Inguinal Hernioplasty Research Articles

Evaluation of Efficacy of Ultrasound Guided Ilioinguinal and Iliohypogastric Nerve Block for Post Operative Analgesia after Addition of Dexamethasone in Adult Patients Undergoing Unilateral Inguinal Hernioplasty under Subarachnoid Block

Background: We assessed postoperative analgesic effect of ultrasound guided ilioinguinal and iliohypogastric nerve block, duration of action of the said block as well as the overall analgesic consumption in the first 24 hours of postoperative period after addition of dexamethasone.
 Methods: After approval from the institutional ethics committee, hospital based randomized prospective study was carried out in patients of age group 40-60 years by dividing them into two groups A and B, posted for unilateral inguinal hernioplasty, comparing ilioinguinal and iliohypogastric block with ropivacaine 0.375% and ropivacaine 0.375% with dexamethasone 4mg respectively. The aim of the study was to assess the postoperative analgesia with visual analogue scale (VAS) and satisfactory score and total analgesic consumption and time till rescue analgesia. Statistical Analysis: We used Chi-square test and paired t test and P<0.05 was considered statistically significant.
 Results: Mean of duration of analgesia was significantly prolonged in group B (14.13±3.461 h) as compared to group A (5.77±2.161 h). Patients in group B had significantly lower VAS score and less number of rescue analgesic requirements in first 24 hours (h) postoperatively. No adverse effects recorded in any group.
 Conclusion: Dexamethasone as an adjuvant with ropivacaine in ultrasound guided ilioinguinal and iliohypogastric block provided profound prolongation of duration of postoperative analgesia and reduces analgesic consumption of patients undergoing subarachnoid block for unilateral inguinal hernioplasty.

Laparoscopic Prostatectomy in Surgical Treatment of Benign Prostatic Hyperplasia

In a contrast to the trauma of open prostatectomy, an alternative treatment for benign prostatic hyperplasia (BPH) is laparoscopic prostatectomy. It was implemented in the practical work of urologists as a minimally invasive alternative procedure to open prostatectomies (transvesical and pubic) in patients with large BPH. The objective: to consider technique and analysis of the results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in patients with large BPH (more than 80 ml). Materials and methods. The early (inpatient) and long-term (after discharge from the hospital and up to two years of followup) results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in 50 patients with BPH who were operated in Center for Plastic Reconstructive and Minimally Invasive Oncourology of the Cherkasy Regional Oncology Dispensary and the Urology Department of the Vinnytsia Regional Clinical Hospital named after M. I. Pirogov during 2021–2023 are presented. The average age of the patients was 68.2±2.4 years old, the average body mass index was 28.5±1.5, and the average volume of the prostate gland (PG) was 111.5±17.4 ml. Laparoscopic extraperitoneal pubic prostatectomy was performed by creating a pre-abdominal pubic space using a Space Marker balloon trocar. The incision of the PG capsule is transverse, hyperplastic parts of the bladder were removed with step-by-step hemostasis with an attempt to preserve the wall of the prostatic urethra, the anastomosis between the bladder neck and the bladder capsule was placed using a continuous V-Loc suture (2-0). Hyperplastic nodes of the PG were removed by morcellation. The urethral catheter was removed on the 5th day after surgery. The quality of urination before and after surgery was assessed using the International Symptom Questionnaire for PG diseases before and after surgery. Results. The average operation time was 120.3±11.7 min, the average intraoperative blood loss was 118.7±33.6 ml. In 10 (20%) patients the prostatic part of the ureter was saved. One patient had a stone removed from the urinary bladder by cystotomy, another patient had simultaneous pre-abdominal laparoscopic inguinal hernioplasty with a mesh polypropylene implant for an oblique hernia. No intraoperative or postoperative bleeding was observed, no hemotransfusion was performed. The average postoperative bed-day was 6.1±1.1 days. In the postoperative period (up to two years), complications (ureteral and bladder neck strictures, bladder stones, urinary incontinence, infectious complications, etc.) were not registered. Conclusions. The obtained results of laparoscopic extraperitoneal pubic prostatectomy in patients with large BPH confirmed its reliable intra- and postoperative hemostasis, short postoperative bed-day, satisfactory recovery of the act of urination with a minimum number of complications. Further studies should be conducted to establish the benefits of performing laparoscopic extraperitoneal pubic prostatectomy in patients with BPH.

Role of Scrotal Support to Prevent Scrotal Edema After Inguinal Hernioplasty

Inguinal hernia is a quite common condition that is often seen in the elderly as compared to younger patients. Objective: To find out the prevalence of patients developing scrotal edema after inguinal hernioplasty and evaluate the role of scrotal support in avoiding it in our setting. Methods: We conducted a cross-sectional study at K.V.S.S. Site Hospital, Karachi for the period of January 2021 to December 2022. All the data that were collected and analyzed on the latest version of SPSS. The frequencies calculated for the categorical data while the mean found for the numerical data. The chi-square test was run to find out the effectiveness of scrotal support in reducing the frequency of scrotal swelling. A p-value of less than 0.05 was considered significant. Results: 50(55.6%) patients were in the age group of 50-70 years. The majority were smokers (66.7%) and had a BMI>30 (83.3%). 40(44.4%) patients had a significant surgical history. The majority of the patients in our study had diabetes (66.7%). 59% of the patients in our study had an indirect hernia. 25(27.8%) patients who were not given scrotal support developed scrotal edema however only 1(1.1%) who were provided scrotal support immediately after the surgery developed scrotal edema. The association between scrotal support and scrotal edema was statistically significant (p<0.01). Conclusions: Scrotal support has a positive role in preventing scrotal edema in our study.

Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP).

Inguinal hernias and benign prostatic hyperplasia (BPH) can coexist in about one fifth of patients undergoing BPH surgery. There is scarce evidence about performing laser enucleation along with open inguinal hernia repair. Our goal is to describe the perioperative outcomes of performing both surgeries in the same operating session compared to doing HoLEP alone. A retrospective analysis of patients undergoing HoLEP and hernioplasty with mesh in the same anesthetic time (group B) at an academic center was conducted. They were compared to a randomly picked control group of patients submitted to HoLEP alone (group A). Preoperative, operative and postoperative features were compared among both groups. 107 patients submitted to HoLEP alone were compared to 29 combined approach patients (HoLEP + hernia repair). Patients in group A were found to be older and had larger prostates. Group B showed a significant longer operative time. Length of stay and duration of catheter was comparable among groups. In multivariate analysis, the combined approach was not associated to a higher complication rate. Performing benign prostatic hyperplasia surgery with HoLEP in conjunction with open inguinal hernioplasty is not related to a higher length of stay or a significantly increased risk of morbidity.

P-097 FEMORAL AND OBTURATOR HERNIA INCARCERATED: A CASE REPORT

Abstract Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case. A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours. On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia. Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful. Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.

P-086 NERVE IDENTIFICATION DURING OPEN MESH HERNIOPLASTY: A DESCRIPTIVE CROSS-SECTIONAL STUDY

Abstract Background It is recommended to identify nerves in the surgical field during open inguinal hernioplasty. This ensures proper dissection and reduces the incidence of post-operative inguinodynia. From limited surgical studies, it appears that identifying nerves may not be possible in all cases. Little is known about the factors that affect their identification. Materials and methods We conducted a cross-sectional study on thirty-six male patients with primary inguinal hernia. We looked for the nerves during Lichtenstein hernioplasty. We collected data on the identification & preservation of nerves for calculating the nerve identification rates. We observed the course of the nerves and evaluated the effect of BMI, height, anaesthesia type, surgical experience, ASA, type of hernia and sac contents on nerve identification. Results Ilioinguinal nerve (IIN), Iliohypogastric Nerve (IHN), and Genital branch of genitofemoral nerve (GBN) were identified in 86.1%, 75%, and 50% of the groin dissections. It was easier to identify the IIN when the omentum was the content of the sac. The IHN was easily identified in patients with BMI ≤ 25 kg/m2. Conclusion Nerve identification can be challenging during surgery. The GBN and IHN are more prone to dissection-related injuries. Identification of IHN and IIN is difficult in overweight individuals and cases where hernia contains bowel.

P-096 EVALUATION OF EPIDEMIOLOGICAL PARAMETERS OF INGUINAL HERNIA IN A SPANISH RURAL AREA

Abstract Aim To describe the epidemiological, clinical and surgical parameters of the population undergoing inguinal hernioplasty in a small rural hospital Material and method All patients who underwent an inguinal hernia repair at our Hospital in 2021 were included. A search was made in the medical records to identify epidemiological, clinical and surgical risk factors. Results 208 patients were gathered, of which 31 (14,9%) had a bilateral hernia, 50 (24%) had previously been operated on the other side and 11 (5,2%) were recurrences. This translates into an annual incidence of 227,27/100.000, with a recurrence rate of 5%. 136 (65%) were outpatient with only 1 hospitalization. Conclusion In our rural hospital the incidence and recurrence rate is the same as described in the literature.

P-011 OPEN PREPERITONEAL APPROACH IN AN INCARCERATED ABSCESSIFIED GARENGEOT HERNIA

Abstract Aim The Garengeot hernia is a a rare entity (incidence 0.15–5%) that appears more frequently in elderly women and contents the vermiform appendix. Different surgical approaches are available but the most appropriate one is unknown. Association or conversion to laparotomy may be needed in complicated cases entailing higher morbimortality. Results 82-year-old female with hypertension, dyslipidemia and left inguinal hernioplasty. She presented acute right inguinal pain with a 1 month of evolution mass associated extended to the limb. Blood tests were normal but CT scan was performed reporting a right incarcerated inguinal hernia with acute perforated and abscessified appendicitis. Besides antibiotics, an open preperitoneal approach was performed. An incarcerated crural hernia was found: the sac was opened, the perforated appendix was reduced and the abscess was debrided. Appendicectomy was performed and after aseptic measures and critical view, a 15×15cm gentamicin impregnated large-pore light-weight polypropylene mesh was placed in the preperitoneal space covering the myopectineal orifice. Patient was successfully discharged 4 days after surgery with no complications after two years of follow-up. Conclusion The treatment of a complicated crural hernia in a septic environment in the emergency room represents a challenge. In an incarcerated and abscessified Garangeot hernia, an open preperitoneal approach (modified Nyhus technique) can be safely performed to confront both pathologies. Not only it allows access to the abdominal cavity through a small incision, avoiding the need for a laparotomy, but also favours an optimal exploration and repair of the myopectineal orifice.

OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES

Abstract Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.

P-082 THE EFFECT OF CLOSED DRAINAGE SYSTEM ON SEROMA IN LAPAROSCOPIC TOTAL EXTRAPERITONEAL INGUINAL HERNIA REPAIR

Abstract Aim Seroma that can be seen after endoscopic completely extraperitoneal inguinal hernioplasty (TEP) is a major problem in patients who are concerned about recurrence.In this study,a prospective study design was prepared in our clinic in order to see the incidence of seroma afterTEP and the effect of closed system negative pressure drainage, which is one of the methods thought to reduce it. Methods January2021-February2022patients who will undergo unilateral TEP were randomly selected and divided into two groups.Group I was the group where a drain would be placed after TEP,and Group II was the group where no drain was placed after TEP.A hemovac drain was placed behind the mesh, with the perforated end of the drain coming into the preperitoneal cavity,in the patients in Group I.All cases were anatomical 3Dmesh(3DMax™Mesh,BD,USA)was applied to all cases. Results There were 41patients in Group I and 39patients in Group II.73 of the patients were male and 8 were female.According to the EHS classification,47of the hernias wereL1 and 33 were M1 hernias.On the 7th postoperative day,seroma was observed in 5patients in Group I and13 patients in Group II (p<0.024).There was no difference between the groups in the seromas seen at the postoperative 3rd month. Conclusion The frequent occurrence of seroma after TEP is confused with recurrence, especially after hernia surgery.This may cause fear and panic in the patient.It is effective for the patients to come to the surgeon who performs the operation at regular intervals for control in order to eliminate the concerns of the patients.

ЭФФЕКТИВНОСТЬ ОТКРЫТЫХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ ПРИ ПАХОВЫХ ГРЫЖАХ У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА

Purpose. To evaluate the effectiveness of open methods of surgical treatment of inguinal hernia in elderly patients. Material and methods. The study includes 336 elderly patients with inguinal hernias. The Bassini hernioplasty was performed on 106 patients, the Liechtenstein technique was applied to 110 patients and the new tension-free method – to 120 patients. The effectiveness of hernioplasty was evaluated according to the results of the examination of patients in the early and remote postoperative periods, as well as the methodology for calculating the effectiveness of medical technologies in healthcare. Results. With open surgical interventions in patients with inguinal hernias in the early postoperative period there is an increase in the volume of the testicle on the side of surgery. In the remote period only after the Lichtenstein hernioplasty there was a decrease in the volume of the testicle (p<0.05). The relapse of the hernia (1-3 years later) after the Bassini hernioplasty took place in 9.4% cases, after the Liechtenstein hernioplasty - in 3.6% patients, and after applying the new method of hernioplasty there was no relapse of hernia. The new technique of tension-free hernioplastics was characterized by the highest level of medical (Km=1.00) and social efficiency (Ks=0.86). Conclusion. The new technique of open tension-free inguinal hernioplasty is characterized by the highest level of medical and social efficiency.

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial.

Inguinal hernia repair is associated with moderate to severe pain that is most extreme in the first 24 hours. The aim of this study was to compare the efficacy of dexamethasone versus magnesium sulphate (MgSO4) with bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing unilateral inguinal hernioplasty. Eighty patients were randomly allocated to two groups to receive ultrasound-guided TAP block postoperatively with either 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone (Group BD) or 20 ml of 0.25% bupivacaine with 250 mg of MgSO4 (Group BM). Patients were assessed for the first 24 hours after surgery for pain at rest and movement using a numerical rating scale (NRS). Two mg/kg of tramadol was administered as rescue analgesia. The time to first demand tramadol, total consumption of tramadol, patient satisfaction score and side effects were evaluated. The time to the first dose of rescue analgesia was significantly longer in BD group (596.13 ± 57.93 min) than in the BM group (422.50 ± 51.95 min). The NRS scores in the BD group were significantly lower compared to the BM group both at rest and on movement. The total requirement of tramadol was significantly less in the BD group (154.55 ± 59.11 mg) compared to the BM group (270.25 ± 105.72 mg). The incidence of side effects was lower and patient satisfaction was higher in BD group compared to BM group. Bupivacaine with dexamethasone in TAP block after unilateral open inguinal hernioplasty provides increased duration of analgesia and decreased requirement for rescue analgesics compared to magnesium sulphate, with lesser side effects and better patient satisfaction.

INCIDENTALLY DIAGNOSED TRIORCHIDISM IN AN ELDERLY PATIENT PRESENTING WITH HYDROCOELE

A supernumerary gonad is a rare nding and can be encountered incidentally in a variety of clinical scenarios like inguinal hernioplasty, scrotal exploration for testicular torsion, or simply on palpation of the external genitalia as part of routine examination. Till date, approximately 190 cases have been reported regarding this rare anomaly. Herein we report one such case who presented to us with left hydrocele and incidentally detected to have a palpable nubbin of tissue at the base of the scrotum, which later turned out to be a supernumerary testis. The location of the supernumerary testis in our case was caudal to the orthotopic testis, and this particular location, to the best of our knowledge, has not been reported in medical literature so far.

A comparative study on short term surgical outcome between laparoscopic inguinal hernia mesh repair vs. open inguinal hernia mesh repair for primary unilateral inguinal hernias

Background: Current study was performed to compare the short-term surgical outcome of laparoscopic (TAPP) and open inguinal hernia mesh hernioplasty (Lichtenstein) in primary unilateral inguinal hernias such as time taken by patients to return to routine daily activities and return to work. Methods: This is a prospective, comparative study done in Apollo Main Hospital, Chennai comparing surgical outcomes between laparoscopic and open primary unilateral inguinal hernia mesh repair in a total of 60 patients with 30 patients in each arm. Results: Return to Job is 8 median days in laparoscopic group and 9 median days in open group which is significant with a p value of 0.000. Pain score at 12th hour is significantly lesser in laparoscopic group with a VAS score of 3 compared to open group with a VAS score of 4 with p value of 0.015. VAS score at POD 1 in laparoscopic group is 2 and in open group is 3 which is significantly lesser in laparoscopic group with a p value of 0.026. Pain score at POD 3 and 4 is significantly lesser in laparoscopic group with a p value of 0.001 and 0.008 respectively. laparoscopic group takes analgesia for a lesser number of days than the open group with a p value of 0.019. Conclusions: This study concludes laparoscopic repair for primary unilateral inguinal hernias is superior to Lichtenstein tension free mesh hernioplasty in terms of postoperative pain, early return to job and less consumption of postoperative analgesia.

Surgical Outcomes from Lichtenstein Inguinal Hernioplasty using Polypropylene Suture Vs Skin Staples for Mesh Fixation

Objective: To compare surgical outcome of polypropylene suture and skin staples for securing mesh in Lichtenstein Inguinal Hernioplasty Methodology: There were a total of two hundred people with an inguinal hernia who were involved in the study. They were randomly randomized to receive either polypropylene mesh or staples. Each patient voluntarily undergoes a Lichtenstein tension-free inguinal hernioplasty at the THQ Kherpur operating room. This procedure is performed under spinal anesthesia, and rigorous hygiene standards are adhered to throughout the procedure. In Group A, the anchorage of the mesh was conducted using 2/0 polypropylene suture, whereas in Group B, the anchorage of the mesh was accomplished using skin staples. Both methods were successful in achieving the desired results. The operating time, total surgical time, and wound infection rates were all compared between the groups. Results: The common age in cases of Group-X 36.52+9.41 years, and 38.63+8.76 years in Group B cases. Mean postoperative pain was 2.16+1.98 in Group-X and 1.46+1.24 in Group-Y, both of which had p values of 0.0001. Mean postoperative duration in Group-X was 56.7+5.47 and 48.54+4.38 in Group-Y, both of which had p values of 0.0001. The percentage of patients who had a post-operative wound infection was reported as 22 (22%) in Group-X and 6 (6% in Group-Y), whereas 78 (78%) in Group-X and 94 (94%) in Group-Y did not develop an infection; the p value for this comparison was 0.0011. Conclusion: When performing a Lichtenstein inguinal hernioplasty, anchoring the mesh with skin staples rather than polypropylene suture results in a reduction in both the average amount of time needed for the operation as well as the amount of postoperative pain experienced by the patient. Keywords: Inguinal Hernioplasty, skin staples, polypropylene suture, outcome

Evaluation of postoperative pain in patients undergoing unilateral inguinal hernioplasty by Lichtenstein

Background: Lichtenstein's surgery is the most recommended technique in the treatment of unilateral inguinal hernias in men, due to its simplicity, speed, pain-free, and almost unrestricted return to physical activities. The evidence indicates that work and leisure activities can be resumed, by most patients, in three to five days after laparoscopic or conventional hernioplasties, without the risk of recurrences or complications. Nevertheless, chronic pain is the most common postoperative complication affecting about 30% of patients regardless of the surgical technique used. Predictive factors for chronic pain are young age, female gender, preoperative pain level, and postoperative pain intensity. Aim: To evaluate the perception of postoperative pain in patients who have undergone unilateral elective inguinal hernioplasty using the Lichtenstein technique in order to define predictors of the development of chronic pain and to identify the average time to return to work and to normal physical activity. Methods: Analysis of electronic forms applied to patients that underwent elective unilateral inguinal hernia repair by Lichtenstein at a state hospital in a small town in the interior of Brazil. The statistical analyses were processed using the software Statistical Package for Social Sciences (SPSS) version 22.0. Results: Data from 38 participants were analyzed with an average of 41.45 (± 13.94) years. Most of them returned to work and to light physical activities 45 days after surgery. There was a positive correlation between the presence of pain 90 days after surgery and the development of chronic pain (Spearman correlation of 0,818 and p < 0.001). Conclusion: Despite the small sample of this study, it awakens us to the consequences that Lichtenstein surgery can trigger for patients with inguinal hernia and the importance of good management and evaluation of postoperative pain in order to improve the quality of life of these patients.

Comparative Study between Lichtenstein versus Lichtenstein Combined with Mesh Plug in Management of Inguinal Hernia

Inguinal hernioplasty is an ordinary operation all over the world. Many types of repair are present. Aim of the surgeon is to improve the outcome and decrease the recurrence. We evaluated the addition of a mesh plug with the usual repair as a

Immediate and long-term results of Lichtenstein hernia repair

More than 20 million inguinal hernioplasties are performed annually worldwide by various methods [1]. The Lichtenstein operation recommended by the European Society of Herniologists as the "gold standard" in open inguinal hernia treatment, despite its leading position in the world, has a number of disadvantages. According to the studies of some surgeons, the introduction of implants has a correlation with the development of local wound complications and chronic pain syndrome in the postoperative period. And the percentage of recurrences after Lichtenstein hernioplasty ranges from 0.8 to 8% [2]. Some authors have noted an increased frequency of pain syndrome when using the ligature method of fixation of mesh implants. Their frequency ranges from 7 to 12% [3,4]. However, the issue of fixation is still controversial [5,6,7]. Aim of the study: to compare the results of Lichtenstein inguinal hernioplasty using self-fixing implants and implants requiring ligature fixation.

A COMPARATIVE STUDY OF EFFICACY OF SINGLE DOSE PROPHYLACTIC V/S CONVENTIONAL PERIOPERATIVE ANTIBIOTIC THERAPY IN CLEAN CASES OF MESH HERNIOPLASTY

Introduction: One of the most often carried out general surgical procedures is inguinal hernia surgery. Despite the fact that open inguinal hernioplasty is one of the cleanest surgical procedures, some surgeons nevertheless provide antibiotics as a preventative measure .The present study was undertaken to compare the efcacy of the single dose prophylaxis v/s conventional perioperative operational therapy. Material And Methods: This study was a hospital based observational comparative study which was conducted in the in the Department of General surgery at Aarupadai Veedu medical college and hospital, Puducherry, A study 60 cases were included. Patients were divided into two groups. Each group consists of 30 cases of Inguinal Hernia. The study group (Group SDA) received single dose of antibiotic preoperatively while the other group (Group CA) received 3 days of empirical antibiotic therapy post operatively. After obtaining pre anaesthetic check-up patients were posted for surgery. All the cases in study group (group SA) were administered with single dose of 1.5gm of inj. Cefuroxime 30 minutes before skin incision was given. They received no further antibiotics intravenously or oral. The data was analysed using SPSS software Pvalue less then 0.05 consider as statistically signicant. Data in the form of age, gender, BMI, type of work, side of hernia, type of hernia, habit of alcohol consumption and smoking, presence of DM, hypertension, CVD, COPD, duration of surgery, immediate postop fever, nausea and vomiting were noted in prescribed format and statistical analysis was done. Conclusion: However, the SSI in the single dose antibiotic group was remarkably lower than the proportion of SSI in conventional group on post op day 7 however this difference was not substantial on day 14. Also the length of hospital stay, time taken to return to daily activities and work were substantially less in single dose antibiotic group compared to conventional group. We infer that single dose antibiotic is preferred over conventional antibiotics in inguinal hernia repair

Influence of the learning curve on the immediate postoperative pain intensity after laparoscopic inguinal hernioplasty.

Inguinal hernia repairs represent one of the most commonly performed surgical operations worldwide. As more experience has been gained over the past decades with laparoscopic techniques, they are now widely used also for the repair of primary and unilateral inguinal hernias, representing a safe and effective alternative. One of the major concerns of patients undergoing inguinal hernia repair is postoperative pain and socio-professional reintegration. This study started from the hypothesis that the learning curve could influence postoperative pain intensity after laparoscopic inguinal hernioplasty. A retrospective - comparative study was performed, including a general surgeon's first consecutive cases (n=87) of TAPP (transabdominal preperitoneal procedure) hernioplasty procedures with implantation of self-gripping surgical prosthesis were investigated. The evaluation of clinical and surgical aspects resulted in similar values in case of the studied groups. A reduction in surgical time was observed in case of patients operated after completing the learning curve (p = 0.0005) On the first postoperative day patients complained mostly about persistent and severe type of pain. Average Pain Index calculated with help of Simple Numeric Pain Scale resulted in similar values. Length of analgesic treatment showed no significant differences. Although higher intensity pain was mostly caracteristic in case of patients operated during the learning process, no significant relationship between learning curve and postoperative pain intensity were highlited. TAPP can be a safe technique for young surgeons as well, with the right study program the procedure can be mastered safely.