Inguinal Surgery Research Articles

(130) Multicenter Study Comparing Stripping vs Ligation of Vas Deferens During Microscopic Denervation of Spermatic Cord in Men with Chronic Orchialgia Across the US

Abstract Introduction Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation while others perfer stripping of the Vas deferens to preserve the vasal artery, hence preserving vasculature to testis and possibly decreasing post operative congestion pain. Objective This multicenter study analyzes outcomes of patients that underwent MSCD by either stripping or ligating the vas deferens. Methods A retrospective chart review of 85 patients who underwent MSCD from 2020–2023 was performed. Patients’ demographics including history of prior surgical procedures was recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain or no improvement in pain. Results 85 patients underwent MSCD with a median (IQR) age of 36 (25.5–46.5) years and median duration of pain of 16 months. 37 patients underwent stripping of vas while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. 21(43.5%) patients had prior inguinal scrotal surgery in ligation group compared to 5 (13.5%) in the stripping group p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the 2 groups was similar (p=0.968), with similar post op complications (Table 1). Conclusions In men with intractable chronic scrotal content with no interest in preserving fertility, ligation or stripping of the vas deferens yields similar outcomes with regards to pain resolution. Both techniques are safe with no reports of any testicular atrophy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data.

Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. A total of 351,528 planned day-caseelective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.

(079) Stripping vs Ligation of Vas Deferens in Microscopic Denervation of Spermatic Cord in Men with Chronic Orchialgia: A Multicenter Study

Abstract Introduction Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation while others perfer stripping of the Vas deferens to preserve the vasal artery, hence preserving vasculature to testis and possibly decreasing post operative congestion pain. Objective This multicenter study analyzes outcomes of patients that underwent MSCD by either stripping or ligating the vas deferens Methods A retrospective chart review of 85 patients who underwent MSCD from 2020-2023 was performed. Patients’ demographics including history of prior surgical procedures was recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain or no improvement in pain. Results 85 patients underwent MSCD with a median (IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 months. 37 patients underwent stripping of vas while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. 21(43.5%) patients had prior inguinal scrotal surgery in ligation group compared to 5 (13.5%) in the stripping group p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the 2 groups was similar (p=0.968), with similar post op complications (Table 1). Conclusions In men with intractable chronic scrotal content with no interest in preserving fertility, ligation or stripping of the vas deferens yields similar outcomes with regards to pain resolution. Both techniques are safe with no reports of any testicular atrophy. Disclosure No.

Inguinal metastases of testicular cancer. Report of two cases

Case description: We present a series of two cases of patients presenting testicular cancer associated to inguinal masses. First, a 28 year-old male with history of bilateral orchidopexy presenting a right abscessed inguinal mass associated to a left testicular mass. Teratoma was diagnosed by the pathological anatomy. The second case is a 52 year-old male patient with a history of bilateral orchidopexy and right inguinal orchiectomy due to seminoma. A PET scan obtained during follow-up, showed a right inguinal mass with enhanced tracer uptake. A biopsy of such mass was performed, reporting metastasis of seminoma. Relevance: Due to the anatomy of the lymphatic drainage of the testes, retroperitoneal nodes constitute the first station for metastases. However, this drainage is modified in patients with history of inguinal or scrotal surgery, as anastomosis with inguinal vessels are formed. Clinical implication: Even though testicular cancer spreads through the lymphatic system to retroperitoneal nodes, in the rare cases that inguinal masses occur, these are considered as distant metastasis, changing the patient´s stage. Conclusion: Although inguinal metastases in testicular cancer are infrequent, they can be present in patients who underwent scrotal surgery. These should be considered as regional and not distant metastases.

Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study

ABSTRACT Background and aim The anesthetic management of premature neonates has many challenges resulting from immature physiological adaptations, the transitional circulation, increased presence of comorbidities and, prominently, the occurrence of apnea in preterm infants. The aim of the present study was to compare the efficacy and safety of levobupivacaine with hyperbaric bupivacaine for spinal anesthesia in preterm infants scheduled for inguinal hernia repair. Methods A double-blinded randomized, prospective, controlled study was conducted in a tertiary care pediatric surgery center from January 2017 to February 2021 where 60 preterm infants aged <45 weeks post-menstrual age (PMA) were scheduled for an elective inguinal hernia repair procedure. Preterm infants comforted by a sugared pacifier were divided randomly into two groups (30 infants each). Group I received spinal anesthesia with 1 mg/kg 0.5% hyperbaric bupivacaine, while group II received spinal anesthesia with1mg/kg o.5% levo-bupivacaine. The primary objective was to assess the hemodynamic stability, sensory and motor blockade of intrathecal levo-bupivacaine compared to hyperbaric bupivacaine in premature infants, and secondarily was to monitor the incidence of postoperative apnea, length of stay (LOS), and need for postoperative ventilator support. Results The onset of sensory block of spinal anesthesia in group II was statistically significantly faster than in group I (Group I = 2.6 ± 0.52 min, Group II = 2.3 ± 0.35 min, p = 0.0112), with a statistically significant rapid regression in group II compared to group I (group I = 86 ± 2.45 min, Group II = 84 ± 3.67 min, p = 0.016). Conclusions Levo-bupivacaine is an effective and safe agent for spinal anesthesia and has an equivalent potency to hyperbaric bupivacaine for motor blockade in premature infants requiring inguinal hernia repair surgery.

Analgesia strategy for inguinal hernia repair in children: a systematic review and network meta-analysis of randomized clinical trials based on regional blocks.

Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children. A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation. The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability. Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity. PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).

时效性激励联合快速康复模式在小儿腹股沟疝日间手术护理中的应用

时效性激励联合快速康复模式在小儿腹股沟疝日间手术护理中的应用

Challenges Encountered during Anaesthetic Management of a Patient with Congenital Methaemoglobinemia Posted for Laproscopic Inguinal Hernia Repair: A Case Report

Methaemoglobinemia is a rarely encountered haematological condition that can be congenital or acquired. Methaemoglobin is an abnormal type of haemoglobin that is oxidised and incapable of delivering oxygen to tissues. This can lead to cyanosis, hypoxia, acidosis, arrhythmias, and more, depending on the methaemoglobin concentration, and can be fatal. A thorough understanding of the disease process is essential to develop a suitable anaesthesia plan and prevent complications. Ensuring adequate tissue oxygenation, assessing oxygenation using appropriate monitoring tools, and avoiding trigger agents are the cornerstones of anaesthetic management. A co-oximeter is the gold standard for monitoring, as it detects and quantifies methaemoglobin levels. Methylene blue acts as an antidote, functioning as an oxidising agent that converts itself to leukomethylene blue, which reduces methaemoglobin back to haemoglobin. In the present case of a 60-year-old male, the authors present the anaesthetic management and challenges in a diagnosed case of congenital methaemoglobinemia undergoing laparoscopic inguinal hernia repair surgery. Methylene blue was administered prophylactically preoperatively. An arterial line was established before anaesthesia induction for close haemodynamic monitoring and quick blood gas and oxyhaemoglobin sampling, as a co-oximeter was not available. Adequate oxygenation during induction and emergence was ensured to prevent hypoxia, given the lower amount of normal haemoglobin in these patients. All potential trigger agents, such as nitrous oxide, local anaesthetics, nitrates, and metoclopramide, were avoided. The patient had an uneventful intraoperative and postoperative course and was discharged after one day.

Rescue designs in analgesic trials from 0 to 2 years of age: scoping review.

Pediatric analgesic trials are challenging, especially in newborns and infants. Following an FDA-academic consensus meeting, we analyzed pragmatic rescue designs in postoperative trials of local anesthetics, acetaminophen, opioids, and NSAIDs involving children ages 0-2 years and assessed surgical volumes to provide trial design recommendations. Searches of PubMed, Embase, CINAHL, The Cochrane Library, and Web of Science were conducted. A scoping approach identified trends in analgesic trials with an emphasis on randomized controlled trials (RCTs) utilizing immediate rescue designs. Age-specific surgical volumes were estimated from French national databases. Of 3563 studies identified, 23 RCTs used study medication(s) of interest and immediate rescue paradigms in children ages 0-2 years. A total of 270 studies met at least one of these criteria. Add-on and head-to-head designs were common and often used sparing of non-opioid or opioid rescue medication as a primary outcome measure. According to French national data, inguinal and penile surgeries were most frequent in ages 1 month to 2 years; abdominal and thoracic surgeries comprise approximately 75% of newborn surgeries. Analgesic trials with rescue sparing paradigm are currently sparse among children ages 0-2 years. Future trials could consider age-specific surgical procedures and use of add-on or head-to-head designs. IMPACT: Clinical trials of analgesic medications have been challenging in pediatrics, especially in the group from newborns to 2 years of age. Following an FDA-academic workshop, we analyzed features of completed analgesic trials in this age group. Studies using immediate rescue in placebo control, add-on, and head-to-head trial designs are pragmatic approaches that can provide important information regarding clinical effectiveness, side effects, and safety. Using a French national dataset with a granular profile of inpatient, outpatient, and short-stay surgeries, we provide information to future investigators on relative frequencies of different operations in neonates and through the first 2 years of life.

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis. We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events. This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies. The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries.

Is PONV still a problem in pediatric surgery: a prospective study of what children tell us.

Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.

Self-resolving, benign subcutaneous emphysema after bilateral open inguinal hernioplasty: a case report

Subcutaneous emphysema after surgery is commonly seen after thoracic or laparoscopic procedures but very rarely as a post-operative complication in open abdominal inguinal surgeries. Typically, if subcutaneous emphysema or abdominal crepitus is present after open abdominal surgeries it can mean grave underlying cause like hollow viscous perforation or gas gangrene which calls for prompt life-saving interventions. Here, we present a case of benign self-resolving post-operative subcutaneous emphysema after open bilateral inguinal hernioplasty with no apparent obvious underlying cause.

THU575 The Canonical Wnt/β-catenin Pathway Is Not Involved In Estrogen-induced Skeletal Muscle Fibrosis In A Mouse Model Of Inguinal Hernia

Abstract Disclosure: T. You: None. H. Zhao: None. T. Potluri: None. P. Yin: None. S.E. Bulun: None. Inguinal hernias affect up to 27% of elderly men, with approximately 800,000 inguinal hernia repair surgeries performed annually. While these procedures are often effective, a significant subset of hernias are refractory to treatment, resulting in high mortality, high recurrence, and chronic pain. Until recently, little research has been done examining the molecular mechanisms that drive hernia-associated lower abdominal wall weakening. Our lab previously created a transgenic mouse model expressing the human aromatase gene (Aromhum) and showed that male Aromhum mice produced high levels of estrogen in the lower abdominal muscle (LAM) tissue, leading to extensive LAM fibrosis, muscle atrophy, and hernia formation. Single-cell analysis of fibrotic LAM tissue in these mice showed high expression of estrogen receptor alpha (ERα) in LAM fibroblasts as well as upregulation of Wnt signaling pathways in these ERα-positive fibroblasts. The canonical Wnt/β-catenin signaling pathway has been implicated in fibroblast activation and fibrosis in multiple organs, including the lung, heart, and skin. Thus, we hypothesized that canonical Wnt/β-catenin signaling acts as a downstream mediator of ERα to cause LAM fibroblast activation, tissue fibrosis, and hernia. To test our hypothesis, we cultured primary ERα-positive LAM fibroblasts from Aromhum mice in the presence of estrogen with or without siRNA knockdown (KD) of β-catenin. However, KD of β-catenin under these conditions did not alter fibroblast proliferation as measured by EdU assay, nor did it alter expression of genes involved in fibroblast activation or extracellular matrix formation. Furthermore, administration of LGK974, a Wnt signaling inhibitor, in male Aromhum mice did not prevent hernia development, decrease hernia size, or decrease the extent of LAM fibrosis and muscle atrophy. Thus, we concluded that the canonical Wnt/β-catenin signaling pathway does not serve as a downstream mediator of estrogen-induced skeletal muscle fibrosis in our Aromhum mouse model of inguinal hernia. Further studies are needed to evaluate the role of Wnt/β-catenin signaling in other inguinal hernia models or in humans. Presentation Date: Thursday, June 15, 2023

Comparison of the Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block and Ilioinguinal-Iliohypogastric Nerve Block in Paediatric Patients After Inguinal Hernia Surgery: A Prospective Randomized Controlled Trial.

To compare the postoperative analgesic efficacy of quadratus lumborum block (QLB) and ilioinguinal-iliohypogastric nerve block (IIIHB) in paediatric patients who have undergone unilateral inguinal hernia surgery. This prospective randomized controlled study was designed in a single center and included 60 paediatric patients aged 2-7 years who had undergone inguinal hernia repair surgery and received an American Society of Anesthesiologists score of 1-2. Patients were randomized into two groups: those receiving ultrasound-guided QLB and those receiving IIIHB. The primary outcomes of the study were patients' face, legs, activity, cry, and consolability (FLACC) scores at 1, 2, 6, 12, and 24 hours post-surgery. The mean heart rate 15 and 30 minutes post-surgery in the QLB group was lower than that of the IIIHB group, and the difference at both times was statistically significant (P < 0.001). The mean FLACC score of the QLB group was lower than that of the IIIHB group at 6, 12, and 24 hours post-surgery, and the differences were statistically significant (P=0.004, P=0.006, and P < 0.001, respectively). Between the groups, there was no statistically significant difference in the number of patients who were administered rescue analgesics or oral ibuprofen, the time of first ibuprofen administration, or the frequency of complications (P=1.000, P=0.145, P=0.195, and P=1.000, respectively). Compared with IIIHB, QLB achieves superior postoperative analgesic effects in paediatric patients who have undergone inguinal hernia surgery, as evidenced by longer analgesic periods, lower pain scores, and lower analgesic consumption.

A randomized clinical study to compare postoperative pain relief in ilioinguinal nerve block versus transversus abdominis plane block following inguinal hernia repair surgery

Background: Inguinal hernia surgeries are associated with postoperative pain and discomfort. Transversus abdominis plane (TAP) block and Ilioinguinal/Iliohypogastric (IIIH) nerve blocks are widely used to control postoperative pain. In this study we have compared postoperative pain relief between TAP block and IIIH nerve block in the patients undergoing inguinal hernia surgery under spinal anesthesia. Aims and Objectives: The primary aim of this study was to compare postoperative pain relief of TAP block and IIIH block in patients undergoing inguinal hernia surgery. Secondary objectives were to observe hemodynamic parameters and to observe for postoperative side effects if any. Materials and Methods: Sixty patients of age group 18–65-year-old males, ASA grade I, II, were randomised into two groups TAP group (n=30) and IIIH group (n=30). TAP group received 30 mL of 0.25% ropivacaine TAP block and group IIIH received 20 mL, and wound infiltration with 10 mL of 0.25% ropivacaine. Duration of analgesia was recorded, visual analogue scale (VAS) score compared in first 24h postoperatively. Perioperative haemodynamic parameters were recorded. Results: VAS score was found significant at 1, 2, 3, 4, 5, 8, 10, 16 h (P&lt;0.001). The mean duration of analgesia was found to be 4.64±1.16 h and 6.3±1.84 h for IIIH group and TAP group respectively which was statistically significant (P&lt;0.001). Haemodynamic were stable and no complication was there in both the groups. Conclusion: As a part of multimodal analgesia regimen both TAP block and IIIH block provided good pain relief postoperatively in patients undergoing inguinal hernia. In this study TAP block provided prolonged pain relief than IIIH block after inguinal hernia repair.

A STUDY OF SINGLE DOSE PRE-OPERATIVE ANTIBIOTIC PROPHYLAXIS VERSUS CONVENTIONAL MULTIPLE DOSE POST OPERATIVE ANTIBIOTIC THERAPY IN INGUINAL HERNIA REPAIR SURGERY

Background: Elective inguinal hernioplasty is considered to be a clean procedure which does not require antibiotic prophylaxis but prosthetic material like polypropylene mesh is routinely used during procedure. This makes the topic debatable because the use of prosthetic material like mesh increases the risk of surgical site infection. The incidence of surgical site infection (SSI) after inguinal hernioplasty ranges from 0% to 14 % in international literature. It is also more controversial whether single dose antibiotic or conventional multiple doses of antibiotics for 5 to 7 days is effective. Hence our study aims to compare the efficacy of single dose versus multiple dose antibiotic prophylaxis in open inguinal hernioplasty Patients And Methods: A total of 120 cases of inguinal hernia admitted in Gadag Institute of Medical Sciences in the Department of general surgery underwent Lichtenstein tension free mesh hernioplasty and received either pre-op single dose or post-op multiple dose antibiotic therapy. The two groups were then compared for SSI. Conclusion: Our study shows that a single dose of antibiotics given half an hour prior to open surgery in elective uncomplicated inguinal hernia repair surgery is as effective as multiple doses of antibiotics post-operatively in preventing post-operative surgical site infection.

Analgesic Sparing Effect of Dexamethasone with Levobupivacaine in Quadratus Lumborum Block in Patients Undergoing Unilateral Inguinal Hernia Repair

Abstract Background The QLB is an effective analgesic technique for various abdominal wall incisinos. The QLB covers T7 to L2 dermatomes. Levobupivacaine is a long-acting LA agent, commonly used for peripheral nerve block due to its better safety profile than that of bupivacaine. Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction and lesser incidence of nausea and vomiting. Objective To assess the analgesic sparing effect of adding dexamethasone to levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair under general anesthesia. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this prospective double blind randomized clinical trial study was conducted in Ain Shams University Hospitals. Sixty patients scheduled for elective ingunial surgeries under general anesthesia were included in this study. Results Our study did not have any complications associated with the use of dexamethasone with levobupivacaine in QLB. Type 1 QLB failed to provide postoperative analgesia in surgeries involving dissection in the retroperitoneal area as there were high chances of damaging the thoracolumbar fascia. Conclusion The addition of dexamethasone to levobupivacaine in QLB in unilateral inguinal hernia repair surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to levobupivacaine alone group.

Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP.

Postoperative seroma is the most common minor complication after inguinal hernia repair surgery and can have negative consequences. The objective of this study was to identify potential risk factors for postoperative seroma. This study consecutively included 354 elderly patients with inguinal hernia who underwent laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP). Seroma diagnosis was conducted by the same experienced surgeon based on the physical examinations combined with ultrasound. Risk factors for seroma were identified through univariate analysis and subsequently included in the binary multivariate logistic regression model. A total of 40 patients experienced postoperative complications of seroma, with an incidence rate of 11.3% (40/354). The binary logistic regression analysis revealed that obesity (OR: 2.98, 95% CI: 1.20-7.41, P = 0.018), disease duration ≥ 4.5 years (OR: 4.88, 95% CI: 2.14-11.18, P < 0.001), albumin-fibrinogen ratio (AFR) level < 9.25 (OR: 6.13, 95% CI: 2.00-18.76, P = 0.001), and modified frailty index (mFI) score ≥ 0.225 (OR: 6.38, 95% CI: 2.69-15.10, P < 0.001) were four independent risk factors for postoperative seroma. Obesity, prolonged disease duration, decreased AFR level, and increased mFI score independently predict postoperative seroma after laparoscopic TAPP.

A reliable and replicable test protocol for the mechanical evaluation of synthetic meshes

Despite the worldwide spread of surgical meshes in abdominal and inguinal surgery repair, the lack of specific standards for mechanical characterization of synthetic meshes, used in hernia repair and urogynecologic surgery, makes performance comparison between prostheses undoubtedly difficult. This consequently leads to the absence of acknowledged specifications about the mechanical requirements that synthetic meshes should achieve in order to avoid patient discomfort or hernia recurrences.The aim of this study is to provide a rigorous test protocol for the mechanical comparison between surgical meshes having the same intended use. The test protocol is composed of three quasi-static test methods: (1) ball burst test, (2) uniaxial tensile test, and (3) suture retention test. For each test, post-processing procedures are proposed to compute relevant mechanical parameters from the raw data. Some of the computed parameters, indeed, could be more suitable for comparison with physiological conditions (e.g., membrane strain and anisotropy), while others (e.g., uniaxial tension at rupture and suture retention strength) are reported as they provide useful mechanical information and could be convenient for comparisons between devices. The proposed test protocol was applied on 14 polypropylene meshes, 3 composite meshes, and 6 urogynecologic devices to verify its universal applicability towards meshes of different types and produced by various manufacturers, and its repeatability in terms of coefficient of variation.The test protocol resulted easily applicable to all the tested surgical meshes with intra-subject variability characterized by coefficient of variations settled around 0.05. Its use within other laboratories could allow the determination of the inter-subject variability assessing its repeatability among users of alternative universal testing machines.

Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial

Background &amp; Objective: Preemptive analgesia aims at minimizing the development of central sensitization thereby decreasing postoperative pain and analgesic requirements. Various drugs have been used for this purpose. Tapentadol, is a newer centrally acting analgesic which is effective in moderate to severe pain. The aim of this study was to analyze the effect of preoperative oral tapentadol upon postoperative analgesia and analgesic requirements in patients undergoing inguinal hernia surgeries. Methodology: One hundred adult patients undergoing elective unilateral inguinal hernia repair were randomized into two groups of fifty each. Group P received placebo tablets and Group T received tapentadol (100 mg) tablets orally 30 min before anesthesia. All patients received spinal anesthesia and the duration of postoperative analgesia and analgesic consumption in the first postoperative day was recorded. Diclofenac was administered when the patients demanded analgesia. Results: Time for first analgesic demand was significantly delayed in Group T as compared to Group P (328.00 ± 129.71 vs. 252.00 ± 101.38 min, P = 0.017) and the total analgesic consumption of diclofenac was also less than in the placebo group (73.33 ± 28.57 mg vs. 95.00 ± 31.30 mg; P = 0.006). No adverse events were observed in either group. Conclusion: Preemptive oral tapentadol is effective for minimizing postoperative pain and analgesic requirement in patients undergoing inguinal hernia surgeries under spinal anesthesia. Key words: Anesthesia, Spinal; Tapentadol; Hernia surgery; Analgesia, Postoperative Citation: Vadhanan P, Rajendran I, Kumar V. Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial. Anaesth. pain intensive care 2023;27(3):356−359; DOI: 10.35975/apic.v27i3.2230 Received: April 15, 2023; Reviewed: April 29, 2023; Accepted: May 10, 2023