Inguinal Repair Research Articles

Optimal timing of surgery for inguinal hernia in premature neonates

AbstractAimThe surgical repair of inguinal hernias represents a significant risk for premature infants. Despite ongoing discourse, the optimal approach to hernia management remains contentious. Our investigation aims to establish the most favourable timing for inguinal repair in premature neonates.Patients and MethodsOur investigation involved the analysis of medical records for 536 neonates, born prematurely, who underwent inguinal hernia repair from January 2018 to December 2023. We dichotomised the cohort into two groups: those who received early repair and those who underwent late repair. The timing of the surgery was primarily determined by the surgeon's decision, in conjunction with familial consent to the surgical intervention. The primary endpoints were the incidence of recurrence or incarceration within 1 year after surgery. The secondary endpoints encompassed length of neonatal intensive care unit stay, post‐operative ventilator dependency, and frequency of return visits, whether to the inpatient and emergency department or an outpatient clinical setting, for hernia‐related issues.ResultsThe analysis encompassed a total of 454 neonates born prematurely, of which 163 underwent early repair, while 291 received late repair for inguinal hernia. The demographic data between the two groups demonstrated no significant differences. The occurrences of hernia recurrence and post‐operative apnoea presented similar trends across both cohorts. Notably, the late repair group exhibited an increased incidence of preoperative incarceration and return visits due to hernia complications. In this group, testicular atrophy or ovarian necrosis was observed in five cases, despite the overall absence of significant differences.ConclusionsOur findings suggest that the surgical repair of inguinal hernia in preterm neonates, performed at the time of presentation to our clinics, is both safe and feasible. However, a delay in hernia repair appears to be associated with a heightened risk of severe complications, such as testicular atrophy or ovarian necrosis.

Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials.

There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% -34.31- -17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24h and one week.

The Impact of a Specialized Hernia Center and Standardized Practices on Surgical Outcomes in Hernia Surgery: A Systematic Review and Meta-Analysis.

Aim: Hernia registries report that guidelines are not always implemented by general surgeons and suggest that the success rate of this procedure is higher in hernia specialty centers. There are many definitions of hernia centers, but their objectives consist of improving healthcare by homogenizing the clinical practice. We performed a systematic review and meta-analysis to analyze hernia centers' definitions and compare hernia centers with non-specialized centers. Material and Methods: Cochrane Central, Scopus, Scielo, and PubMed were systematically searched for studies defining a hernia center or comparing hernia centers and non-specialized centers. Outcomes assessed were recurrence, surgical site events, hospital length of stay (LOS), and operative time. We performed subgroup analyses of hernia type. Statistical analysis was performed with R Studio. Results: 3,260 studies were screened and 88 were thoroughly reviewed. Thirteen studies were included. Five studies defined a hernia center and eight studies, comprising 141,366 patients, compared a hernia center with a non-specialized center. Generally, the definitions were similar in decision-making and educational requirements but differed in structural aspects and the steps required for the certification. We found lower recurrence rates for hernia centers for both inguinal (1.08% versus 5.11%; RR 0.21; 95% CI 0.19 to 0.23; p < 0.001) and ventral hernia (3.2% vs. 8.9%; RR 0.425; 95% CI 0.28 to 0.64; p < 0.001). Hernia centers also presented lower surgical site infection for both ventral (4.3% vs. 11.9%; RR 0.435; 95% CI 0.21 to 0.90; p = 0.026) and inguinal (0.1% vs. 0.52%; RR 0.15; 95% CI 0.02 to 0.99; p = 0.49) repair. Conclusion: Our systematic review and meta-analysis support that a hernia center establishment improves postoperative outcomes data. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024522263, PROSPERO CRD42024522263.

Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital

Objective: The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications. Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26. Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications. Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.

TEP or TAPP: who, when, and how?

Groin hernia repair is the most common procedure performed by general surgeons. The open mesh technique generally represents the main technique for an inguinal repair, but a different approach is often required. Laparoscopy was found to be the answer to minimizing the impact of the preperitoneal open techniques described by Nyhus and Stoppa. The introduction of the totally extraperitoneal hernia repair (TEP) and transabdominal preperitoneal repair (TAPP) in the early 1990s started a new chapter in groin hernia surgery. The minimally invasive techniques vs. open mesh, and then one against the other, soon became a hot topic among abdominal wall surgeons. With time, the number of procedures and indications increased and are still increasing. This review aims to provide an overview of the two main laparoscopic techniques for groin hernia repair, answering the following questions: Who should perform them? What is the learning curve required to minimize complications and optimize operative time? When is a minimally invasive approach indicated, and which one (both in elective and in emergency setting)? How are they performed? The standard techniques have been described in detail, and personal observations from an abdominal wall surgery referral center were added. The main reviews from the early 2000s up to date, which compared the techniques, were analyzed, and the results reported, confirming the comparable safety and efficacy of both these techniques.

Comparison of operative outcome of open versus laparoscopic inguinal hernia in rural tertiary care hospital in Haryana: A randomized controlled study

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p &lt;0.01). Operating time was observed to be more with TEP group with mean of 59 ± 17.02 minutes compared with open group which had mean of 44.92±12 minutes. Mean number of analgesic in open cases was 6.65 ± 1.81 whereas in case of TEP group it was 4.35±1.47 over a period of one month. Conclusion: Lichtenstein tension free mesh hernioplasty still remains the gold standard operation done for inguinal hernia. TEP repair has proven to be superior in terms of perioperative hemorrhage and post-operative analgesia requirement. Study concluded that laparoscopic TEP repair of inguinal repair have a considerable clinical advantage over open hernia repair in terms of postoperative pain and analgesia requirement, hospital stay and postoperative complications.

Quadratus lumborum block in laparoscopic inguinal hernia repair: A single center study.

Objective: To evaluate the efficacy of QL block in patients undergoing laparoscopic TEP inguinal hernia repair. Study Design: Randomized Clinical Trial. Setting: Kalsoom International Hospital, Islamabad. Period: Dec 2022 to June 2023. Methods: In this, all patients between the ages of 18 and 70 who were scheduled for laparoscopic TEP inguinal hernia repair to repair a one-sided inguinal hernia and did not have any complications related to the hernia. In one group, the patients received general anesthesia and in the other group, the patients were given sedation along with a technique called QL block. Age, gender, pain score on VAS at 1 hours, 6 hour and 12 hours after procedure was noted. Comparison of pain according to the VAS by type of anesthesia was done between the two groups and independent sample t-test was applied to see the statistical significant. Results: The patients' mean age was 43 + 9.09 years. Around 70% of the patients were males, while 30% were females, indicating a male predominance. The study's outcome was the mean pain score after 1 hour, 6 hours, and 12 hours. The two techniques of anesthesia utilized in the two groups were compared in terms of pain. The mean VAS at 1 hour after the initiation of anesthesia was not significantly different between the two groups, but it was statistically significant at 6 and 12 hours (p value of 0.001). Conclusion: QL block is a safe and effective alternative for patients undergoing TEP inguinal repair because to the observed reduction in early postoperative pain, shorter hospitalization, and cheaper anesthetic and hospital costs. Although our research showed that pain was significantly reduced for up to 12 hours after the operation, more information is needed before we can confidently endorse it for widespread use.

Retrospective evaluation of a single surgeon’s experience in robot-assisted inguinal repair with the Dexter System™ during the learning curve

Retrospective evaluation of a single surgeon’s experience in robot-assisted inguinal repair with the Dexter System™ during the learning curve

Gallbladder sinistroposition (left-sided) finding in laparoscopic cholecystectomy, a case report

A left-sided gallbladder (LSGB), also known as sinistropostition, is a rare anatomical variant with a reported incidence of 0.2-1.1%. It is defined as a gallbladder located on the left side of the falciform ligament, embedded in the third hepatic lobe, without situs inversus viscerum. A 37-year-old Latino man with a history of bilateral inguinal repair underwent a scheduled laparoscopic cholecystectomy due to multiple gallbladder polyps. Preoperative ultrasound reported a gallbladder of 60x20 mm, wall thickness of 1 mm, with polyps of up to 10 mm. Standard laparoscopic cholecystectomy trocar placement was used. Upon revision of the right hepatic lobe, there was an absence of the GB in the visceral side of segments IV, V, or VI. It was identified to the left of the falciform ligament with adhesions to the anterior and superior portions of the pylorus and lesser curvature. The subxiphoid trocar was adjusted to the left of the falciform ligament, and Calot’s triangle dissection was performed to obtain a critical view of safety. No other anatomical variants were identified. The procedure was performed safely with a satisfactory view of critical cholecystectomy steps and anatomy identification. After the procedure, the surgeon complained of right-hand pain and numbness due to a medial position of the subxiphoid trocar for dissection. The surgical approach of a LSGB in laparoscopic surgery should be individualized for each patient. A minimally invasive approach may be realized successfully when critical thinking by the surgeon is applied and always prioritizing the safety of the patient.

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

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

Revisiting femoral hernia diagnosis rates by patient sex in inguinal hernia repairs

IntroductionGuidelines recommend MIS repairs for females with inguinal hernias, despite limited evidence. We investigated rates of femoral hernias intraoperatively noted during MIS and Lichtenstein repairs in females. MethodsACHQC was queried for adult females undergoing inguinal hernia repair between January 2014–November 2022. Outcomes included identified femoral hernia and size, hernia recurrence, quality of life, and sex-based recurrence. Results1357 and 316 females underwent MIS and Lichtenstein inguinal repair respectively. Femoral hernias were identified more frequently in MIS than open repairs (27%vs12%; (p ​< ​0.001). Most femoral hernias in MIS (61%) and Lichtenstein repairs (62%) were <1.5 ​cm(p ​< ​0.001). Identification rates of femoral hernias >3 ​cm were 1% overall(p ​= ​0.09). Surgeon and patient-reported recurrences were similar between approaches at 1–5-years for females(p ​> ​0.05 for all) and similar between sexes(p ​> ​0.05). ConclusionMost incidental femoral hernias are small and both repair approaches demonstrated similar outcomes. The recommendation for MIS inguinal hernia repairs in females is potentially overstated.

464 Incidence of recurrent inguinal hernias and their repairs at a large DGH

Abstract In the UK 100,000 hernia operations are performed annually – this includes umbilical/epigastric/incisional etc. Options of inguinal repair are either open or laparoscopic (TAPP vs TEP). Recurrence rates for Liechtenstein repairs are quoted as 5.6%. Median recurrence rates for TAPP repair are quoted as 2.3% and for TEP 0.6%. However, several meta-analyses comparing TEP/TAPP to open repairs found no significant difference in recurrence rates. At our trust, 331 inguinal hernia operations were performed between August 2021- August 2022 (post-COVID). The aim of this project was to look at the incidence of recurrent hernias and their initial repairs at our trust. We obtained a list of all inguinal hernia repairs in our trust (across all sites) between August 2021- August 2022. We looked at the number of patients that underwent an operation for a recurrent hernia and whether that patient’s primary repair was done laparoscopically or open. 76% of total inguinal hernia repairs were performed open, compared to 24% laparoscopic repairs (72% TEP repairs). About 10% of total repairs were for recurrent hernias. 56% of those had a primary open repair and 44% had a primary laparoscopic repair. 75% of the recurrent hernias underwent a second open repair and 25% underwent a second laparoscopic repair. We aim to repeat this study with more data (i.e. looking at pre-COVID years) and encourage our laparoscopic hernia surgeons to look into their own practice.

Laparoscopic TAPP Inguinal Hernia Repair: Mesh Fixation &amp; Peritoneal Closure by Sutural Technique

Background: The laparoscopic transabdominal preperitoneal (TAPP) inguinal repair is an evolving technique associated with well-known advantages of a minimally invasive approach. This prospective study was conducted to evaluate the feasibility, safety and effectiveness of laparoscopic TAPP using sutural mesh fixation &amp; peritoneal closure. Intracorporeal sutural technique needs steep learning curve. Methods: Between May 2018 to December 2019, a total of 41 inguinal hernias underwent TAPP repair in 37 adults under general anesthesia. All the patients scheduled for elective inguinal hernia repair were offered the choice of the laparoscopic TAPP repair under general anesthesia. A detailed explanation of the procedure was given to all patients and informed consent was obtained. We used 2/0 vicryl for mesh fixation &amp; peritoneal closure which took only 6.80 US Dollar in comparison to Protack from Covidien which is 167.80 US Dollar. Intraoperative &amp; postoperative variables were recorded in pre structured proforma. Results: The 41 hernia includes 34(82.92%) direct, 07(17.08%) indirect. Unilateral hernia were 33(89.19%), &amp; bilateral were 4(10.81%). Mean operating time for unilateral cases was 122 minutes &amp; for bilateral 210 minutes. Mean operating time in the cases using 3D-4K image system was 70 minutes. Mean duration of hospital stay was 2.9 days. There was no conversion in this study. Postoperative complications included scrotal seroma 2(5.40%), hematoma 1(2.70%), port site infection 2(5.40%) &amp; mesh infection 1(2.70%). Assessment of intensity of postoperative pain was evaluated according to VAS. 05 patients complained of mild pain: pain on the visual analog score (VAS) = 1-3 during one month follow-up. No patient reported with chronic pain &amp; recurrence during the followup period. Conclusion: TAPP inguinal hernia repair with sutural mesh fixation &amp; peritoneal closure is a feasible &amp; safe technique with minimum postoperative morbidity and maximum patient’s satisfaction. J Bangladesh Coll Phys Surg 2023; 41: 187-192

Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone

IntroductionIn low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training.MethodsAll trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training.ResultsDuring three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery.Discussion and conclusionMesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.Trial Registration: International Clinical Trial Registry ISRCTN63478884.

V-045 PREPERITONEAL APPROACH FOR BILATERAL SPIGELIAN AND RECURRENT LEFT INGUINAL HERNIAS

Abstract This is a case presentation of a preperitoneal repair of a bilateral Spigelian hernia and a recurrent left inguinal hernia. A 71 year old male patient was admitted in the Emergency department after a 3 hour right quadrant acute pain. On his medical record he had an anterior left inguinal repair (Lichtenstein) 6 months before. The physical examination revealed a bulge on the right lower quadrant. The Spigelian hernia was incarcerated but easily reduced. The CT scan findings include a bilateral Spigelian hernia (bowel content), a small umbilical and a left inguinal omental hernia. The patient did not suffer any other incarceration episodes before the surgery, programmed 10 days later. We present the video of the surgical TEP repair, a preperitoneal access, triple hernia reduction, double 15×20cm polypropilene tailored mesh placement. The patient was discharged on the second postoperative day, and had an uneventful recovery with no recurrence after 3 months followup.

P-053 LAPAROSCOPIC APPROACH WITH EXTRAPERITONEAL PREFERENCE AS A STANDARD INDICATION FOR PATIENTS WITH INGUINAL HERNIA. OUR FIRST RESULTS

Abstract Aim Laparoscopic inguinal repair originated in the early 80's, but despite the time elapsed its use is not generalized, although more groups are adopting it as the technique of choice. With this wordk we seek to analyze our results after generalizing the laparoscopic approach. Material &amp; Methods Descriptive and retrospective study of patients electively operated by Totally Extraperitoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair, between January 2020 and December 2022, for primary or recurrent inguinal hernia. Results A total of 138 patients underwent surgery, 92.8% male, mean age 60.7 (SD 11.9) years. Of these, 113 had unilateral hernia and 25 bilateral. In 115 (83.3%) the hernia was primary. The mean operative duration was 61.3 (SD 24.3) minutes, and 2 complications (1 right inferior epigastric artery injury on postoperative day 10 and 1 intraoperative ligament bleeding). There were 3 TEP to TAPP conversions and 3 recurrrences (1 no surgery due to patient refusal, 1 repair by anterior approach and another reoperated by TAPP). At one month possoperatively, 87.7% reported no or mild pain, 113 patients being discharged. The average follow-up wa 83.1 (SD 129.2) days. When analyzing the specific approach, TEP was predominant: 110 (79.7%) with similar postoperative results of pain vs TAPP although with significantly shorter operative duration: 53.1 vs 68.9 minutes (p &amp;lt;0.001). Conclusions Inguinal laparoscopy in our setting is safe and effective in the short term for primary repair. Our results support laparoscopic repair with TEP as the first choice and TAPP as an alternative.

BILATERAL TRANSVERSUS ABDOMINIS PLANE BLOCK REDUCES POSTOPERATIVE NSAIDS USE AFTER LAPAROSCOPIC HERNIA REPAIR

INTRODUCTION: Bilateral peripheral block (TAP - block) is usually performed under ultrasonography (US) guidance in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle, and it aims to block the thoracoabdominal nerves from Th6 to L1 by infiltrating local anesthetic. TAP block is effective tool of managing pain control, especially in the first twenty-four hours after surgery. It improves recovery pathway following minimally invasive surgery and reduces narcotic and non-steroidal anti-inflammatory drugs (NSAIDs) use for postoperative pain management in various different abdominal surgery. AIM: The purpose of this research was to assess the analgesic efficacy of TAP block in regard to used NSAIDs concentrations during the first 24 hours following laparoscopic inguinal hernioplasty. METHODS: The study was conducted with 60 patients, who were randomized into two groups. Control group – were patients who received general anesthesia (GA), and experimental group, were patients who have received GA and a bilateral TAP block. All patients received NSAIDs in the postoperative period. RESULTS: From the acquired data, during the first postoperative hour (POH) only 20% of the experimental group required Paracetamol in a dosage of 1000 mg. Control patients used three times more NSAIDs (60%). Compared to the control group, 63.3% of TAP-block patients did not require analgesia from the 6th to the 12th POH. In the control group average amount of paracetamol was 5167 mg, while in experimental group it was twice lower. Similar finding was established in regard to Ketonal consumption. The control group (without TAP-block) consumes around twice as many NSAIDs as the experimental group at all post-operative time intervals. CONCLUSION: The findings of our research demonstrate that patients undergoing bilateral laparoscopic inguinal repair, administering ropivacaine as part of an US-guided bilateral TAP-block decreases the requirement of NSAIDs in the first twenty-four hours after surgery. TAP-block is a component of multimodal anesthesia and an adjuvant for intraoperative and postoperative analgesia.

P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract Background An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ). Method A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence. Results Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity. Conclusion Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.

P-044 LEARNING AND DATA FROM OUR TEP LEARNING CURVE

Abstract Aim Laparoendoscopic techniques for inguinal repair (TEP) offers advantages such as less postoperatory pain, less local complication rates and early comeback to work activities. We describe the TEP learning curve in our unit and we present a preliminary analysis of our results. Material and Methods We present the retrospective analysis of patients who underwent TEP inguinal hernioplasty between 2018 and 2021 in a Wall Surgery Unit of Navarra Hospital. We perform a descriptive analysis of the collected data. Results 182 patients were analysed, including 91.6% male with an average age of 57.1 years. 11patients required conversion from TEP to another technique (mainly TAPP and open preperitoneal surgery) due to surgical or anesthetic problems, with a conversion rate of 6%. 4 patients (2%) presented early recurrence and 6 patients (3%) late recurrence. 16 patients (8.8%) had moderate pain (VAS &amp;lt; 5) while 7 patients (3.8%) had severe pain (VAS ≥5). All the patients who presented postoperative pain were reviewed and none presented postoperative neuralgia. No patient showed surgical site infection neither epididymitis. 4 patients (2%) presented seroma and 23 (12.6%) hematoma. Conclusions Laparoendoscopic techniques, especially TEP, has more demanding learning curve than open repairs. Support and tutoring are imperative in the first cases. An adequate selection of cases at the beginning is important. Mastering open preperitoneal hernioplasty surgery leads to better and faster results in TEP approach.

Ultrasound-guided paravertebral block for inguinal herniorrhaphy

Background There has been an increasing trend toward performing inguinal repair surgeries under regional anesthetic techniques like paravertebral block (PVB). Neostigmine has been used as an adjuvant to local anesthetics, but the existing research studies are few. This study was conducted to evaluate the efficacy of neostigmine as an adjuvant to local anesthesia used for PVB in inguinal hernia repair procedures. Patients and methods This prospective randomized study included 72 patients prepared for elective inguinal hernia repair under PVB. They were allocated into two groups: the neostigmine group received a mixture of bupivacaine and neostigmine (5 μg/kg), whereas the control group received bupivacaine alone. During the postoperative period, pain score, hemodynamic parameters, first analgesic request, total analgesic consumption, and the incidence of adverse effects were noted and recorded. Results Both groups showed comparable findings regarding age and weight. However, the number of patients requiring rescue analgesia showed a significant increase in the control group. Moreover, controls reported significantly earlier first analgesic requests. Both diclofenac and fentanyl consumptions were increased without neostigmine administration. Pain score was significantly better with neostigmine at 4 and 6 h after surgery. Hemodynamic parameters were almost comparable between the two groups. Conclusion Neostigmine appears to be an efficient adjuvant to local anesthetics when administered during PVB as it significantly improves its analgesic profile. Its administration should be encouraged in clinical practice.