck reconstruction and extensive adhesiolysis at RARP. The necessary equipment includes a 14-F PST balloon catheter set, a three-way connector, a connecting tube, a suture passer, 1/0 polypropylene sutures on a CT1 needle, a sterile plastic button, adhesive and steri-strips. The important steps for PST placement are: Step 1: robot-assisted placement of a bladder wall anchor suture; Step 2: transferring the bladder wall suture to anterior abdominal skin; Step 3: guided placement of the PST under robotic vision; Step 4: securing the PST within the bladder and abdominal wall; Step 5. postoperative care: clamping the PST on postoperative day 5, recording each void and post-void residual urine volumes in a patient diary, removal of the PST on postoperative day 7 after 48 h of voiding with residual urine <100 mL per void. We provide a concise step-by-step guide for placement of a PST during RARP as well as important management aspects for the successful adoption of this technique.

INGUINAL HERNIA;

Objective: To find out the frequency of recurrence in inguinal hernia mesh repair in Surgical Unit, Khalifa GulnawazTeaching Hospital Bannu / DHQ, Bannu. Material &amp; Methods: 60 consecutive cases of inguinal hernia (direct/ indirect) of either side, inthis study were repaired by Lichtenstein's repair. The study was conducted from January, 2010 to October, 2010 with an initial follow up ofone year. Cases above 76 yrs were excluded from the study. Conclusions: The procedure of choice for inguinal hernia repair is tensionfree mesh repair.