Inguinal Hernia Repair Research Articles

Can e-TEP be a Better Option than TEP for Inguinal Hernia Repair?

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally resides, for making a hernia. Among different hernias inguinal hernia repair is the most frequently done procedures by surgeons in Bangladesh and worldwide. Now-a-days Laparoscopic repair is performed in this country and accepted by the people. Laparoscopic TEP and e-TEP are excellent procedure for repair of inguinal hernia. In this Centre, we performed both procedures. In Technical aspects e-TEP is better approachable than TEP. Objective: In this article we present how to overcome the difficulties of TEP technique by doing the enhanced view totally extra peritoneal technique for repair of inguinal hernia. Methods: It is a non-randomized comparative study. The study consists of patients with laparoscopic hernioplasty for the period of one year (From July 2018 to July 2019). Total 20 cases were included in the study (10 cases of Laparoscopic e-TEP and 10 cases of Laparoscopic TEP). Data were collected by follow up visit, questionnaire and by phone call. Results: The study consists of 20 patients among whom 10 were placed in group A (e-TEP group) and 10 cases were placed in group B (TEP group). Mean operating time in group A was 108.5 min while in group B was 114 min. Pain scoring in group A was 75% and giving score 1-2 (mild pain). All are male. Mean age for e-TEP was 26.5 years and for TEP was 35.6 years. Conclusion: Laparoscopic e-TEP provides wide area than TEP for repair of inguinal hernia. It is a surgeon friendly procedure for repairing hernia. It is easier to learn e-TEP than TEP. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 21-23

The Madrid Posterior Component Separation: An Anatomical Approach for Effective Reconstruction of Complex Midline Hernias.

In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Between January 2015 and June 2023, a total of 223 patients underwent the Madrid PCS. The mean age was 63.4years, with a mean BMI of 33.3kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30% and 60%. A total of 105 patients (48.4%) had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed by CT scan with an average follow-up of 23.9months (range 6-74). The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.

Standardized porcine integrated robotic inguinal hernia training: the SPIRIT model.

Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the technological aspects of the robotic system but also enhancing surgical proficiency in manipulating robotic instruments. Furthermore, procedural expertise in specific surgeries is critical. Minimally invasive inguinal hernia repair is particularly suitable as an initial procedure for human application. The development of a comprehensive training model for this type of repair is a crucial element of such an educational pathway. Anatomical dissections were carried out on pigs to assess both the similarities and differences between pig and human anatomy. A structured minimally invasive inguinal hernia repair was performed to determine the suitability of the porcine inguinal region for training purposes. A detailed anatomical description of the porcine inguinal region is outlined, to provide a framework for assessing the critical view of the porcine myopectineal orifice. By integrating the human 'ten golden rules' for safe and effective minimally invasive inguinal hernia repair, the standardized porcine integrated robotic inguinal hernia training (SPIRIT) model describes a step-by-step approach to practice surgical techniques in a realistic setting. The SPIRIT model is designed to be a well-structured training model for minimally invasive inguinal hernia repair and incorporates the specific surgical steps as encountered in a human patient.

Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: A case report

Introduction: Xiphodynia is a rare musculoskeletal disorder characterized by epigastric or anterior chest pain, for which xiphoidectomy is considered as a definitive treatment. This procedure and its complications are not well researched, particularly within Australasian populations. We describe the novel laparoscopic incisional hernia repair from a xiphoidectomy complicated by recurrent epigastric hernias. Case Report: A 49-year-old female presented with chronic epigastric pain post-xiphoidectomy for xiphoidynia. The patient previously underwent open mesh repair for an incisional epigastric hernia, complicated by infection and subsequent removal of the mesh. A vacuum-assisted closure device was then utilized, followed by delayed primary closure. However, she experienced ongoing pain, a recurrent mass, and hypertrophic scarring, confirmed by abdominal computed tomography (CT) scan. Our laparoscopic approach involved a standard supine position with three ports and preperitoneal dissection similar to transabdominal preperitoneal (TAPP) hernia repair. The defect was 5 × 8 cm in size. A simple prolene mesh (9 × 12 cm) was secured with AsorbaTack and Glubran 2, followed by peritoneal closure with a 3/0 V-Loc suture. At two months follow-up, the patient had no evidence of recurrent hernia, no ongoing pain, and satisfactory wound healing. Conclusion: Laparoscopic surgical repair using a TAPP approach is a safe alternative to open repair of an incisional recurrent epigastric hernia post-xiphoidectomy.

Hematuria after inguinal hernia repair in a child: a case report

Inguinal hernia repair is one of the most common surgical procedures in the pediatric population. While a rare complication, bladder injury can impose a significant burden on patients. This study outlined a case of bladder injury following selective inguinal hernia repair and summarized methods to prevent this complication, aiming to emphasize the importance of not underestimating interventions labeled as “routine surgery” in order to avoid avoidable harm to patients.

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Cord lipoma in minimally invasive surgical repairs of inguinal hernias: a prospective study.

Cord lipomas are frequent findings in laparoscopic inguinal hernia surgeries in male patients. The symptoms of lipoma and the potential benefits of removing them are often overlooked because the focus is on the primary pathology of the hernia itself. Current recommendations are to reduce this fatty content, when present. When inguinal cord lipomas are left untreated in inguinal hernia surgery they can potentially cause symptoms and be detected in follow-up imaging exams. The objective of this study was to study incidence of cord lipomas in a cohort operated on by a single group specializing in abdominal wall surgery, as well as to analyze the possible relationship of this finding with the patient's symptoms, the characteristics of the operated hernia and postoperative outcome. This is a prospective study of male patients operated on for inguinal hernia laparoscopically or robotically in a single reference center. Of the total of 141 hernias, the distribution according to European Hernia Society classification showed that 45.4% were lateral, 19.1% medial and 35.5% mixed, highlighting a variety in the presentation of hernias. Analysis of the size of the hernias revealed that the majority (35.5%) were ≤ 1.5cm. Inguinal cord lipoma was present in 64.5% of the samples, with no statistically significant association between the presence of the lipoma and an indirect hernia sac or obesity. The incidence of surgical site occurrences (SSO) was 9,2%, with seroma and hematoma. No recurrences were observed during follow-up, indicating a successful approach. There were no statistically significant relationships between SSO, the presence of lipoma and indirect hernial sac.

Subcutaneous fat thickness predicts postoperative seroma following laparoscopic total extra-peritoneal hernioplasty.

Seroma formation is the most common cause of morbidity associated with laparoscopic inguinal hernia repair. This study aimed to examine the relationship between the thickness of subcutaneous fat (TSF) and the risk of postoperative seroma. We reviewed data from a prospective cohort of 229 male patients who underwent laparoscopic total extra-peritoneal (TEP) hernioplasty for indirect inguinal hernia between August 2018 and July 2021. The TSF was assessed using preoperative ultrasound images. The risk factors for postoperative seroma were determined using univariate and multivariate logistic regression models. Postoperative seromas occurred in 26 patients (11.4%). The factors associated with postoperative seroma included longer hernia duration, larger hernia defects, extension into the scrotum, and greater TSF (P < 0.05). In multivariate analysis, a greater TSF was independently associated with a greater risk of postoperative seroma (per 1mm: odd ratio [OR] 1.105, 95% confidence interval [CI] 1.048-1.165, P < 0.001; TSF ≥ 26.0mm: OR 7.033, 95% CI 2.485-19.901, P < 0.001). Similar results were obtained in the subgroup analysis. The area under the curve of TSF for predicting seroma formation was 0.703 (95% CI 0.601-0.806). Ultrasound-derived TSF may be a promising prognostic factor for postoperative seroma in patients undergoing laparoscopic TEP repair. Further validation is required and then this parameter can be used to improve decision-making process.

The work relative value estimation assessment in China: an empirical research for common surgical procedures.

China's National Health Service Items Standard (NHSIS) establishes a relative value system and plays an important role in pricing. However, there are few empirical evaluations of the objectivity of the NHSIS-estimated relative value. This paper presents a comparison between physician work relative value units (wRVUs) estimates for 70 common surgical procedures from NHSIS and those from the U.S. Medicare Physician Fee Schedule (MPFS). We defined the ratio of the wRVUs for sample procedures to the benchmark procedure (inguinal hernia repair) as a standardized relative value unit (SRVU), which was used to standardize the data for both schedules. We examined the variances in the ranking and quantification of SRVUs across specialties and procedures, as well as how SRVUs impact procedure reimbursement prices between the two schedules. There was no systematic difference between MHSIS-estimated SRVUs and MPFS-estimated, but the dispersion of MPFS-estimated SRVU was greater than that of MHSIS-estimated, and the discrepancies increased with surgical risk and technical complexity. The discrepancies of SRVUs were significant in cardiothoracic procedures. Additionally, whether SRVUs were based on MPFS or MHSIS, there was a positive association between them and payment prices. However, in terms of the impact of SRVUs on payment pricing, the NHSIS system was lower than the MPFS system. China has made incremental progress in estimating the relative value of healthcare services, but there are shortcomings in valuation methods and their impact on pricing. The modular assessment method should be considered as a component to optimize reform.

LAPARASCOPIC VERSUS OPEN MESH REPAIR FOR RECURRENT INGUINAL HERNIA: A SYSTEMATIC REVIEW

Background: Inguinal hernia is one of the most common conditions seen in clinic, and is often treated through the general surgery department. Laparoscopic repair and open repair with mesh are the typical treatments for inguinal hernia, and both regimens have proved beneficial in treating inguinal hernia. However, recurrence, with a rate as high as 33, poses a significant problem to the effective treatment of inguinal hernia. The aim: This study aims to show about laparascopic versus open mesh repair for recurrent inguinal hernia. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 10 articles, whereas the results of our search on SagePub brought up 60 articles. The results of the search conducted for the last year of 2013 yielded a total 2 articles for PubMed and 14 articles for SagePub. The result from title screening, a total 1 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 7 papers. We included five research that met the criteria. Conclusion: The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.

Single-port versus traditional three-port laparoscopic total extraperitoneal inguinal hernia repair: A single-centre, prospective, randomised study.

To explore the efficacy and safety of single-incision laparoscopic (SIL) technique compared with the traditional three-port total extraperitoneal (TEP) technique for inguinal hernia repair. This prospective, randomised study involved patients who underwent surgery for inguinal hernia at our hospital from December 2021 to July 2023. Patients were randomly assigned to SIL-TEP or TEP groups based on a computer-generated random number table. Perioperative clinical indicators for the surgical approaches were evaluated. Of the 127 patients eligible for study, 66 were randomised to the SIL-TEP group and 61 to the TEP group. The operation time for SIL-TEP was significantly longer than for TEP but the time to return to normal activities was significantly shorter and short-term pain score was significantly lower. There were no differences between groups in intraoperative blood loss, postoperative hospital stays, pain relief time, hospitalization costs or cosmetic satisfaction scores. While SIL-TEP is more challenging than TEP for hernia repair, we found that at our centre it is comparable with regard to overall safety and feasibility. Further studies are needed to validate our findings.

Long term outcomes of mesh versus non-mesh repair in inguinal hernia surgery: a systematic review of randomized case controlled study

Long term outcomes of mesh versus non-mesh repair in inguinal hernia surgery: a systematic review of randomized case controlled study

Chronic Pain after Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

Introduction: Chronic pain, defined as pain persisting for more than 3 months after inguinal hernia surgery, poses a significant challenge in postoperative management. This study compares outcomes, including chronic inguinal pain, pain levels before and after surgery, and hernia recurrence rates, among patients undergoing mesh fixation using tacker, histoacryl glue, or no mesh fixation in the context of Transabdominal Preperitoneal (TAPP) hernioplasty. Methods: A prospective, double-blinded, two-site study was conducted on patients undergoing TAPP hernioplasty. The study included 59 male patients aged 26 to 76 years who underwent 85 hernioplasties using the TAPP technique. Postoperative pain intensity was assessed using the Carolinas Comfort Scale (CCS). Results: Patients were followed up at 3, 12, and 24 months postoperatively. Chronic pain was present in 10.6% of patients at 3 months, 4.8% at 12 months, and 2.4% at 24 months post-surgery. Conclusion: Our findings suggest that the type of mesh fixation does not significantly impact the risk of chronic postoperative pain. Additionally, we observed no significant difference in pain scores pre- and postoperatively. Further studies may be warranted to explore optimal mesh fixation techniques in TAPP hernioplasty

Spectrum of Minimally Invasive Surgical Techniques for the Managment of Inguinal Hernias in Infants and Children

One of the most common surgical procedures in infants and children is the repair of an indirect inguinal hernia. This can be carried out by open technique or using minimally invasive surgery (MIS). Since 1998, numerous different MIS techniques have been described. Scientifically proven advantages include a shorter operation time for bilateral hernias, along with a lower risk of metachronal, contralateral hernia. Nevertheless, the proportion of inguinal hernias treated using MIS in children in this country is relatively low, at around 8% of all operations. The aim of this synopsis is to describe the different MIS techniques for inguinal hernia repair in children, including their respective advantages and disadvantages.This video compilation shows the spectrum of different techniques for laparoscopic inguinal hernia repair in children. It includes the intracorporeal suturing technique, the incision of the peritoneum, extracorporeal percutaneous techniques, and the cauterisation of the open peritoneal vaginal process in girls.Although minimally invasive inguinal hernia repair in children is technically and scientifically established, it is not yet being widely used. This video manuscript provides an overview of the various techniques, thus facilitating clinical application.

Laparoscopic surgery for De Garengeot’s hernia in a man after inguinal hernia surgery with a mesh plug: a case report and review of literature

BackgroundDe Garengeot’s hernia is a rare case of a femoral hernia that contains the appendix. Here we report a case of De Garengeot’s hernia that occurred in a male patient who had a history of inguinal hernia surgery using a mesh plug. There were no reports of De Garengeot’s hernia with a history of surgery for inguinal hernia, and the surgical question was whether we could successfully treat a patient with minimally invasive laparoscopic surgery using a mesh.Case presentationThis case involved 75-year-old man with a history of right indirect inguinal hernia surgery using a mesh plug without on-lay mesh, who presented with a 5-day history of a right groin lump. Abdominal CT revealed an incarcerated appendix within the right femoral hernia and fluid collection around the appendix. Laparoscopic surgery was initiated and the incarcerated appendix was released with traction. There was no contamination around the appendix or the femoral ring, the appendix was removed, and the femoral hernia was repaired using mesh. Laparoscopic surgery was useful in first evaluating the inflammatory status of the appendix. As it was determined that there was little inflammation around the appendix and femoral ring, it was possible to repair the hernia using mesh.ConclusionsDe Garengeot’s hernias are rare and there is currently no standardized approach. Even if it is a recurrent hernia in the groin, laparoscopic surgery can be useful for diagnosis and treatment, but the use of mesh requires further careful consideration.

An observational study of clinical presentation and emergency surgical management of obstructed inguinal hernia repair

An observational study of clinical presentation and emergency surgical management of obstructed inguinal hernia repair

RECURRENCE RATE AND QUALITY OF LIFE IN OPEN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY OF LICHTENSTEIN VS TRABUCCO REPAIR

Abstract Background The aim of this retrospective observational study with prospective follow-up is to evaluate the clinical outcomes and patients' Quality of Life (QoL) after either a Lichtenstein or a Trabucco inguinal hernia repair. Materials and Methods 532 patients who underwent inguinal hernia repair from 2016 to 2022 were included in this analysis. All the patients' baseline characteristics and data were collected from the hospital medical records. A phone interview was conducted to investigate long-term outcomes and patients’ QoL (EuraHS-QoL questionnaire) was performed between December 2022 and January 2024. The primary endpoint was the evaluation of patients’ recurrence rate and QoL in two technique groups: Lichtenstein (nA = 391) or Trabucco (nB = 141). Results The two groups didn’t show significant differences in main baseline characteristics. With a comparable median follow-up, no differences in complication rate (nA = 10.2% vs. nb= 11.3% p = 0.78) and recurrence rate (nA = 7.9% vs. nb = 4.96% p = 0.08)were detected among the two groups. Patients’ QoL improvement compared to the baseline was statistically significant in both groups. On the other hand, the weight of the mesh appears to have no impact on clinical outcomes (such as recurrence and complications), but it could worsen QoL when a heavier mesh is employed. Conclusion This analysis did not reveal any significant differences in outcomes between the two primary inguinal hernia repair techniques. Based on our experience, the choice of surgical techniques could be made depending on the preferences of the surgeons. It is crucial to select the weight of the mesh carefully.

Is implementation of robotic-assisted procedures in acute care general surgery cost-effective?

Over the past 2 decades, the use and importance of robotic surgery in minimally invasive surgery has increased. Across various surgical specialties, robotic technology has gained popularity through its use of 3D visualization, optimal ergonomic positioning, and precise instrument manipulation. This growing interest has also been seen in acute care surgery, where laparoscopic procedures are used more frequently. Despite the growing popularity of robotic surgery in the acute care surgical realm, there is very little research on the utility of robotics regarding its effects on health outcomes and cost-effectiveness. The current literature indicates some value in utilizing robotic technology in specific urgent procedures, such as cholecystectomies and incarcerated hernia repairs; however, the high cost of robotic surgery was found to be a potential barrier to its widespread use in acute care surgery. This narrative literature review aims to determine the cost-effectiveness of robotic-assisted surgery (RAS) in surgical procedures that are often done in urgent settings: cholecystectomies, inguinal hernia repair, ventral hernia repair, and appendectomies.

COMPARATIVE ANALYSIS OF ANATOMICAL SHAPED AND STANDARD FLAT MESH IN TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR: EARLY OUTCOMES

Abstract Background Mechanical fixation in transabdominal preperitoneal inguinal hernia mesh repair (TAPP) is associated with pain syndrome and mesh migration may occur without flat protheses fixation. An anatomical shaped mesh (4DTM Cousin Biotech) using no fixation would improve the pain syndrome. Method A retrospective case study, that included 100 patients and 200 TAPP performed from 2019 to 2023. This study was conducted to compare laparoscopic inguinal hernia repair with (group A) or without mesh fixation (group B) regarding outcomes using two different mesh technologies: well-established flat macroporous partially absorbable mesh and the anatomical shaped partially absorbable lightweight mesh (4DTM Cousin Biotech). Results Recurrence rates, postoperative outcomes, and complication rate and type were analyzed to provide insights into the performance of each mesh in TAPP. There was statistically significant difference in postoperative early pain, assessed via VAS score, 3 days after surgery (group A versus group B; 3,4 ± 1.46 vs. 4 ± 1.6, P &amp;lt;0.001) and a week after surgery (group A versus group B; 1.5 ± 0.9 vs. 2.5 ± 0.6, P &amp;lt;0.001). Operative time, on average, was longer in group B (92 ± 12. vs. 79 ± 20 min, P &amp;lt;0.001). Conclusion The study results revealed that laparoscopic TAPP inguinal hernia repair with anatomical shaped mesh without fixation is safe and feasible with no increase in recurrence rate. In addition, it offers an improvement of operation time than TAPP mesh fixation. However, further study with a longer follow-up will be needed to confirm the results.

CAUSES OF CHRONIC PAIN UNRELATED TO SURGICAL TRAUMA AFTER GROIN HERNIA REPAIR: A PROSPECTIVE COHORT STUDY

Abstract Background Chronic inguinal pain (CIP) can be caused by several factors including musculoskeletal or neurological pathologies as well as by surgical trauma following groin hernia repair. The principal 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. Method During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were physically evaluated by surgeons and filled out an Inguinal Pain Questionnaire and a Numerical Rating Scale pain-questionnaire. For patients undergoing groin hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on postoperative questionnaires were reevaluated by phone consultation and physical examination. Results 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. Conclusion 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 groin pain on pain-questionnaires did not have chronic post-operative 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 surgical trauma.