Internal Ring Research Articles

Exergetic efficiency analysis of impingement jets integrated with internal conical ring roughened solar heat collector

ABSTRACT In the present work, the exergetic efficiency of a solar heat collector with air jet impingement on an internal conical ring-roughened absorber plate has been analytically determined. The motivation behind the present investigation is to determine the performance of the selected heat transfer enhancement technique in order to bring out the feasibility of the investigation. The geometric parameters of the absorber plate and the jet plate that have been examined are derived from the internal conical ring height , inlet flow diameter , internal print diameter of ring , streamwise pitch , and spanwise pitch . The optimum values of the roughness parameters have been determined. The optimal values of geometric parameters that fetch the highest for in the analyzed range between 4000 and 12,900 are a relative roughness height of , a ratio of internal flow diameter to internal print diameter of ring of , a ratio of ring diameter to ring height of , a relative streamwise pitch of , and a relative spanwise pitch of . As compared with smooth duct, the value of the solar heat collector investigated was found to be enhanced 2.2 times higher under similar analytical conditions.

Validation of experimental results with theoretical by using ANSYS workbench on vertical tube subjected to natural convection heat transfer without internal obstacles

Experimental and theoretical work by using ANSYS workbench on the vertical tube without internal rings is presented. The dimensions of the test section are: internal diameter of the tube (D) is 45 mm. thickness of the tube are 3.8 mm, length of test section (L) as 450 mm. The ratio between length and diameter (L/D) is 10. The test section is insulated with five layers of insulating material. The tube is heated by electric supply to a coil, which is wound around the test section. Constant heat flux is maintained in the tube ranging from 250 to 3341 W/m2. Observations are conducted on the vertical tube without internal rings inside it. Experimental results are found from the experimental set up and the theoretical results are obtained by using ANSYS workbench. The basic intent of this work is to present the heat transfer behavior along the length of the tube as well as at exit condition of the tube. Theoretical results using ANSYS workbench were validated with the experimental data. The work concluded that results of the theoretical investigation match well with the experimental data.

The emergent past: past natural and human disturbances of trees can reduce their present resistance to drought stress

Forest tree growth is primarily explained, modelled, and predicted depending on current age or size, environmental conditions, and competitive status in the stand. The accumulated size is commonly used as a proxy for a tree's past development. However, recent studies suggest that antecedent conditions may impact present growth by epigenetic, transcriptional, proteomic, or metabolic changes alongside physiological and structural properties. Here, I analysed the ecological memory effect embedded in the xylem as a tree-ring structure. I used 35 mature Norway spruces (Picea abies (L.) H. Karst.) and 36 European beeches (Fagus sylvatica L.) of the Kranzberg Forest water retention experiment KROOF in South Germany to scrutinise how their past development determines the growth of control plots and plots with 5-year water retention. I hypothesised that the current size and growing conditions determine tree growth and drought stress resistance. Metrics quantifying the trees’ recent and past growth, and correlation and linear mixed models with random effects revealed the following ecological memory effects. (1) For both species, the progressive growth course, low inter-annual growth variation in the long term, and low growth deflections in the recent past increased the growth resistance to drought. (2) The correlation between the past growth metrics and current stress reactions revealed that legacy effects could reach back 5–30 years; I found short- and long-term ecological memory. (3) Parameters of model prediction of the basic model with only size as a predictor of tree growth could be improved. The results suggest differences in the internal stem structure and ring pattern cause-specific differences in the trees' functioning and growth. I conclude that a long-term progressive increase and low variation in ring width may improve water conduction and reduce embolism in both species. Annual growth variation and low growth events in the recent past may have primed the morphology and allocation of the Norway spruce to better resist drought. The strong reduction in current growth, drought resistance by irregular growth, and past growth disturbances reveal a memory effect embedded in the tree ring pattern, suggesting further exploration and consideration in tree monitoring, growth modelling, and silvicultural prescriptions.

Single Incision Laparoscopic Percutaneous Extraperitoneal Closure of Internal Ring for Incarcerated Inguinal Hernia in Children: A Single Center Experience with 104 Cases.

Introduction: The aim of this report is to present our technique and outcomes of single incision laparoscopic percutaneous extraperitoneal closure of internal ring (SILPEC) for incarcerated inguinal hernia (IIH) in children. Patients and Methods: The medical records of all children undergoing emergency SILPEC for IIH after unsuccessful attempted manual reduction between June 2016 and September 2020 at our center were reviewed. For SILPEC, two trocars 3.5-6 mm were placed through a single umbilical incision. A 17G epidural needle and a small wire-lasso were used for extraperitoneal closure of the internal ring. Results: From a total of 2904 consecutive patients with inguinal hernia (IH) undergoing SILPEC, 104 patients (3.6%) had IIH. There were 84 boys and 20 girls with a median age of 18.5 months (ranged 1 month to 11 years). At the time of surgery under general anesthesia IIH was found to be spontaneously reduced in 26.9%; the hernia contents were bowel in 52.9%, great omentum in 13.5%, and ovary in 6.7% of the patients. All hernias were successfully reduced without additional ports or conversion to open surgery. Patent contralateral processus vaginalis (PCPV) was detected intraoperatively in 44.2% of the cases. The median operative time was 24 minutes for unilateral and 30 minutes for bilateral procedures. The median postoperative stay was 1 day. At a median follow-up of 28 months, there was no case of hydrocele, testicular atrophy, or iatrogenic cryptorchism. The postoperative cosmesis was excellent as all patients were virtually scarless. Recurrence occurred in 1.9% with no significant difference (P = .669) compared to the 1.4% recurrence rate of the 2800 patients with ordinary IH undergoing elective SILPEC during the same study period. Conclusions: SILPEC for IIH in children is feasible, safe, with excellent postoperative cosmesis, and no significant difference in hernia recurrence between emergency SILPEC for IIH and elective SILPEC for ordinary IH.

Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia with prolapsed ovary.

Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

Surgical Management of Inguinal Endometriosis

Study Objective To demonstrate surgical management of an inguinal endometrioma. Design Stepwise demonstration of surgical techniques with narrated video footage. Setting Yale New Haven Hospital, New Haven, CT. Patients or Participants A 31-year-old woman with a painful right inguinal endometrioma. Interventions The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Measurements and Main Results Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Conclusion Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery. To demonstrate surgical management of an inguinal endometrioma. Stepwise demonstration of surgical techniques with narrated video footage. Yale New Haven Hospital, New Haven, CT. A 31-year-old woman with a painful right inguinal endometrioma. The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery.

Experimental study on the steel–concrete bond behaviour of circular concrete-filled stainless steel tubes

The paper reports an experimental investigation on the bond stress–slip relationship in concrete-filled stainless steel tube (CFSST) structures. Push-out tests were conducted on twelve specimens covering two stainless steel grades, two concrete grades, two cross-sectional dimensions and two internal ring conditions (with and without the internal ring). The effects of these factors on the bond stress–slip relationship in CFSST members were analysed and discussed. A theoretical model, based on the assumption that no restraining force from the steel tube was applied to the concrete core, was developed to predict the bond stress–slip response of CFSSTs and was evaluated against the test results. An empirical model was also proposed based on regression analysis to replicate the experimental bond stress–slip relationships, which can be used as input data for analytical and numerical simulations in future studies of CFSST structures.

Needlescopic Disconnection and Peritoneal Closure for Pediatric Inguinal Hernia Repair: A Novel Technique.

There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.

Laparoscopic Excision of Patent Processus Vaginalis for Pediatric Hydroceles.

BackgroundThe standard surgical practice for pediatric hydrocele is resection and ligation of the patent processus vaginalis (PPV). Non-ligation of PPV for pediatric hydrocele is another possibility that can be repaired laparoscopically.Material & methodsA retrospective study was undertaken over 10 years (Jan 2011-Feb 2020), of a case series of boys with hydroceles that underwent laparoscopic PPV (Lap PPV) excision. Exclusion criteria were for parents who requested open surgery (10 cases) or an omental plug noted at the PPV site during laparoscopy (one case). Laparoscopic PPV excision was performed via a transperitoneal approach.ResultsThere were 43 cases of Lap PP excision, including three recurrences after open surgery. There were no conversions, complications, or recurrences in any patients. The average operative time for unilateral cases was 21 mins (range 15-30 mins). Three concurrent contra-lateral hydroceles were noted and resected during the primary procedure. Time to regular activity was within one day. There was no visible scar or recurrence after Lap PPV at six months post-surgery review.ConclusionLap PPV excision appears to be at least equivalent to the “open and ligation” approach. During laparoscopy, both internal rings are assessed for a PPV.By avoiding an inguinal incision(s), a better cosmetic result is possible. It is conceivably safer than open surgery in recurrent cases.

Steel dual-ring dampers: Micro-finite element modelling and validation of cyclic behavior

Extensive studies have been performed by researchers to increase the ductility and energy-absorption of concentrically braced frames. One of the most widely used strategies for increasing ductility and energy-absorbing is the utilization of energy-dissipation systems. In this regard, the energy-dissipation system consisting of a steel dual-ring damper (SDRD) with different construction details is presented, to improve hysteresis behavior and performance of steel ring dampers (SRD). The most important cause of energy-dissipation in SRDs are the development of bending plastic hinges in the rings. Therefore, by adding an inner ring to the SDR system, it increases the number of moment plastic hinges and in turn increases energy dissipation. Parametric studies havse been performed applying the nonlinear micro-finite element (MFE) procedure to investigate the improved models. The parametric studies comprise examining the efficacy of thickness parameters and the inner ring diameters of the improved models. The SRD models was selected as the base model for comparing and evaluating the effects of improved dampers. MFE models were then analyzed under cyclic loading and nonlinear static methods. Confirmation of the results of the MFE models were performed against the test results. The results indicated that the diameter to the thickness ratio of inner ring of SDRDs has a considerable influence on determining the hysteresis behavior, ductility, ultimate capacity and performance, as well as energy dissipation. Also, the results show that the details of the construction of the internal and external ring connections were a considerable effect on the performance and hysteresis behavior of SDRDs.

An analytical determining the internal ring gear rim stiffness for practical purpose

An analytical determining the internal ring gear rim stiffness for practical purpose

The role of ring opening reaction chemistry of sultones/lactones in the direct zwitterionization of polyamide nano-filtration membranes

A facile one-step surface modification strategy was developed to zwitterionize polyamide based thin-film composite (PA-TFC) nanofiltration membranes via in-situ ring-opening reactions with a series of cyclic chemical reagents, including γ-butyrolactone(γ-BL), δ-valerolactone(δ-VL) and ε-caprolactone(ε-CL), 1,3-propanesultone (1,3-PS) and 1,4-butanesultone (1,4-BS). The impact of chemical reactivity, ring size, and length of formed zwitterionic chains of these modifiers on the surface properties and nanofiltration performance were comprehensively investigated. It was found that the loading density of the zwitterionic chains was mainly determined by internal ring strain of the cyclic modifying reagents, while the chemistry effect on water permeability was mainly reflected in the surface hydrophilic nature of the formed membranes. Loading of zwitterionic chains with medium length sulfonic acids tends to increase surface hydrophilicity and membrane water permeability while loading of short carboxylate zwitterionic chains tends to increase the retention selectivity of membranes. NF membranes with long and soft hydrophobic –C4H8- and –C5H10- hydrocarbon chains tend to have less flux and retention selectivity. Owing to these competing factors, the NF membranes modified by 1,4-BS exhibited the greatest water permeability (10.9 L/m2⋅h⋅bar) with high retention selectivity (MgCl2/NaCl ratio: 4.2 and Na2SO4/NaCl ratio: 3.1) while the NF membranes modified by γ-BL showed the greatest retention selectivity (MgCl2/NaCl ratio: 5.5 and Na2SO4/NaCl ratio: 4.2). All the zwitterionic membrane possessed high Na2SO4 and MgSO4 rejections (97–99%) and enhanced anti-fouling performance with 100% recovery capability. This work provided a facile and straightforward way to prepare zwitterionic membranes with significantly improved water permeation and retention selectivity of divalent/monovalent ions.

Wavefronts and modal structure of long surface and internal ring waves on a parallel shear current

We study long surface and internal ring waves propagating in a stratified fluid over a parallel shear current. The far-field modal and amplitude equations for the ring waves are presented in dimensional form. We re-derive the modal equations from the formulation for plane waves tangent to the ring wave, which opens a way to obtaining important characteristics of the ring waves (group speed, wave action conservation law) and to constructing more general ‘hybrid solutions’ consisting of a part of a ring wave and two tangent plane waves. The modal equations constitute a new spectral problem, and are analysed for a number of examples of surface ring waves in a homogeneous fluid and internal ring waves in a stratified fluid. Detailed analysis is developed for the case of a two-layered fluid with a linear shear current where we study their wavefronts and two-dimensional modal structure. Comparisons are made between the modal functions (i.e. eigenfunctions of the relevant spectral problems) for the surface waves in homogeneous and two-layered fluids, as well as the interfacial waves described exactly and in the rigid-lid approximation. We also analyse the wavefronts of surface and interfacial waves for a large family of power-law upper-layer currents, which can be used to model wind generated currents, river inflows and exchange flows in straits. Global and local measures of the deformation of wavefronts are introduced and evaluated.

Stress concentration analysis of internally ring-stiffened two-planar tubular KK-joints

ABSTRACT The majority of tubular joints commonly found in offshore jacket structures are multi-planar and investigating the effect of loaded out-of-plane braces on the values of the stress concentration factor (SCF) in offshore tubular joints has been the objective of numerous research works. In the present research, data extracted from the stress analysis of 243 finite element (FE) models, verified against available numerical and experimental data, was used to study the effects of geometrical parameters on the chord-side SCFs in two-planar tubular KK-joints reinforced with internal ring stiffeners subjected to balanced axial loading of braces which is usually the dominant loading type in a KK-joint. Parametric FE study was followed by a set of nonlinear regression analyses to develop three new SCF parametric equations.

Surgical treatment of a canal of Nuck cyst presenting as a femoral hernia: An unusual case report

Introduction and importanceA canal of Nuck cyst forms because of a patent peritoneal fold evaginating through the inguinal canal in a female patient. It is a rare diagnosis because the canal often obliterates within the first year of a female patient's life. A persistent canal of Nuck may cause indirect inguinal hernias, or form hydroceles, termed canal of Nuck cysts. Here we report the first case of a canal of Nuck cyst discovered to be evaginating through the femoral canal.Case presentationA 70-year-old female patient initially presented with a symptomatic groin mass, and a suspected inguinal hernia on pre-operative ultrasound. Intraoperatively, she was found to have a canal of Nuck cyst terminating within the femoral canal. This was successfully repaired using a modified McVay approach, and approximation of the internal inguinal ring. She performed well post-operatively with no signs of recurrence at her six-month follow-up.Clinical discussionThis case report serves to highlight the canal of Nuck cyst, a rare embryologic remnant, and the first literature-reported femoral canal of Nuck cyst. We re-affirm the diagnostic unreliability of ultrasound imaging in the workup of groin hernias. Furthermore, we describe surgical techniques to repair a canal of Nuck cyst found within the femoral canal.ConclusionTo the best of our knowledge, no prior literature reports a canal of Nuck cyst presenting as a femoral hernia. This rare diagnosis may be encountered in common operations and is amenable to definitive repair using traditional hernia repair techniques.

A case of prenatally diagnosed prune belly syndrome variant and congenital pouch colon in the United States: A case report

Background: Prune belly syndrome (PBS) and congenital pouch colon (CPC) are rare congenital syndromes with a low incidence in the United States (U.S.) with most CPC cases being from India. In this case report, we describe, to the best of our knowledge, the first PBS variant and CPC patient in the U.S. Case Presentation: A 30-year-old G2P0010 woman was referred to a tertiary center after an 18-week ultrasound showed a fetal abdominal mass. A prenatal MRI showed a dilated loop of bowel containing a mixture of urine and meconium, oligohydramnios, and a protuberant abdominal wall. Born at 37 weeks, the child’s physical exam was notable for a distended abdomen with thin abdominal musculature, non-palpable bilateral testes, no anal opening, and flat buttocks. Intra-operatively, a dilated cecum/ascending colon was noted with an abrupt change in caliber at the transverse colon, bilateral enlarged ureters, a left testis at the internal ring and no visualized right testis. A colostomy and mucous fistula were created 5 cm from the sigmoid pouch. Conclusion: While most reported cases of CPC undergo single stage repair (one operation) at 1 day of life, our patient underwent the first procedure of a staged repair at 16 hours of life given his clinical instability at the time as well as his unknown urological anatomy in the setting of urinary obstruction. This case demonstrates the importance of fetal imaging, multidisciplinary approach at a tertiary care center, and reinforces a staged repair when necessary.

Хірургічна корекція пахвинних гриж в дітей із застосуванням міні-інвазивного методу PIRS

Вступ. Пахвинна грижа (ПГ) — одне із найбільш поширених захворювань дитячого віку, що вимагають хірургічного лікування. Основним показанням до оперативного лікування ПГ є ризик її защемлення. Серед способів лапароскопічної герніорафії особливо перспективним є метод PIRS (percutaneous internal ring suturing). Мета роботи — провести аналіз власного клінічного матеріалу хірургічного лікування ПГ у дітей із використанням методу PIRS. Матеріали та методи. У дослідження включено 62 дитини з ПГ віком від 2 місяців до 7 років, яких прооперували впродовж 2012–2015 років методом PIRS з ушиванням внутрішнього кільця пахвинного каналу. Серед пацієнтів було 48 (77,4 %) хлопчиків і 14 (22,6 %) дівчат. Правобічну грижу діагностовано в 45 (72,6 %) хворих, а лівобічну — у 10 (16,1 %). Двобічну ПГ перед операцією діагностовано в 7 (11,3 %) дітей. Для оперативних втручань використовували прямий або 30° лапароскоп 5 мм.Результати та обговорення. Серед переваг лапароскопічних методів, і зокрема способу PIRS, виділяють можливість виявлення незарощення вагінального паростка очеревини з контралатерального боку. Так, у 6 (9,7 %) хворих розширення внутрішнього кільця пахвинного каналу з протилежного боку візуалізовано інтраопераційно. Також перевагами цього методу є використання лише одного оптичного порту діаметром 3–5 мм та відсутність потреби в накладанні інтракорпоральних швів. Жоден оперований пацієнт при застосуванні нитки Ethibond* Excel 2–0 не скаржився в післяопераційному періоді на неприємні відчуття в ділянці післяопераційного вузла, що розміщували підшкірно в пахвинній ділянці. У дослідженні рецидив ПГ виявлено в 2 (3,2 %) хлопчиків. Цих пацієнтів повторно також прооперовано з використанням методики PIRS. Висновки. PIRS — простий та ефективний міні-інвазивний метод хірургічної корекції ПГ, що дає добрий косметичний результат. Застосування лапароскопічного методу в лікуванні ПГ у дітей дозволяє ретельно оглянути внутрішні кільця пахвинних каналів і, за потреби, виконати корекцію вади з обох боків. Використання нитки Ethibond* Excel 2–0 для ушивання внутрішнього кільця пахвинного каналу є ефективним та дає оптимальні функціональні результати. Ризик рецидиву ПГ після операції методом PIRS є порівнянним з ризиком рецидиву після операції класичним методом.

Comparison of laparoscopic transabdominal preperitoneal hernioplasty and laparoscopic iliopubic tract repair for Nyhus type II hernia in women.

Indirect inguinal hernia with a dilated internal ring but an intact posterior inguinal wall is classified as Nyhus type II. Females have a higher incidence of indirect hernia than direct hernia. The purpose of this study was to evaluate the efficacy of laparoscopic iliopubic tract repair (IPTR) compared with laparoscopic transabdominal preperitoneal (TAPP) hernioplasty in treating women with Nyhus type II hernia. This retrospective study included 318 women aged ≥ 20years who were treated for Nyhus type II hernia from January 2013 to December 2018. The patients were categorized into two groups in accordance with the operative technique: the TAPP group (33 patients) and the IPTR group (285 patients). In the IPTR group, intraabdominal suturing of the iliopubic tract and transversalis fascia arch was performed without mesh implantation. The mean operation time was shorter in the IPTR group (17.2 ± 3.9min) than the TAPP group (20.5 ± 8.1min, p = 0.028). The postoperative complication rate was higher in the TAPP group than the IPTR group [6.1% (2/33) vs. 0.4% (1/285), respectively; p = 0.001]. Inguinodynia occurred in one patient in the TAPP group and no patients in the IPTR group. The hospital stay did not significantly differ between the two groups. The numeral rating scale pain scores at 1day and 1week postoperatively did not significantly differ between the two groups. There was no recurrence in either group. Laparoscopic IPTR was safe and feasible for treating Nyhus type II hernia in women.

Safety and Efficacy of Laparoscopic Management of Intracanalicular Testes in Pediatrics.

Introduction: Undescended testis is a relatively common congenital anomaly in male children with a prevalence of 1%-2% in live births. Upon discovering an empty scrotum, it is important to determine whether the testis is palpable, ectopic, retractile, or nonpalpable. A canalicular or "emergent" testis is a peeping one that freely slides to and fro between the abdominal cavity and inguinal canal. It may be impalpable initially, but at a time, it emerges from the internal ring to be palpable when it is "milked" down (where it was concealed from detection). It is reported that 15%-40% of cryptorchidism are viable peeping/canalicular testis. The laparoscopic approach for treating intracanalicular undescended testes offers many advantages over open inguinal orchiopexy. It maintains the integrity of the inguinal canal and eliminates the need to divide the epigastric vessels during dissection. The ability to dissect the testicular vessels at a higher level would increase the vessel length available to bring the testis down to the scrotum without strain. The aim of this study is to present our experience and evaluate laparoscopic approach for management of intracanalicular testes regarding operative safety, efficacy, and postoperative outcomes. Patients and Methods: This is a prospective study conducted at Department of Pediatric Surgery, MCH Hospital, Bisha, Saudi Arabia and Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt, in the period from October 2018 to August 2020 to evaluate the safety and efficacy of laparoscopic orchiopexy for intracanalicular testis. Patients with retractile testes, ectopic testes, testes located distal to the external inguinal ring, and nonpalpable testes were excluded from the study. Results: The study was conducted on 62 male children with 70 intracanalicular (peeping) testes, with age range from 8 months to 48 months (mean age: 24 months). Among them, 26 cases (∼42%) were left-sided, 28 (∼45%) were right-sided, and 8 (∼13%) cases were affected bilaterally. Postoperatively, all testes maintained good size without postoperative hydrocele or inguinal hernia. One case (1.4%) required open redo-orchiopexy because of testicular re-ascent to the level of scrotal neck. Moreover, there was no evidence of testicular atrophy confirmed by postoperative ultrasonography. All patients had good satisfied cosmetic results obtained by parent's questionnaire at postoperative follow-up visits. Conclusion: Laparoscopic orchiopexy for management of (intracanalicular) undescended testes is safe, effective, less invasive, without disturbance of inguinal canal anatomy, and with better cosmetic results.

Comparison of laparoscopic percutaneous internal ring suturing method and open inguinal hernia repair in children under 3 months of age.

Laparoscopic inguinal hernia repair in younger infants has not been completely accepted worldwide. The aim of this study was to evaluate the safety and feasiblity of laparoscopic percutaneous internal ring suturing method in children aged younger than 3 months and compare the recurrence and complication rates with open repair; which may still be mentioned as the gold standard procedure. A total of 387 children underwent inguinal hernia repair in the clinic between 2016 and 2019. One hundred and forty of them were under 3 months old and divided into two groups; children who underwent laparoscopic percutaneous internal ring suturing (Group 1) and open surgery (Group 2). Selection of the surgical method was regardless of weight, sex or any patient characteristics other than surgeon's choice. Operation durations, complications and recurrences were compared between the two groups. A total of 140 patients underwent surgery due to inguinal hernia. Group 1 included 85 and Group 2 included 55 children. There were two recurrences in each group (p> 0.05). Operative durations were shorter in Group 1 for both; unilateral and bilateral repairs (p <0.0001). There were no intraoperative complications in any group. There was one major postoperative complication in Group 2: iatrogenic undescended testis, and none was observed in Group 1. In the laparoscopic group, 47% of the children who were diagnosed to have unilateral hernia were revealed to have bilateral inguinal hernias (n= 31). Laparoscopic percutaneous internal ring suturing method seems favourable in terms of operative time. It also has the advantage of detecting contralateral patent processus vaginalis or asymptomatic contralateral inguinal hernia.