Inguinal Ring Research Articles

Features of recurrence and contralateral metachronous inguinal hernia (CMIH) in the patients underwent laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia.

Recurrence and contralateral metachronous inguinal hernia (CMIH) are important postoperative complications in patients with inguinal hernia (IH) who undergo laparoscopic percutaneous extraperitoneal closure (LPEC). This study aimed to evaluate the incidence and causes of recurrence and CMIH after LPEC. Among the included patients, 2484 hernias were included in the analysis of recurrence. CMIH was analyzed in 2094 cases with unilateral IH without a history of contralateral IH. Overall, 21 hernias (0.85%) recurred and seven patients (0.34%) experienced CMIH. Based on the video inspection, injury and skipping of the peritoneum were suspected as the cause of recurrence in eight cases, while loose ligation was suspected in five cases. The cause of recurrence could not be predicted in the remaining eight patients. Of the seven patients with CMIH, three had a mild depression around the internal inguinal ring at the first surgery. In the remaining four CMIH cases, no noteworthy findings were noted around the internal ring. More than half of the recurrences, in which skipping of the peritoneum and loose ligation were suspected, could have been prevented by secure ligation during the first surgery. Extending the indications of prophylactic surgery for shallow depressions may reduce CMIH.

Etiopathogenesis of oblique inguinal hernia, new concept of its surgical treatment, postoperative complications and their correction

Objective. To study the results of applying a new conceptual approach to the surgical treatment of oblique inguinal hernia in order to reduce the frequency of its recurrence and preserve the function of the male reproductive system. Materials and methods. The study is based on the results of topographic and anatomical examination of 50 unfixed male cadavers on the 1st day after death. As clinical material, 144 patients who were inpatients in the surgical department were involved in the study. Results. Patients of the main group (n=71) underwent hernioplasty according to the developed method. The control group included 73 patients operated on by the Lichtenstein method. The etiopathogenetic basis of oblique inguinal hernia and the causes of its recurrence, the frequency of which after open and laparoscopic use of mesh implants is 5 – 15%, were studied. It is after the use of these implants in the Lichtenstein operation that a complication no less important than recurrence occurs, which is a decrease or even loss of male reproductive function. Conceptually, the new approach is to eliminate the deep inguinal ring, move the spermatic cord under the transverse fascia, and create a new inguinal ring. Conclusions. The proposed method of hernioplasty has significant advantages over the Lichtenstein method of surgery, which are to prevent recurrence of the disease and preserve male reproductive function.

Liposarcoma del cordón espermático

Introduction: liposarcoma of the spermatic cord (LSC) is a rare condition and accounts for about 3 to 7% of all paratesticular sarcomas. A case is presented in an 80-year-old patient who consulted for a left inguinoscrotal painless swelling, that had been present for several years. Physical examination revealed a soft left hemiscrotal tumor that appeared not to be adherent to the testicle. Ultrasonography showed a solid, heterogeneous hyperschoic paratesticular mass with central calcifications and peripheral hypervascularity. During surgery, a diffuse lipomatous tumor was found in the spermatic cord on the superior pole of the left testicle, separated from it. Anatomopathological examination revealed a well-differentiated liposarcoma of the spermatic cord. Discussion: this neoplasm features a slow-growing palpable paratesticular mass. This site of occurrence is rare and represents 7 to 10% of all scrotal tumors. Imaging differentiation between LSC and benign lesions is sometimes challenging. Surgical treatment should include radical orchiectomy wide local excision, and spermatic cord and inguinal ring surrounding soft tissue resection. Conclusion: spermatic cord liposarcoma is a rare and unusual mesenchymal tumor and should be considered among the differential diagnoses of scrotal tumors.

ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes

Abstract Aim SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015). We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique. Methods Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023). The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above. A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure. Results The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children.

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

The downregulation of genes encoding muscle proteins have a potential role in the development of scrotal hernia in pigs.

Testicular descent is a physiological process regulated by many factors. Eventually, disturbances in the embryological/fetal development path facilitate the occurrence of scrotal hernia, a congenital malformation characterized by the presence of intestinal portions within the scrotal sac due to the abnormal expansion of the inguinal ring. In pigs, some genes have been related to this anomaly, but the genetic mechanisms involved remain unclear. This study aimed to investigate the expression profile of a set of genes potentially involved with the manifestation of scrotal hernia in the inguinal ring tissue. Tissue samples from the inguinal ring/canal of normal and scrotal hernia-affected male pigs with approximately 30 days of age were used. Relative expression analysis was performed using qPCR to confirm the expression profile of 17 candidate genes previously identified in an RNA-Seq study. Among them, the Myosin heavy chain 1 (MYH1), Desmin (DES), and Troponin 1 (TNNI1) genes were differentially expressed between groups and had reduced levels of expression in the affected animals. These genes encode proteins involved in the formation of muscle tissue, which seems to be important for increasing the resistance of the inguinal ring to the abdominal pressure, which is essential to avoid the occurrence of scrotal hernia. The downregulation of muscular candidate genes in the inguinal tissue clarifies the genetic mechanisms involved with this anomaly in its primary site, providing useful information for developing strategies to control this malformation in pigs and other mammals.

Modifications of surgical techniques in laparoscopic percutaneous extraperitoneal closure of inguinal ring for childhood inguinal hernia to achieve zero recurrence and zero subcutaneous stitch granuloma.

To present our technical modifications of single incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of the internal inguinal ring (IIR) for pediatric inguinal hernia (PIH). The prospectively collected data of all children diagnosed with PIH undergoing SILPEC at our center from 2016 to 2023 were reviewed and divided into two groups for result comparison: Group A: before and Group B: after the implementation of full modifications. Our modifications included using a nonabsorbable monofilament suture, creating a peritoneal thermal injury at the internal inguinal ring (IIR), employing a cannula to ensure the suture at the IIR ligates only the peritoneum, and double ligation of the IIR in selected cases. 1755 patients in group A and in group B (1 month to 14 years old) were enrolled. There were no significant differences regarding baseline patient characteristics between the two groups. At a median follow-up of 40 months, the rate of recurrent CIH and subcutaneous stitch granuloma (SSG) was 2.3% and 1.5% in group A vs. 0% and 0% in group B (p < 0.001). There were no hydroceles, no ascended or atrophic testis. Our SILPEC technical modifications can achieve zero recurrence and zero SSG for PIH.

Familial cross-testicular ectopia: a clinical case report

Cross or transverse testicular ectopia is a rare congenital condition of the reproductive system that involves the migration of a testicle into the opposite inguinal canal, along with the presence of an inguinal hernia on the same side as the ectopic testicle. In the modern literature, there are discussions about diagnostic issues, particularly the use of ultrasound scanning and magnetic resonance imaging to diagnose this condition. However, it is the results of laparoscopic examination that determine the most accurate criteria for surgical treatment. Many publications discuss the choice of surgical tactics, including separate transabdominal orchiopexy, with or without laparoscopic assistance; transeptal orchiopexy on both sides of the scrotum; and rare cases of orchiopexy for both testicles on one side of the scrotum. Ultimately, the choice of surgery depends on the individual characteristics and needs of the patient, and the surgeon should make the decision based on these factors. The article describes, for the first time, a case of familial testicular ectopia with bilateral inguinal hernia in siblings who underwent surgery using laparoscopic assistance. The method used was single-trocar laparoscopic access with transscrotal transeptal orchiopexy and simultaneous bilateral puncture of the inguinal ring and suture. During the long-term follow-up period (50 and 20 months after surgery) in both siblings, there were no signs of malformation or atrophy of the gonads.

Gubernaculum-sparing orchiopexy versus gubernaculum excision; A randomized trial on success and atrophy rates

Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy. This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman's tests were used where appropriate. Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25±17 months (range 6-84). The mean testis size of cases intraoperatively was 460±226, 396±166, and 520±258mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p<0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p=0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p=0.002). Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint. https://irct.ir/trial/58842.

CYSTIC INGUINAL LYNFHANGIOMA IN ADULT FEMALE

Abstract Background To present a clinical case of cystic inguinal lymphangioma in an adult female, an atypical site and age of presentation. Method A 42-year-old woman was referred for consultation due to persistent pain and swelling in the right inguinal region, with initial suspicion of inguinal hernia. A mobile, irreducible mass without protrusion during the Valsalva maneuver was identified. Faced with diagnostic uncertainty, inguinal ultrasound and magnetic resonance imaging were requested, revealing a cystic lesion indicative of cystic inguinal lymphangioma. Results Elective surgery was decided. A right inguinal incision revealed a cystic tumor extending along the inguinal canal from the labium majus to the preperitoneal space. Complete excision was performed, requiring section of the round ligament. Subsequently, closure of the deep inguinal ring was conducted, with the conjoint tendon approximated to the inguinal ligament using a continuous suture of slowly absorbable monofilament. Hernioplasty with self-adhesive polypropylene mesh was employed to repair the inguinal defect. The procedure was carried out in the ambulatory major surgery program. At the one-month post-surgery follow-up, the patient exhibited satisfactory recovery with no signs of clinical recurrence. Histopathological examination of the surgical specimen confirmed the diagnosis of cystic inguinal lymphangioma, with no additional pathological findings. Conclusion Cystic lymphangioma is a benign and uncommon malformation of the lymphatic system. It should be considered in cases of inguinal masses with progressive growth whose examination is not consistent with an inguinal hernia. Ultrasound is the imaging test of choice, with definitive diagnosis confirmed by histopathology. Surgery with complete resection is recommended due to the risk of recurrence.

Accuracy of ultrasonography in predicting contralateral patent processus vaginalis compared with laparoscopic findings in children

ObjectiveThe study aims to evaluate the usefulness of preoperative ultrasonography (US) at the internal inguinal ring level in predicting contralateral patent processus vaginalis (CPPV).MethodsThis is a prospective study of patients who presented with unilateral inguinal hernia and underwent laparoscopic hernia repair and contralateral side exploration. The gender, age, initial presenting side, and the preoperative width of the low echoic region at the internal ring (WLIR) of the contralateral side that was determined using US and laparoscopic findings were recorded. The preoperative diagnosis of CPPV was considered if the WLIR is > 4 mm. We compared laparoscopic with US findings.ResultsThis study included 30 patients with a median age of 3.5 years (range, 25 days to 10 years), with 3 females and 27 males. The preoperative US and laparoscopic diagnoses of the contralateral side were concordant in 19 (63.3%) and discordant in 11 (36.6%) patients. US showed a sensitivity of 50.00%, specificity of 72.22%, and accuracy of 63.3% in diagnosing CPPV.ConclusionsMeasuring the WLIR by US was inadequate for an accurate CPPV diagnosis in our study. Therefore, more distinctive US criteria are required for a proper CPPV diagnosis.

Does the contralateral testicular volume decide the need for diagnostic laparoscopy in cases of unilateral impalpable undescended testis?

BackgroundThis study aimed the evaluation of the value of the calculated volume of a normal testis to predict the status of its contralateral impalpable side and hence decide the importance of laparoscopic exploration.MethodsPatients with unilateral impalpable undescended testis – as confirmed by clinical and sonographic examination- were enrolled in our prospective interventional study between November 2018 and August 2022 at Elshatby University Hospital, Faculty of Medicine, Alexandria University. The volume and three-dimensional diameter of the normal contralateral testis were measured by the pre-operative US using the formula: Volume = L x W x H x π/6, where L is the length, W is the width, H is the height, and was correlated with the intra-operative laparoscopic findings.ResultsSeventy-six patients were included in our study. The age of the studied patients ranged between 6 months and 4 years with a mean of 2.17 ± 1.30 years; most of them were between one and three years old. Forty-six patients (60.5%) have left-sided impalpable testis and 30 patients (39.5%) have right-sided impalpable testis. The calculated volume of the contralateral normal testis was significantly larger in those patients who had both blind ending vas and vessels (0.89 ± 0.16) and in those who had an atrophic testis passing through the deep inguinal ring (DIR) –which was excised through the inguinal region- (0.83 ± 0.20) than in those patients who had their testes intra-abdominal (0.53 ± 0.18) or passing through the DIR to the inguinal region (0.80 ± 0.19). (Kruskal Wallis test; p < 0.001*).ConclusionsThe calculated sonographic volume of a normal testis can predict the status of its contralateral impalpable side significantly with sensitivity & specificity of 75.0% & 88.89% respectively and a cut-off point of ≤ 0.674; hence, helps in parent counselling preoperatively.Trial registrationName of the registry: Clinicaltrials.gov PRS. Trial registration number: NCT05933811. Date of registration: 10-7-2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov.

Inguinal hernia containing pyometra, jejunum and ileum in a dog

AbstractAn 8‐year‐old, intact, female, mixed breed dog was presented due to vomiting, constipation and inguinal swelling. Haematology and biochemistry revealed leukocytosis. A lateral abdominal radiograph revealed a soft tissue opacity, round to ovoid mass, in the caudal inguinal region. Gas‐filled intestinal loops were present at the cranial aspect of the mass. Further imaging was declined. Thus, an exploratory laparotomy was performed. An inguinal hernial sac containing fluid, a closed pyometra and intestinal loops was revealed. The contents of the inguinal hernia were returned to the abdominal cavity, an ovariohysterectomy was performed via a median laparotomy and the inguinal ring was closed, leaving the caudal aspect open. The dog's recovery was uneventful. To the authors’ knowledge, this is the first reported case of pyometra inguinal herniation in a dog with concurrent herniation of the jejunum and ileum.

Extended pelvic lymph node dissection during robotic prostatectomy: antegrade versus retrograde technique

BackgroundRobot-assisted radical prostatectomy (RARP) with extended lymphadenectomy (ePLND) is the gold standard for surgical treatment of prostate cancer (PCa). Recently, the en-bloc ePLND has been proposed but no studies reported on the standardization of the technique. The aim of the study is to describe different standardized en-bloc ePLND, the antegrade and the retrograde ePLND, and to compare their surgical and oncological outcomes.Materials & MethodsFrom January 2018 to September 2019, all patients subjected to RARP plus ePLND by one single surgeon were enrolled. ePLND was performed in a retrograde fashion by starting laterally to the medial umbilical ligament from the internal inguinal ring proceeding towards the ureter, or in an antegrade way by starting from the ureter at its crossing with the common iliac artery and proceeding towards the femoral canal. Patients’ demographic data, clinical and surgical data were collected. Each en-bloc ePLND was categorized as “efficient” or “inefficient” by the operator, as surrogate of surgeon’s satisfaction.ResultsAntegrade and retrograde ePLND were performed in 41/105 (group A) and 64/105 (group R) patients, respectively. The two groups (A vs R) had similar median (IQR) number of lymph nodes retrieved [20 (16.25–31.5) vs 19 (15–26.25); p = 0.18], ePLND time [33.5 (29.5–38.5) min vs 33.5 (26.5–37.5) min; p = 0.4] and post-operative complications [8/41 (19.5%) vs 9/64 (14.1%); p = 0.61]. In group A, 3/41 (7.3%) clinically significant lymphoceles were reported, while 1/64 (1.6%) in group R (p = 0.3). 33/41 (80.5%) and 28/64 (44%) procedures were scored as efficient 59 in group A and R, respectively (p = 0.01). On multivariate regression, only BMI (B = 0.93; 95% CI 0.29–1.56; p = 0.005) was associated with a longer ePLND time.ConclusionsThe study indicates that antegrade and retrograde en-bloc extended pelvic lymph node dissection (ePLND) have comparable surgical and oncologic outcomes, supporting the importance of standardizing the procedure rather than focusing on the direction. Although both techniques aligned with current evidence regarding lymph node invasion and complications, the antegrade approach was subjectively perceived as safer due to early isolation of critical anatomical landmarks. Encouragement for the use of en-bloc ePLND, regardless of direction, is emphasized to improve prostate cancer staging accuracy and procedural standardization.

A case of indirect inguinal bladder hernia treated with laparoscopic transabdominal preperitoneal repair with high peritoneal incisional approach

BackgroundInguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years.Case presentationA 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient’s postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.ConclusionPreoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.

Indirect inguinal herniation of the urinary bladder in a Shetland pony foal

SummaryA 6‐week‐old male Shetland pony was presented with pollakiuria and a scrotal mass. The diagnostic procedures conducted included a thorough clinical examination, external palpation, a scrotal ultrasonographic examination and urinary catheterisation. These revealed an indirect herniation of the urinary bladder into the tunica vaginalis. Subsequently, the case was managed surgically with a partial cystectomy through an inguinal approach. Bilateral castration was performed with an additional closure of the superficial inguinal ring. Five months post‐surgery, a routine telephone questionnaire highlighted no postoperative concerns. Gross examination of the inguinal region revealed no abnormalities and the foal was maturing as expected.

Postoperative outcomes in patients after modified inguinal reconstruction: An observational cohort study

Background. Despite major progress in surgical care, the need remains to reduce the number of recurrences in the postoperative period in inguinal hernia patients and to improve their quality of life (QoL). To this end, the development of a technique for hernia repair, which would decrease dependence on the availability of consumables, appears promising. We present the surgical outcomes of inguinal hernia patients treated by the technique of tension-free hernioplasty using implants and auto-tissue flaps. Objective. To develop a technique for hernia repair with a reduced dependence on the availability of consumables, which could decrease the number of recurrences in the postoperative period in inguinal hernia patients and to improve their QoL indicators. Methods. An observational cohort study of 759 patients with inguinal hernias aged 18 years and older was conducted. The patients underwent treatment at the Ryazan City Clinical Hospital No. 11 and the Ryazan Region Clinical Hospital in the period from 2006 to 2022. The main group included 39 patients, who were operated by the Desarda technique modified by the authors. The modification consisted in the formation of a flap from the aponeurosis of the external oblique muscle, covering the seminal canal, with fixation of its free end to the inguinal ligament. The control group included 720 patients, 454 and 266 of whom were operated by the Bassini and Lichtenstein techniques, respectively. In order to evaluate the surgical outcomes, a comprehensive examination was performed, including collection of complaints, anamnesis, examination of the postoperative suture, and inguinal region. This included the size, shape, and hernia repairability, if any, dilation of the external inguinal ring, skin condition, painfulness and cough tremor at palpation, and ultrasound examination of the inguinal region. QoL was assessed using the SF-36 (Short Form) questionnaire. Statistical analysis was performed using the Statistica 13 software package (StatSoft, USA). Results. The patients of the main and control groups were divided into those who were admitted as planned and emergency patients. Long-term hernioplasty outcomes in the planned surgery patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 24 (0.00%); recurrences after the Bassini technique — 44 out of 310 (14.20%); recurrences after the Lichtenstein technique — 7 out of 181 (3.87%). Long-term hernioplasty outcomes in the emergency patients were as follows: recurrences after the Desarda technique modified by the authors — 0 out of 15 (0,00%); recurrences after the Bassini technique — 31 out of 144 (21.53%); recurrences after the Lichtenstein technique — 4 out of 85 (4.70%). In the planned surgery patients of the main group, 5 QoL indicators were statistically significantly higher in relation to at least one method of hernioplasty of the control group. In the emergency patients, this number was 4 indicators. The absence of recurrences, both in planned and emergency patients, was associated with the non-invasiveness of auto-tissue, preserved non-tension, reduced dependence on the availability of consumables, and improved QoL of patients with inguinal hernias. These factors determine the advantages of the Desarda technique modification proposed by the authors. Conclusion. The application of the Desarda technique modified by the authors reduced the number of recurrences in the postoperative period in inguinal hernia in both planned surgery and emergency patients, improving their QoL. The suggested method of herniorrhaphy ensures reduced dependence on the availability of consumables.

Comparison of the results of open repair and laparoscopic repair with the PIRS method in the treatment of hydrocele in children.

Hydrocele is a result of intraperitoneal fluid filling into the scrotum through the patent processus vaginalis (PPV). While the traditional approach of pediatric hydrocele has been open repair (OR) for years, laparoscopic repair (LR) of hydrocele has been accepted worldwide after the proven efficacy of laparoscopy. The purpose is to compare the outcomes of both techniques in a single center. We retrospectively analyzed the clinical data of all the patients who underwent hydrocele repair from August 2016 to November 2022. In our center, the standard approach was OR in hydrocele until the November of 2021. Starting from this date, LR has begun to be preferred, as the experience has increased and its success has been observed. In the LR group, single-port percutaneous internal ring suturing technique was performed. The data of 113 patients (OR 58.4% (n = 66), LR 41.6% (n = 47)) were collected. In preoperative examination, 12.4% (n = 14) patients were diagnosed as communicating and 87.6% (n = 99) non-communicating hydrocele. Intraoperatively, 65.5% (n = 74) patients were communicating and 34.5% (n = 39) were non-communicating. Total recurrence rate was 7% (n = 8). The OR group experienced a recurrence rate of 10.6% (n = 7), while the LR group experienced 2.12% (n = 1). Laparoscopy may reveal intrabdominal connection of hydrocele better than open approach. It provides a high quality view of both inguinal rings and has the advantages of minimally invasive surgery.

(194) Midline Reservoir Placement of Infrapubic Inflatable Penile Prosthesis: A Step-by-Step Surgical Technique

Abstract Introduction Various alternative placements of inflatable penile prosthesis (IPP) reservoirs have been previously documented, differing from the traditional retroperitoneal placement in the Space of Retzius. Pelvic trauma, history of surgery in the pelvic region, and atypical anatomy can necessitate an alternative location for implantation of the IPP reservoir. The midline placement of the IPP reservoir provides numerous advantages in outcomes, patient experience, and versatility of implantation. This video demonstrates the surgical procedure for midline placement of the IPP reservoir. Objective We outline a surgical technique to place the IPP reservoir in an alternative midline location. Methods The patient was instructed to void his bladder prior to the procedure to circumvent Foley catheter insertion. A 2.5 cm-wide horizontal incision was made 2 finger widths cranially to the dorsal aspect of the base of the penis. The surgeon’s index finger was used for blunt dissection along the linea alba above the pubic tubercles. A tonsil clamp is used to pierce the rectus fascia at the midline, below the arcuate line, to leave a defect just wide enough to accommodate a 70 mm nasal speculum. The surgeon’s finger is used to assess the space to determine if a 9/10 mm Hegar dilator is necessary to expand the avascular space by sweeping it parallel to the fascia. The speculum is inserted and positioned with the blades pointed cranially parallel to the facial axis and the handles pointed superiorly. The reservoir is prepared and delivered into this space using a metal pediatric Yankauer suction tip through the open blades of the nasal speculum. A syringe filled with saline solution is connected to the reservoir tubing, and the fluid is transferred completely to the reservoir and the tubing is clamped. The tubes originating from the reservoir and implant cylinders are both clamped, trimmed to length, and connected to each other in a watertight fashion to permit the bidirectional flow of saline solution. Proper IPP cylinder inflation is tested prior to closing the incision. Results The reservoir is thus safely deployed cranially to the pubic bone and avoids interfering with the urinary bladder. No complications were observed in this patient, and he was discharged on the same day. Conclusions The midline surgical placement of the reservoir during the infrapubic implantation of an inflatable penile prosthesis is a safe and effective alternative placement for patients with prior pelvic surgery, injuries, or atypical pelvic anatomy. Patients with compromised pelvic, abdominal, or inguinal regions due to hernia repair, patulous inguinal rings, or dense lateral pelvic scarring stand to benefit the most from this reservoir placement. This procedure outlines the surgical steps of midline reservoir placement for new IPP implantation or relocation during a revision procedure. Disclosure No.

Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report

BackgroundHydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established.Case presentationA 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision.ConclusionsLaparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.