Inguinal Hernia Repair In Patients Research Articles

Sensory assessment of intramuscular quadratus lumborum block at the L2 level in open inguinal hernia repair patients

BackgroundThe effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level.MethodsTwenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery.ResultsAll 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery.ConclusionQuadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations.Chinese clinical trial registryJune 2, 2018; ChiCTR1800016457.

Inguinal hernia repair in patients with artificial urinary sphincter after radical prostatectomy.

Stress urinary incontinence (UI) often develops after radical prostatectomy for prostate cancer, and in those patients with moderate-to-severe stress UI an artificial urinary sphincter (AUS) is implanted. Inguinal hernias (IHs) often occur after radical prostatectomy. As the prevalence of AUS implantation increases, it is possible to encounter patients with IHs undergoing AUS implantation (IHA). This study investigated our treatment and discussed an appropriate approach for IHAs. We retrospectively investigated patients who underwent IH repair with AUS implantation at our hospital from January 2018 to March 2023. We classified IHAs into Types A-D based on the positions of the IHs and AUS devices (the positions of the control pump, pressure-regulating balloon, and connecting tube). The hernia and control pump were ipsilateral in Types A and B, whereas the hernia and pressure-regulating balloon were ipsilateral in Types A and C. This study included 12 IHs of 11 patients. The median patient age was 77years. We conducted open repair in nine patients with all types and laparoscopic repair in two patients with Type B. The median operation times for unilateral and bilateral repairs were 96 and 182min, respectively. There were no complications with AUS or hernia surgeries. IHA has its own characteristics, and multidisciplinary knowledge thereof will help surgeons safely perform IH surgery.

Non-mesh inguinal hernia repair with early resumption of peritoneal dialysis in patients on continuous ambulatory peritoneal dialysis.

Inguinal hernia is a common complication of peritoneal dialysis (PD). Although tension-free mesh repair is a leading option for inguinal hernia repair, concerns over serious mesh-related complications may indicate a role for non-mesh inguinal hernia repair. In addition, there is no consensus on the perioperative dialysis regimen. Early resumption of PD may avoid the additional risks associated with hemodialysis. We report on the outcomes of non-mesh inguinal hernia repair in patients on continuous ambulatory PD (CAPD) and provide a perioperative dialysis protocol that aims to guide early resumption of PD. Between May 2019 and September 2023, thirty CAPD patients with 43 inguinal hernias who underwent non-mesh inguinal hernia repair were retrospectively analyzed. Data on the patient characteristics, perioperative dialysis regimen, perioperative features, complications, and hernia recurrence were collected and assessed. Thirty patients with a total of 43 inguinal hernia repairs were included in this study. The median age was 53years. 23 patients were male and 7 were female. Non-mesh inguinal repair was performed for all patients. PD was resumed at a median of 2days after the surgery. Five patients received interim hemodialysis. There were no postoperative surgical or uremic complications and no recurrence after a median follow-up of 31.5months. Our study demonstrates the effectiveness and safety of non-mesh repair with early resumption of PD in patients on CAPD. Interim HD is unnecessary in selected patients. Choosing the optimal perioperative dialysis regimen is essential to managing inguinal hernias in CAPD patients.

Female sex and ipsilateral reoperation risk following mesh-based inguinal hernia repair: a cohort study including 131,626 repairs in adults from an integrated healthcare system over a 10-year period.

We sought to compare females and males for the risk of reoperation following different inguinal hernia repair approaches (open, laparoscopic, and robotic). We conducted a retrospective cohort study including all patients aged ≥ 18 who underwent first inguinal hernia repair with mesh within a US integrated healthcare system (2010-2020). Data were obtained from the system's integrated electronic health record. Multiple Cox proportional-hazards regression was used to evaluate the association between sex and risk for ipsilateral reoperation during follow-up. Analysis was stratified by surgical approach (open, laparoscopic, and robotic). The study cohort was comprised of 110,805 patients who underwent 131,626 inguinal hernia repairs with mesh, 10,079 (7.7%) repairs were in females. After adjustment for confounders, females had a higher risk of reoperation than males following open groin hernia repair (hazard ratio [HR] = 1.98, 95% CI 1.74-2.25), but a lower reoperation risk following laparoscopic repair (HR = 0.70, 95% CI 0.51-0.97). The crude 5-year cumulative reoperation probability following robotic repair was 2.8% in males and no reoperations were observed for females. Of females who had a reoperation, 10.3% (39/378) were for a femoral hernia, while only 0.6% (18/3110) were for femoral hernias in males. In a large multi-center cohort of mesh-based inguinal hernia repair patients, we found a higher risk for reoperation in females after an open repair approach compared to males. Lower risk was observed for females through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.

Feasibility of totally extraperitoneal inguinal hernia repair in patients with previous prostatectomy.

Laparoscopic totally extraperitoneal inguinal hernia repair (TEP) surgery technique includes three key steps: reaching the preperitoneal space, reducing hernias, and placement of mesh. However, reaching the preperitoneal space can be complicated in patients with previous lower abdominal surgeries. This study aimed to assess the feasibility of laparoscopic inguinal TEP in patients with previous prostatectomies. Inguinal hernia patients who underwent laparoscopic TEP between January 2015 and February 2021 at Koç University Faculty of Medicine, Department of General Surgery, were included in this retrospective study. The operations were performed by five senior surgeons experienced in laparoscopy. Patients were divided into two study groups, as the radical prostatectomy (RP) group which included patients with previous prostatectomy non-RP which included patients without previous radical prostatectomy. Operative time (OT), length of hospital stay (LOS), and postoperative complications were compared within two groups. Three hundred and forty-nine patients underwent laparoscopic TEP, and 27 had previous prostatectomies. Among them, 190 patients had unilateral inguinal hernias, and 159 had bilateral inguinal hernias. Mean age of the patients in the non-RP and RP groups was 58.1 ± 14.7 and 73.9 ± 9.6 years, respectively. Only one (3.7%) case was complicated with urinary tract infection in the RP group, and 10 (3.1%) were complicated in the non-RP group. Complications for the non-RP group include hematomas in six cases, urinary tract infection in three cases, and urinary retention in one case. No significant difference in mean operative time was seen between non-RP and RP groups (p= 0.43). There was no significant difference in the means of the length of hospital stay between the two groups (p= 0.7). Laparoscopic TEP in patients with a previous prostatectomy can be performed safely without prolonging the operative time and increasing the length of hospital stay.

A Cross-Sectional Study to Detect the Findings of Hernial Repair Procedure in Iraqi Children

Background: One of the most prevalent conditions in children and young adults is an inguinal hernia. For full-term and preterm newborns, the estimated prevalence rates of inguinal hernia are 1-5% and 9-11%, correspondingly. Aim: This paper aims to analyse a cross-sectional study to detect the findings of hernial repair procedure in Iraqi children. Patients and methods: This paper was conducted in different hospitals in Iraq from 15th September 2021 to 17th December 2021 as a cross-sectional study to analyse cross-sectional study to detect the findings of hernia in Iraqi children. This study was contained 54 patients, which separate into two kinds of groups. Where the first group have included 27 patients who conduct open surgery, while the second group have 27 patients where present patients who did laparoscopic surgery. The databases collected were analysed and plotted by the SPSS program. Results and Discussion: In this study, we examine the results of two techniques for hernia repair in young girls and boys. The results showed that although laparoscopic surgery and open surgery had differently post-operative problems, open surgery required less time to complete an inguinal hernia repair in patients than laparoscopic surgery did. Conclusion: The results of our investigation generally showed that, despite the near proximity of the two repair procedures' preoperative and postoperative complications. However, herniotomy opening surgery took somewhat less time to complete than laparoscopic surgery when safety for hernia repair in children under the age of six was considered.

Determining the Minimum Clinically Important Difference for the European Hernia Society Quality of Life Instrument in Inguinal Hernia Repair Patients.

Patient-reported outcomes in clinical research allow for a more comprehensive and meaningful assessment of interventions but are subjective and difficult to interpret. European Registry for Abdominal Wall Hernias-Quality of Life (EuraHS-QoL) is a tool designed to assess perioperative quality of life for patients undergoing inguinal hernia repair, one of the most performed operations worldwide. Defining the minimum clinically important difference (MCID) for EuraHS-QoL tool can help standardize its interpretation for research purposes and facilitate improved shared decision making in clinical settings. A combination of 3 approaches for estimating MCIDs was used in this study. First, 2 distribution-based approaches were used that based estimates on statistical parameters of the data. The SEM provided a minimum value for the MCID, and one-half of the SD provided a point estimate of the MCID. Second, anchor-based approaches integrated patient perceptions of their overall well-being before and after surgery to provide benchmarks for the MCID. Last, iterative surveys of expert hernia surgeons were used to yield the final MCIDs for each domain and the composite EuraHS-QoL score. The overall range of EuraHS-QoL is 0 to 90, with subdomain ranges of 0 to 30 for the pain domain, 0 to 40 for the restriction of activities domain, and 0 to 20 for the cosmesis domain, with higher scores representing worse outcomes. The overall MCID for EuraHS-QoL is 10. Domain-specific MCIDs are 3 for the pain domain, 5 for the restriction of activities domain, and 2 for the cosmesis domain. In this study, we define overall and domain-specific MCIDs for the EuraHS-QoL instrument using statistical methods, patient-based methods, and clinical expertise, providing estimates that are both statistically and clinically significant.

V-010 ROBOTIC ASSISTED BILATERAL INGUINOSCROTAL HERNIA REPAIR: STEP BY STEP

Abstract Introduction Robotic surgery in the field of abdominal wall surgery is exponentially growing. In this video we will present a step by step robotic approach for bilateral inguinoscrotal hernia repair. Clinical case A 79 year-old male with history of hypercholesterolemia was diagnosed of bilateral inguinal hernia. On physical examination, a right inguinoscrotal hernia (EHS classification L3P) and left inguinal hernia (EHS classification M1P) were diagnosed. Minimally invasive surgery assisted by DaVinci Xi robot is decided. Under general anesthesia, a supraumbilical 8-mm trocar is located and 2 other trocars are positioned 8 cm laterally. Monopolar scissors and bipolar grasps are introduced. Laparoscopic examination confirmed the diagnosis. First, peritoneum is dissected, allowing to access to the preperitoneal space, dissecting the medial and lateral compartiment, reaching the pectineal ligament. Identification and reduction of the hernia sac is performed, individualizing and preserving the inguinal structures. Critical view of the miopectineal orifice is ensured. Contralateral procedure is performed. 15×15 cm Poplipropilene mesh are located at the preperitoneal space, fixated with 3/0 PDS stitches to the pectineal ligament. Fixation stitches are done at the superior section of the mesh. Peritoneal flaps are closed with V-lock suture. Conclusion Robotic surgery is a safe and feasible procedure for inguinal hernia repair in patients specially selected (BMI <30, bilateral hernias). Further studies are needed in order to clarify its role in the field of minimally invasive surgery.

Impact of nonmalignant ascites on outcomes of open inguinal hernia repair in the USA.

Studies on inguinal hernia repair in patients with ascites are limited, small, and inconsistent, exacerbating a challenging clinical dilemma for surgeons. To fill this gap in the literature, this retrospective cohort study used a national US database to examine the impact of ascites on the outcomes of open inguinal herniorrhaphy. Patients who underwent open inguinal herniorrhaphy between 2005 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Two groups were defined by the presence or absence of nonmalignant preoperative ascites. Ascites patients were propensity matched 1:10 with non-ascites patients. Surgical outcomes at 30days for the matched groups, stratified by electiveness of procedure, were compared, with the primary end points of mortality and the NSQIP composite outcome "serious complication". The study included 682 patients with ascites. Compared to matched controls, those with ascites had significantly increased odds of mortality (OR 3.3, 95% CI 1.5-7.0) after elective repair, but not after nonelective repair. Ascites was associated with increased odds of serious complication after both elective (OR 1.7, 1.2-2.3) and nonelective (OR 2.0, 1.3-3.0) surgery. Among ascites patients, age ≥ 65years was associated with increased mortality (risk-adjusted OR 3.8, 1.2-14.4) and serious complication (OR 2.2, 1.2-3.9). In this largest study to date on patients with ascites undergoing open inguinal herniorrhaphy, ascites increased the odds of mortality after elective repair and of serious complication after elective and nonelective repair. Age ≥ 65 was a risk factor for poor outcome. Inguinal herniorrhaphy is fraught with complications in this population.

No prostate? No problem: robotic inguinal hernia repair after prostatectomy.

Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1month. Mean follow-up time was 8.0months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.

Female Gender and Risk of Ipsilateral Reoperation After Inguinal Hernia Repair: A Cohort Study Including 131,626 Patients in An Integrated Healthcare System Over A 10-Year Period

Introduction: The objective of this study is to compare the male and female patients for the risk of reoperation after different repair approaches (open, laparoscopic, and robotic). Methods: We conducted a cohort study of patients ≥18 years who underwent first inguinal hernia repair within a US integrated healthcare system (2010-2020). Multiple Cox proportional-hazards regression was used to evaluate the association between gender and risk for ipsilateral reoperation during follow-up. Analysis stratified by surgical approach (open, laparoscopic, and robotic) with covariate adjustment for potential confounders. Results: The study cohort comprised 131,626 patients who underwent inguinal hernia repair, 10,079 (7.7%) were women. After adjustment for confounders, females had a higher risk of reoperation than males after open repair (hazard ratio [HR]=1.98, 95% CI =1.74-2.25, P < 0.001), but a lower reoperation risk after laparoscopic repair (HR=0.70, 95% CI=0.51-0.97, P = 0.031). The crude 5-year cumulative reoperation probability after robotic repair was 2.8% (95% CI=0.7-4.8) in men and no reoperations were observed for women during follow-up. 0.3% of reoperations in women were for a femoral hernia while only 0.6% were for femoral hernias in men. Conclusion: In a large multi-center cohort of inguinal hernia repair patients, we found a higher risk for reoperation in women after an open repair compared with men which may be due to missed diagnoses of ipsilateral femoral hernias. Lower risk was observed for women through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.

Regional block anesthesia for adult patients with inguinal hernia repair: A systematic review.

Background:Inguinal hernia repair (IHR) is a common surgical technique performed under regional block anesthesia (RBA). Although previous clinical trials have explored the effectiveness and safety of RBA for IHR, no systematic review has investigated its effectiveness and safety in adult patients with IHR.Methods:This systematic review searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, Wangfang, and VIP) from their inception to July 1, 2022. We included all potential randomized controlled trials that focused on the effects and safety of RBA in adult patients with IHR. Outcomes included operative time, total rescue analgesics, numerical rating scale at 24 hours, occurrence rate of nausea and vomiting, and occurrence rate of urinary retention (ORUCR).Results:Five randomized controlled trials, involving 347 patients with IHR, were included in this study. Meta-analysis results showed that no significant differences were identified on operative time (MD = −0.20; fixed 95% confidence interval [CI], −3.87, 3.47; P = .92; I² = 0%), total rescue analgesics (MD = −8.90; fixed 95% CI, −20.36, 2.56; P = .13; I² = 28%), and occurrence rate of nausea and vomiting (MD = 0.39; fixed 95% CI, 0.13, 1.16; P = .09; I² = 0%) between 2 types of anesthesias. However, significant differences were detected in the numerical rating scale at 24 hours (MD = −1.53; random 95% CI, −2.35, −0.71; P < .001; I² = 75%) and ORUCR (MD = 0.20; fixed 95% CI, 0.05, 0.80; P = .02; I² = 0%) between the 2 management groups.Conclusion:The results of this study demonstrated that IHR patients with RBA benefit more from post-surgery pain relief at 24h and a decrease in the ORUCR than those with CSA.

Safety of laparoscopic inguinal hernia repair in the setting of antithrombotic therapy.

There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT. We conducted a retrospective cohort study using the Vizient Clinical DataBase. We included adults receiving APT/ACT who underwent outpatient, elective, and primary inguinal hernia repair between 2017 and 2019. Subgroup analysis was performed on patients receiving aspirin, non-aspirin antiplatelet, and anticoagulant therapy. Mixed-effects logistic regression was used to assess both the effect of APT/ACT on the probability of receiving LIHR vs OIHR and their respective outcomes. A total of 142,052 repairs were included, of which 21,441 (15%) were performed on patients receiving APT/ACT. Mean age was 69years (± 10.5) and 93% were male. 19% of hernias were bilateral. 40% of operations were performed at teaching hospitals. On multivariable analysis, patients on non-aspirin antiplatelet or anticoagulant therapy were more likely to receive an open procedure (Odds Ratio (OR) = 1.2; 95% Confidence Intervals (CI) [1.1, 1.4] and OR = 1.4; CI [1.3, 1.5], respectively). LIHR was associated with a lower rate of length of stay > 1day (OR = 0.65; CI [0.5, 0.9]). Rates of 30-day postoperative hematoma, transfusions, stroke, myocardial infarction, deep venous thrombosis, pulmonary embolism, readmission, and emergency department visits were similar between the two operative approaches. Patients on APT/ACT represent a substantial proportion of those undergoing inguinal hernia repair. Non-aspirin antiplatelet or anticoagulant therapy are independent predictors of choosing an open repair. Laparoscopic repair appears to be safe in patients receiving APT/ACT under current perioperative management patterns.

Factors associated with bleeding complications in hernia repair of warfarin users.

In this retrospective study, we aimed to determine factors associated with bleeding complications in patients on long-term warfarin, undergoing inguinal hernia repair using low-molecular-weight heparin (LMWH) bridging. Two-year hospital records yielded 44 inguinal hernia repair patients on long-term warfarin (26 men, 4 women, aged 57.4 [38-72] years). All patients were managed with LMWH bridging. Patient and operative characteristics, LMWH bridging characteristics, and international normalized ratio (INR) values were compared between patients with and without postoperative bleeding complications. Indication for warfarin use was heart valve disease (n=15), atrial fibrillation (n=7), deep venous thrombosis (n=3), cerebrovascular event (n=3), and pulmonary embolism (n=2). Four of the operations were urgent, while the remaining were elective. There were four ecchymosis cases and three hematoma cases in a total of seven patients. Baseline (2.94±0.26 versus 2.16±0.38, p<0.001) and preoperative INR values (1.69±0.67 versus 1.31±0.35, p=0.027) were significantly higher, while postoperative INR values (1.04±0.09 versus 1.2±0.13, p=0.004) were significantly lower in patients having bleeding complications. Baseline, preoperative INR, and postoperative INR were the only variables associated with postoperative bleeding complications in patients undergoing LMWH-bridged inguinal hernia repair. We suggest close monitoring of INR levels in long-term warfarin users, even for relatively low-bleeding risk operations such as inguinal hernia repair.

Postoperative pain reduction by pre-emptive N-acetylcysteine: an exploratory randomized controlled clinical trial

BackgroundA new potential target for multimodal pain management is the group-II metabotropic glutamate receptor subtypes, which can be activated by N-acetylcysteine. We investigated whether pre-emptive administration of N-acetylcysteine leads to...

Opioid use after outpatient elective general surgery: quantifying the burden of persistent use.

Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids. This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined. Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135-225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons. Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.

The topical application of tranexamic acid to control bleeding in inguinal hernia surgery candidate patients: A randomized controlled trial

Background and objectivesInguinal hernia surgery is a common procedure, especially for the elderly, who usually use anticoagulants and antiplatelet drugs. In this study, we evaluated the effectiveness of tranexamic acid (TXA) on the complications of inguinal hernia repair in patients using antiplatelets. Patients and methodsThis study is a randomized controlled trial that was performed during the 2018–2019 years. Forty patients with inguinal hernia and antiplatelet use were enrolled randomly into the two groups. In the intervention group, the patients received two injectable form (500mg/5 mL) of TXA, totally 10 mL as a topical application at the surgical site, and then the patient's surgical site was seen every 8 h for 48 h, and the patient was examined daily for one week. ResultsThe mean length of hospitalization, seroma, hematoma and infection in the two groups were not statistically significant (P > 0.05). However, the duration of surgery in the TXA group was significantly shorter than in the control group (54.85 vs. 68.72 min) (P < 0.001). The mean bleeding during surgery was significantly lower in the TXA group than in the control group (P < 0.001). ConclusionThe findings of present study indicate that topical TXA has a high ability to control bleeding. As a result, TXA is beneficial in terms of reducing bleeding and increasing the surgeon's satisfaction. Therefore, it is recommended that TXA be prescribed for patients requiring inguinal hernia surgery with a high risk of bleeding.

Performing total extraperitoneal inguinal hernia repair in patients with previous abdominal surgery is safe: an analysis of 1591 patients

Abstract Objective The safety of endoscopic total extraperitoneal inguinal hernia repair (TEP) in patients who previously underwent open lower abdominal surgery has been discussed for many years, since operative difficulties can be expected due to adhesions and scarring. Some research has been done in this area, most of which ask for further studies to be conducted. The aim of this study was to assess the safety and feasibility of TEP in patients with previous lower abdominal surgery (PLAS). Methods We retrospectively analysed all patients who underwent a TEP inguinal hernia repair at our institution between July 2012 and May 2018. Previous lower abdominal surgery (PLAS) was defined as any previous open surgery with scarring below the umbilicus. In case of scars outside the midline, these were defined as PLAS when on the same side as the operated inguinal hernia. A univariate analysis as well as logistic regression were performed to identify outcomes of surgery between patients with- and without PLAS. Results In total 1591 patients were included in the study. 274 patients had PLAS, corresponding to 17.2%. Comparing to patients without PLAS, the group with PLAS had a significant higher risk of increased operation duration (odds ratio 1.07, p-value 0.004), but no increased risk of conversion, or intra- or postoperative complications. The highest significant risk of increasing operation duration was found after aortoiliac surgery (OR 2.08), bladder surgery (OR 1.71) or prostate surgery (odds ratio 1.22). Conclusion Performing TEP inguinal hernia repair after lower abdominal surgery slightly increases the operation duration, however there is no negative effect on the length of stay and the complication- or conversion rate. Therefore, we consider TEP to be a feasible and safe operation technique also for patients who previously underwent open lower abdominal surgery.

Loss of independence after emergency inguinal hernia repair in elderly patients: How aggressive should we be?

BackgroundLoss of independence (LOI) assesses patient quality of life after surgery and is associated with increased readmission and death. This paper compares LOI among the elderly who received elective versus emergent inguinal hernia repair. MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files from 2015 to 2017 were reviewed for inguinal hernia repairs in patients 70-years-old or older. Chi-square analysis, Student t-test, and backwards multivariate logistic analysis were performed appropriately. ResultsPatients undergoing elective open or laparoscopic repair were less likely to experience LOI (OR 0.061, CI 0.035–0.106) and (OR 0.052 CI 0.024–0.113), respectively, and they were less likely to experience mortality (OR 0.07, CI 0.026–0.185) and (OR 0.059, CI 0.015–0.229), respectively. ConclusionsSignificant debility occurs following emergency inguinal hernia repair in elderly patients. Elective surgery may be indicated more often in order to reduce emergencies and LOI in elderly patients.

Long-Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study.

Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision-making. This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18-100years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis. The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association. The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.