Inguinal Hernia Repair Research Articles

The missed diagnosis of femoral hernias in females undergoing inguinal hernia repair - A systematic review and proportional meta-analysis.

Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women. PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software. From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89). Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH.

Causes of chronic pain unrelated to surgical trauma after groin hernia repair: a prospective cohort study.

Chronic inguinal pain (CIP) can be caused by musculoskeletal or neurological pathologies and by surgical trauma after inguinal hernia repair among other. The aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair. During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were evaluated by surgeons and filled out preoperatively the Inguinal Pain Questionnaires and a Numerical Rating Scale pain-questionnaire. For patients undergoing inguinal hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on pain questionnaires were evaluated by phone and physical examination. 289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies. This cohort study found CIP unrelated to surgical trauma in 4.8% of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring inguinal pain on pain-questionnaires did not have chronic post-surgical pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to the surgical trauma.

Robotic minimally invasive inguinal hernia repair with the Dexter robotic system™: A prospective multicenter clinical investigation.

Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) has been established with various robotic platforms. The Dexter robotic system is an open platform consisting of a sterile surgeon's console, two robotic instrument arms, and one robotic endoscope arm. This study aimed to confirm the perioperative and early postoperative safety and clinical performance of the Dexter system in patients undergoing primary transperitoneal inguinal hernia repair. The primary objectives of this multicenter study conducted at three centers in France, Germany, and Switzerland were to document the successful completion of rTAPP procedures and the occurrence of serious adverse events (Clavien-Dindo grades III-V), device-related events up to 30days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems. 50 patients with a median age of 62.5years (IQR 51.0-72.0) and BMI of 25.1kg/cm2 (IQR 23.5-28.7), respectively,underwent inguinal hernia repair (33 unilateral, 17 bilateral). All surgeries were successfully completed using three standard laparoscopy trocars. There were no conversions to open surgery, intraoperative complications or device deficiencies. The median skin-to-skin operative time was 50min (IQR 45-60) for unilateral hernias and 96min (IQR 84-105) for bilateral hernias. The median console time was 30min (IQR 26-41) for unilateral and 66min (IQR 60-77) for bilateral hernias. Twenty-six patients were discharged on the day of surgery, and 22 on postoperative day 1. This study confirmed the use of the Dexter system in rTAPP was feasible and safe in multicenter cohorts, with operative times consistent with the literature on other robotic platforms. Our data demonstrated the accessibility of this new robotic approach, even when adopted by surgeons new to robotics. The Dexter system emerged as a valuable device in the hernia repair toolkit for both experienced robotic surgeons and those new to the field.

Laparoscopic transabdominal vs. totally extraperitoneal inguinal hernia repair: outcomes, healthcare utilization, and cost differences.

Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair.

Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database.

The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events. All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes. 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001). DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.

BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age &amp;gt; 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.

Post Operative Outcome of Desarda Technique Versus Lichtenstein Mesh Hernioplasty for Inguinal Hernia Repair

Background: Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations to some extents are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured because of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered. In the year 2001, Mohan P Desarda first described a physiological repair technique of inguinal hernia, which is practiced in many centers with significantly positive outcome. To evaluate the post-operative outcome of Desarda technique versus Lichtenstein mesh hernioplasty in inguinal hernia repair, this research has performed. Materials and methods: This Quasi experimental study was carried out in Surgery Department of Chittagong Medical College Hospital, during December 2017 to January 2019. A total of 100 patients with inguinal hernia underwent surgery were included in this study. Samples were selected by convenient technique. Among them 50 patients were selected for Desarda Technique was considered as group I and the rest 50 patients were selected for Lichtenstein Mesh Hernioplasty was considered as group II. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The proposed sample size was 50 in each group. The study group included male patient above 18 years of age undergoing Desarda Technique and Lichtenstein Mesh Hernioplasty for inguinal hernia repair. The mean age was 43.14±14.44 years in group I and 48.33±12.63 years in group II. Indirect hernia was found 37(74.0%) and 28(56.0%) in group I and group II respectively. The mean 3rd POD pain (NPRS) was 4.44±0.97 in group I and 5.52±0.71 in group II. The mean 10th POD pain Numeric Pain Rating Scale (NPRS) was 0.76±1.02 in group I and 2.62±1.21 in group II. The mean 1 month pain (NPRS) was 0.08±0.27 in group I and 0.72±0.7 in group II. The mean 3rd month pain (NPRS) was 0.02±0.14 in group I and 0.34±0.48 in group II. The mean 6th month pain (NPRS) was 0±0 in group I and 0.2±0.45 in group II. Pain (NPRS) was significantly (p&lt;0.05) higher in group II in 3rd POD and all subsequent follow-up. Seroma was found 5(10.0%) at 10th POD in group I and 5(10.0%) in group II. The difference was statistically not significant (p&gt;0.05) between two groups. Wound infection found 2(4.0%) in 3rd POD in group Iand 5(10.0%) in group II. Wound infection didn’t develop in subsequent follow-up in group I but in group II, 1(2.0%) found in 10th POD, 1(2.0%) in 1 month, 1(2.0%) in 3rd month, 1(2.0%) in 6th month. The difference was not significant (p&gt;0.05) between two groups. Recurrence was not observed in either group during this study period. Conclusion: Desarda technique of inguinal hernia repair in our set up is useful with comparable results to Lichtenstein hernioplasty. IAHS Medical Journal Vol 7(1), June 2024; 91-96

Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males.

Inguinal hernia repair, particularly using TAPP, is common in males, and acclaimed for minimal invasiveness but often complicated by seromas, significantly affecting recovery and health care costs. This retrospective study analyzed data from 266 male patients with unilateral indirect inguinal hernia who underwent transabdominal preperitoneal (TAPP) repair. We divided the patients into a training set (n = 188) and a validation set (n = 78). We employed logistic regression to identify independent risk factors for post-TAPP seroma and developed a nomogram to predict the occurrence of seromas. The model's accuracy was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, and decision curve analysis (DCA). Postoperatively, 20.3% of patients developed a seroma. Multivariate logistic regression analysis highlighted several independent risk factors for seroma formation: the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac (P < 0.05). The ROC curves for the training and validation sets demonstrated areas under the curve of 0.893 (95% CI: 0.845-0.942) and 0.864 (95% CI: 0.765-0.963), respectively, indicating good model fits (P > 0.05). DCA confirmed significant clinical applicability of the model. The findings suggest that the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac are significant independent risk factors for seroma formation after TAPP repair. Clinical consideration of these factors and proactive preventive measures are essential. Although many of these factors are non-modifiable, understanding them is crucial for preoperative risk assessment and patient management.

Inguinal hernia recurrence after laparoscopic mesh removal for chronic pain: a single-center experience with 11years of practice.

Up to 12% of patients undergoing minimally invasive inguinal hernia repair may develop chronic postoperative inguinal pain (CPIP), possibly explained by the presence of mesh. Recent studies reported that laparoscopic mesh removal is feasible and safe. However, the risk of a hernia recurrence is unknown. This observational study describes the rate of hernia recurrence and evolution in pain score following laparoscopic mesh removal for CPIP after preperitoneal inguinal hernia repair. Prospectively collected questionnaires and operative notes of consecutive patients undergoing a laparoscopic mesh removal for CPIP in our center of expertise between November 2011 and July 2022 were studied. Pain scores were quantified using the Numeric Pain Rating Scale (NRS, 0-10). The presence of a hernia recurrence was based on patient history and clinical findings. A total of 89 patients underwent laparoscopic mesh removal, and data of 83 patients (93% response rate) were available for analysis. Median decrease in pain score (NRS) after mesh removal was 4 (range + 2 to -9). After a median 4.3years follow up period, a hernia recurrence was present in 18 patients (21.7%). Of these, eight were symptomatic requiring correction using a Lichtenstein repair with a favorable outcome whereas a wait-and-see approach was successfully followed in the remaining 10 patients. Laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair resulted in an inguinal hernia recurrence in one of five patients requiring remedial surgery in one in ten patients. This knowledge may inform the preoperative counseling process.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Transrectus Extraperitoneal Versus Minimally Invasive Inguinal Hernia Repair: A Systematic Review and Meta-Analysis.

Purpose: Recent guidelines have recommended minimally invasive surgery (MIS) for unilateral inguinal hernia due to reduced chronic pain. The most performed approaches consist of posterior mesh placement by the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. However, it remains debatable whether the advantage of those techniques stems from the MIS approach or posterior mesh placement or both. As the transrectus preperitoneal (TREPP) technique is an open option for posterior mesh placement, we conducted a systematic review and meta-analysis comparing TREPP and MIS techniques for groin hernia repair. Material and Methods: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TREPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, cumulative surgical site occurrences (SSO), surgical site infection (SSI), and postoperative pain. Results: Twenty-nine studies were screened, and eight were thoroughly reviewed. Three studies were included, of which two compared TREPP with the TEP technique, and one compared TREPP with both TEP and TAPP techniques. We found lower SSI rates for the MIS approaches (0.61% versus 0.33%; risk ratios (RRs) 3.96; 95% confidence interval (CI): 1.04-15.16; P = .04). We did not find statistically significant differences regarding recurrence (2.42% versus 2.51%; RR 1.01; P = .98), postoperative pain (4.2% versus 6.4%; RR 0.61; P = .4), and SSO (4.2% versus 4.0%; RR 0.6; P = .43) between TREPP and MIS techniques. Conclusion: Our systematic review and meta-analysis found a lower SSI for the MIS repair but did not find differences regarding recurrence, SSO, and postoperative pain. More studies are required to provide a more accurate conclusion about this topic.

Evaluation of Surgical Results and Effectiveness of Laparoscopic Transabdominal Preperitoneal and Laparoscopic Totally Extraperitoneal Approaches in Bilateral Inguinal Hernia Repair: A Randomized Analysis.

Background: Laparoscopic surgery is recommended as the standard approach for bilateral inguinal hernia repair. There are few studies in the literature comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic total extraperitoneal (TEP) approaches for bilateral inguinal hernia repair. This study aimed to compare the surgical outcomes and effectiveness of laparoscopic TAPP and laparoscopic TEP methods applied in bilateral inguinal hernia repair. Methods: A total of 100 patients operated on for bilateral inguinal hernia by applying laparoscopic TAPP and laparoscopic TEP methods from January 2016 to March 2023 were included in the study. The patients were randomized equally in two groups. Postoperative follow-up results were statistically analyzed in terms of recurrence rate, swelling in the incisions, scrotal edema and swelling, suture dehiscence, and the average time to return to work. Results: In bilateral inguinal hernia patients operated with laparoscopic TAPP method compared with bilateral inguinal hernia patients operated with laparoscopic TEP method, postoperative recurrence rate was significantly lower (2% versus 16%), swelling in the incision sites was significantly less (4% versus 24%), and the average time to return to work was significantly shorter (3.6 ± 2.3 versus 6.3 ± 5.8) (P < .05). Scrotal edema and swelling and suture dehiscence results did not show significant differences between the two approaches (P > .05). Conclusions: Both methods are widely used in bilateral inguinal hernia repairs. Postoperative results revealed that the laparoscopic TAPP method with less postoperative recurrence rate and less swelling in the incision sites, and shorter average time of the patients to return to work appears to be superior to the laparoscopic TEP method.

Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants-A prospective evaluation of an alternative anesthesia technique.

Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery. A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1-2 mcg/kg over 10 min and maintenance of 0.2-3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia. Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively. Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.

Comparisons of 30-day outcomes after ventral hernia repair by body mass index and surgical approach: a retrospective cohort study.

Obesity is a known risk factor for postoperative complication after ventral or incisional hernia repair (VIHR). Whether minimally invasive techniques can mitigate this risk for certain patients remains unknown. This study investigates whether MIS approaches offer advantages in reducing any medical or surgical complication after VIHR across clinically meaningful BMI categories. This study analyzes data from the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR). The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan. This study includes adult patients receiving VIHR between Jan 2020 and September 2023. All elective VIHRs captured in the MSQC database were included in analysis. Univariate statistics were used for cohort summary and multivariate logistic regression was used to estimate the probability of any 30-day postoperative complication while controlling for age, sex, the interaction of BMI and surgical approach, medical comorbidities, hernia size, mesh use, use of component separation, and previous hernia repair. A total of 11,886 people met the study inclusion criteria. The median (IQR) age was 55.0 (44-65) and 5,111(43.0%) were female. The median (IQR) BMI was 31.7 (27.6-36.3). 5,260(44.3%) cases were performed with an MIS approach and 6,626(55.7%) were performed with an open approach. The adjusted relative risk of experiencing a complication after open repair when compared to MIS repair was 1.34 (95% CI [1.04-1.70], p = .02) in Obesity Class I, 1.62 (95% CI [1.23-2.14], p < .001) in Obesity Class II, and 2.31 (95% CI[1.49-3.56]) for Obesity Class III. MIS repair was associated with improved 30-day outcomes for patients with class I, II, and III obesity, but not for healthy to overweight patients. In clinical scenarios where delay for severely obese patients may be difficult, electing to use an MIS repair may be the optimal strategy to reduce risk of complications.

How to deal with the variability of peripheral nerve lesion patterns after inguinal herniotomy? A descriptive approach for a new terminology in clinical practice

BackgroundInguinal hernia is one of the most common visceral surgical conditions in industrialised countries. The aim of the present observational clinical study was to investigate the dermatome patterns after nerve injury following inguinal hernia surgery and to demonstrate the marked individual anatomical and topographical variability of peripheral nerves in the inguinal region. Methods220 patients were followed up for one year after inguinal herniotomy. Surgical treatment was performed either with tension-free mesh techniques or open according (Lichtenstein). ResultsOne year after inguinal herniotomy, 25 patients (11.4 %) reported postoperative symptoms. Of these, 15 patients showed evidence of a distinct nerve lesion. The results of the clinical neurological examination sometimes differed considerably from the subjective perceptions of the patients. In addition, a marked individual variability in the dermatomes of surgically lesioned nerves was found, with discrepancies to the classical and conventional dermatome data in textbooks. ConclusionsThis study has shown that it is hardly possible to assign a specific lesional inguinal dermatome to a specific nerve, as nerves show a large individual variability in their anatomical, topographical location and thus in their dermatome boundaries. Therefore, we propose a descriptive approach to the terminology of peripheral inguinal nerve lesions using common regional landmarks. This will avoid a potentially erroneous dermatome assignment to a certain nerve and facilitate the reproducibility of lesion descriptions between different observers, thus facilitating communication in clinical practice.

Evaluation and Analysis of the Clinical Effects of Laparoscopic Surgery for Pediatric Direct Inguinal Hernia.

Objective: To assess both the clinical effectiveness and practical experience of utilizing laparoscopic methods for addressing direct inguinal hernia in the pediatric population. Method: The study collected clinical data from 10 pediatric patients with direct inguinal hernia treated at the Children's Hospital of Anhui Province from July 2014 to July 2023. Among them, there were 8 males and 2 females, with an average age of 43.4 ± 22.0 months. All were initially diagnosed with indirect inguinal hernia before surgery. During the laparoscopic procedures, direct hernia was confirmed. Two cases had undergone open hernial sac high ligation surgery due to misdiagnosis as indirect hernia, resulting in recurrent groin bulges postoperatively. For these cases, laparoscopic direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament was performed. Results: All 10 cases of pediatric patients underwent surgeries smoothly without any need for open conversion. The average surgical duration was 29.8 ± 15.0 minutes, with minimal intraoperative bleeding. Patients were discharged on the first day postoperatively, and no significant surgery-related complications were observed. During the 12-month follow-up period, it was noted that the scar at the umbilical ring was superficial and inconspicuous. There were no occurrences of hernia recurrence, testicular retraction, or atrophy. Conclusion: Laparoscopic treatment for pediatric direct inguinal hernia has demonstrated favorable therapeutic outcomes, ensuring a safe surgical process, rapid recovery, and a low postoperative recurrence rate. The laparoscopic approach, specifically utilizing direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament, proves to be a secure and effective treatment for pediatric direct inguinal hernia. It can be considered as a conventional treatment method.

Surgical Challenges During the COVID-19 Crisis: A Comparative Study of Inguinal Hernia Treatment in Romania

Background and Objectives: The COVID-19 pandemic disrupted healthcare systems worldwide, leading to the postponement of elective surgeries, including inguinal hernia repair (IHR), as healthcare resources prioritized critical care. This study aims to evaluate the impact of the pandemic on the incidence and outcomes of IHR procedures. Materials and Methods: A retrospective review was conducted on 604 patients who underwent IHR over six years, spanning pre-pandemic, pandemic, and post-pandemic periods. Data on patient demographics, type of surgical procedure (elective or emergency), use of mesh, surgical duration, hospitalization period, and postoperative outcomes were analyzed across the three time frames. Results: Patient age remained consistent across the three periods, but a significant increase in female patients was observed during and after the pandemic (p &lt; 0.001). Elective IHR surgeries significantly decreased during the pandemic (p &lt; 0.001), paralleled by an increase in emergency cases (p = 0.004). In the post-pandemic period, elective surgeries rebounded, while emergency interventions declined (21.9% vs. 10.3%). Mesh repair usage increased notably in the post-pandemic phase (p &lt; 0.001). Although surgeries took longer during the pandemic (p &lt; 0.001), both total and postoperative hospital stays were reduced during and after the pandemic (p &lt; 0.001). Minimal postoperative complications were reported throughout, with only one mortality during the pandemic. Conclusions: This study highlights the need for robust healthcare strategies to maintain elective surgical care during global crises, as delays in IHR may elevate risks for complications like hernia incarceration and strangulation.

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Effectiveness of ultrasound-guided ilioinguinal and iliohypogastric nerve block in pediatric inguinal hernia surgery: a systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

A retrospective nationwide comparison of laparoscopic vs open inguinal hernia repair in children

BackgroundUtilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort. MethodsThis retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017-2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates. ResultsWe identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p=0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p<0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS. ConclusionLaparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia. Level of EvidenceTreatment Study – Level III