Laparoscopic Hernia Repair Research Articles

Double mesh in special cases of laparoscopic inguinal hernia repair: case series study

Recurrence of laparoscopic inguinal hernia repair decreases if the technique is systematized and the recommendations are followed. However, there are special cases in which the usual technique may require modifications to avoid it. The use of two polypropylene meshes has been suggested since the early years of laparoscopic hernia repair with good results. However, for almost two decades, there have been no reports in this regard. The objective of this work, is to describe our technique using double mesh, and report a series of complex cases in which this technique was used to reinforce the inguinal wall with good results comparing it with the techniques described in other series.

To Compare the Short-Term Outcome of Open Repair versus Laparoscopic Repair in Abdominal Incisional Hernia Repair

Background: Incisional hernia is a common complication post abdominal surgery. Its effective management is crucial for patient outcomes and healthcare efficiency. This study aims to evaluate and compare the short-term outcomes of open and laparoscopic incisional hernia repair techniques. Objective: The study's objectives are twofold: 1) To ascertain the short-term outcomes, specifically focusing on the length of hospital stay, operative time, wound infections, and recurrence rate in patients undergoing open and laparoscopic incisional hernia repair, and 2) To compare these outcomes between open and laparoscopic repair methods. Methods: A randomized design was employed, with patients assigned to either Group A (open repair) or Group B (laparoscopic repair) using computer software. The duration of surgery, from the first incision to skin closure, was timed with a digital stopwatch. Patients were followed up for one month with specific attention to any redness, persistent pain, or fever. The key outcome parameters assessed were operative time, hospital stay duration, incidence of wound infection, and hernia recurrence. Results: Group A exhibited a 9.9% wound infection rate and 51.1% recurrence rate, with 39.0% of patients achieving satisfactory outcomes. In contrast, Group B demonstrated a 13.5% wound infection rate, a notably lower recurrence rate of 11.3%, and 75.2% of patients reported satisfactory outcomes. Conclusion: Laparoscopic repair shows superior outcomes compared to open repair regarding wound infection, recurrence rate, patient satisfaction, operative time, and length of hospital stay.

Minilaparoscopic total extraperitoneal hernioplasty

The purpose of the study was to assess the feasibility of preperitoneal repair of inguinal hernias using minilaparoscopic instruments — ports with a diameter of 3 mm. From March to June 2023, 10 laparoscopic hernioplasties were performed using mini instruments. All operations were performed using a 10 mm optical trocar and two working trocars with a diameter of 3 mm. The following indicators were analyzed: the severity of pain in the early postoperative period (6 hours after surgery), the severity of pain upon discharge from the hospital, the use of analgesics on demand, operation time, the frequency of intraoperative and delayed complications. The average operative time was 45 ± 10 minutes. There was no conversion to open plastic surgery. One patient used analgesics immediately after surgery. The length of hospital stay was 2 days for all patients. There were no intra- or postoperative complications. Conclusion: This study demonstrates the feasibility of performing minilaparoscopy, which demonstrates good results in terms of postoperative pain, operative time and aesthetics, in laparoscopic hernia repair.

Comparison of Perioperative Complication Rates of Total Extraperitoneal and Transabdominal Preperitoneal Repairs in Primary Inguinal Hernia.

Hernia may be defined as a protrusion of viscus through layers anatomically designed to contain that viscus. Most abdominal hernias occur at well-described sites of potential weakness. Repair of inguinal hernia is one of the most common operations in general surgery. Objectives: To compare the perioperative complication rates of total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs of primary inguinal hernias. It is a randomised comparative study, conducted at the department of general surgery. A total of 50 patients were included and divided into two groups with 25 in each. Group A represents the laparoscopic TEP repair and group B represents the laparoscopic TAPP repair. Patients above 18 years with primary unilateral inguinal hernia were included. Patients having complicated inguinal hernia and history of previous abdominal surgery were excluded. We observed that hernia occurrence is more common in the 31-50 years of age group and right-sided hernia is more common. Scrotal oedema and conversion to open surgery chances are similar in both TEP and TAPP groups. The duration of surgery in TEP is significantly higher as compared to TAPP. Patients who underwent TEP experienced less pain as compared to TAPP as per visual analogue scale. Postoperative hospital stay and time taken to resume the routine activity were significantly less in case of TEP. TEP is preferred over TAPP for laparoscopic hernia repair because it preserves the peritoneal integrity and has lesser postoperative pain. The early recovery and return to the routine work were seen with the patient treated with the TEP and also showed better visual analogue score than the TAPP repair group.

Laparoscopic repair of a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury: a case report

BackgroundA diaphragmatic hernia is a prolapse of the abdominal organs into the thoracic cavity through a hole in the diaphragm. Traumatic diaphragmatic injuries are rare and usually occur after blunt or penetrating thoracic or abdominal traumas. Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. It usually present late with intrathoracic herniation of abdominal viscera and carry a high mortality rate. We experienced a very rare case who showed repeated colon incarcerations 7 years after injury. And, we operated laparoscopically.Case presentationA 64-year-old man presented with multiple left rib fractures that occurred during an accident. After 7 years, he visited the emergency department with the chief complaint of left shoulder pain and epicardial pain after eating. He was diagnosed with transverse colon incarceration due to a left diaphragmatic hernia by computed tomography (CT) and X-ray imaging. Surgical repair was recommended, but he refused as the symptoms improved. Fourteen months later, the patient revisited the hospital in similar symptoms and improved spontaneously. He consulted our hospital for the surgical indication. We recommended that he undergo surgery, showing images of the X-ray and CT when his transverse colon was obstructed and he felt pain and when symptoms improved. Finally, he decided to undergo surgery. We performed diaphragmatic hernia repair with laparoscopic direct suturing in good view. The patient experienced an uneventful postoperative recovery period. The absence of diaphragmatic herniation recurrence was confirmed seven months after surgery.ConclusionsWe experienced a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury and performed surgical repair laparoscopically.

The initial outcomes of laparoscopic surgery for the hiatal hernia repair: a tertiary center study

Background: The surgical approach to hiatal hernia has changed with the advent of laparoscopic techniques. We sought to evaluate the short-term outcomes of laparoscopic hiatal hernia repair. Methods: We conducted a cross-sectional study with a retrospective approach of patients receiving laparoscopic hiatal hernia repair from January 2018 to June 2023 at People’s Hospital 115. Results: In 25 patients included in this study, the male-to-female ratio was 2:1, with a mean age of 46. The types of hiatal hernia included type I (n = 2), III (n = 16), and IV (n = 7). The most common symptoms were epigastric pain (44%), dysphagia (16%), heartburn (25%), vomiting (76%), chest pain (32%), and shortness of breath (20%). Nissen fundoplication was also performed in 19 cases (76%). The median operative time was 130 min, and the median hospital stay was 3 days. No case was converted to open surgery, and minor or major complications occurred in 3 patients (12%). Conclusion: Laparoscopic repair for hiatal hernia is feasible and safe. The short-term outcomes included early return daily activities, and most patients experienced good to excellent functional and symptomatic results and quality-of-life improvement.

Comparison of Single-incision Laparoscopic Percutaneous and Cystoscope Forceps Assisted Morgagni Hernia Repair Techniques

ObjectiveOur goal was to compare single-incision laparoscopic percutaneous and cystoscope forceps-assisted Morgagni hernia repair techniques. Materials and methodsA total of 40 patients were allocated to two groups, each with 20 patients. Group 1: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with a 5 mm Storz laparoscopic scope entered through the umbilicus). Group 2: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with an 11 Fr [3.6 mm] cystoscope entered through the umbilicus + using forceps + sac plication, and sac cauterization). In Group 1; the sac was not removed. In group 2; we advanced the forceps through the cystoscope, caught the sac, pushed the needle through the sac, plicated the sac, and then cauterized the sac with Bugbee electrode. ResultsOf the 40 patients, 70 % (n = 28) were male. The symptoms at admission included repeated chest infections (40 %), dyspnea (30 %), vomiting (22 %), and abdominal pain (22 %). No difference was found between groups in terms of age, gender symptomatology, or associated anomalies. The operation time was shorter in group 2 compared to group 1 (p < 0.05; 25 min vs 40 min). Although there was one recurrence in Group 1, no recurrence was reported in Group 2. The recurrence incidence did not differ between groups (p > 0.05). ConclusionsCystoscope-assisted repair of Morgagni hernia was found to be superior in terms of safety and shorter operation time. Level of evidenceType III. Type of the studyRetrospective study.

Development of an international core outcome set for treatment trials in paediatric inguinal hernia: protocol for a three-phase study including a systematic review and Delphi survey

IntroductionIn children, open inguinal hernia repair has been the gold standard for treatment, but with recent technical advancements in laparoscopy, laparoscopic hernia repair is gaining popularity. Despite available results from...

Surgical Approach to Bilateral Inguinal Hernia. A Case-Control Study.

Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally invasive, in an elective sce-nario. The choice of surgical approach depends on the patient's status, hernia characteristics, surgeons and patient preferences. Whether age criteria should be considered when selecting between the two approaches is still a matter of debate. Considering that there is no consensus regarding the best repair in bilateral inguinal herniorrhaphy, the aim of the study is to perform an analysis regarding elective surgical approach of patients with bilateral inguinal hernias. Material and Methods: To study the relationship between exposure to an open versus laparoscopic approach in patients with bilateral inguinal hernia, we conducted a case-control study. In our retrospective analysis, cases (23 patients) were the open-approach hernia repair, and controls (82 patients) were laparoscopic hernia repair. We analyzed two sets of variables: first, related to patient characteristics (age 65 years, BMI 30 kg/m2, smoking habit, HTA status, COPD status, DM status, use of anticoagulants, presence of neoplastic status) and second, variables related to hernia features (inguinoscrotal hernia, recurrent hernia and complicated hernia). Results: The mean age for cases was 73.26 (Ã+-12.99) years and that of controls, was 56.48 (Ã+-15.15) years. Univariate analysis demonstrated four variables with statistical significance: age 65 years, inguinoscrotal hernia, neo-plastic status, and anticoagulant use. When introduced into the multivariate analysis, we noted that only two variables, age 65 years (OR=4.183, 95% CI [1.289, 13.572], p=0.017) and use of anticoagulants (OR=38.876, 95% CI [1.305, 1158.011], p=0.035) reached statistical significance. Conclusion: This study demonstrates that when we refer to bilateral inguinal hernia repair, patients aged 65 years are at risk of having an open procedure at least fourfold more than patients aged 65 years. In addition, the use of anticoagulants increases the risk of open hernia repair 38 times more than that of minimally invasive repair for the same age group. Interestingly, in our study, hernia characteristics were not found to be associated with open hernia repair and age 65 years. In our study we found that age 65 years is associated with electing open hernia repair over minimally invasive repair, which can be linked to age-related risk factors. Further re-search is needed to investigate the impact of age and age-related risk factors on surgical outcomes of bilateral inguinal hernia repair.

Hernia repair techniques: a comparative analysis of mesh types

A hernia is a condition characterized by the protrusion of an internal organ, often part of the intestine, through a weakened area in the surrounding muscle and tissue. Surgical intervention is the primary treatment option for most hernias, with procedures known as herniorrhaphy or hernioplasty. Traditional open surgery involves a sizable abdominal incision, granting direct access to the herniated tissue. Alternatively, minimally invasive laparoscopic surgery utilizes small incisions and specialized instruments, including a camera, for repair. Synthetic or biological mesh is frequently employed to reinforce weakened muscle or tissue, reducing hernia recurrence risk. Mesh is integral to hernia treatment, providing critical reinforcement and enabling tension-free closure. This article's rationale lies in the necessity for a comprehensive comparative analysis of hernia repair techniques, with a particular focus on the influence of different mesh types in abdominal hernia surgery. This research, initiated on 17 October 2023, involved an exhaustive review of existing literature via databases like PubMed, Web of Science, and Cochrane, employing a broad range of medical terminology combinations. The management of hernias has evolved significantly, and open hernia repair, especially using the Shouldice technique, remains valuable when the mesh is unavailable or undesired. Modern tension-free repair techniques, such as Lichtenstein and plug and patch, provide similar outcomes. Laparoscopic hernia repair, despite the longer surgery duration, offers advantages in terms of recurrence, recovery, and postoperative discomfort. Mesh selection is vital, with options like polypropylene, polyester, composite, biological, and 3D offering tailored attributes. The choice should consider patient history, hernia type, and surgeon expertise, necessitating awareness of evolving techniques and materials for optimal outcomes in hernia repair.

Characterisation and mitigation of gas leaks at laparoscopy: an international prospective, multi-center cohort clinical trial.

Gas leaks polluting the operating room are common in laparoscopy. Studies defining methods for sensitive leak characterisation and mechanical mitigation in real world settings are, however, lacking. Mobile optical gas imagers (both a miniaturised Schlieren system and sensitive tripod-mounted near-infrared carbon dioxide camera (GF343, FLIR)) prospectively defined trocar-related gas leaks occurring either spontaneously or with instrumentation during planned laparoscopic surgery at three hospitals. A boutique Matlab-based analyser usingsequential frame subtraction categorisedleaks (class 0-no observable leak; class 1-marginally detectable leak; class 2-short-lived plume; class 3-energetic, turbulent jet). Concurrently, the usefulness of a novel vacuum-ring device (LeakTrap™, Palliare, Ireland) designed as a universal adjunct for existing standard laparoscopic ports at both abdominal wall and port valve level was determined similarly in a phase I/11 clinical trial along with the device's useability through procedural observation and surgeon questionnaire. With ethical and regulatory approval, 40 typical patients (mean age 58.6years, 20 males) undergoing planned laparoscopic cholecystectomy (n = 36) and hernia repair (n = 4) were studied comprising both control (n = 20) and intervention (n = 20) cohorts. Dual optical gas imaging was successfully performed across all procedures with minimal impact on procedural flow. In total, 1643 trocar instrumentations were examined, 819 in the control group (mean 41 trocar instrumentations/procedure) and 824 in the intervention group (mean 41.2 trocar instrumentations/procedure). Gas leaks were detected during 948(62.6%) visualised trocar instrumentations (in 129-7.8%-the imaging was obscured). 14.8% (110/742) and 60% (445/742) of leaks in control patients were class 0 and 3, respectively, versus 59.1% (456/770) and 8.7% (67/772) in the interventional group (class 3 v non-class 3, p < 0.0001, χ2). The Leaktrap proved surgically acceptable without significant workflow disruption. Laparoscopic gas leaks can be sensitively detected and consistently, effectively mitigated using straightforward available-now technology with most impact on the commonest, highest energy instrument exchange leaks.

OGBN O08 The Safety and Efficacy of Laparoscopic Hiatus Hernia Repair with Biosynthetic Mesh (Phasix-ST®): A Single Centre Experience

Abstract Background Surgical management of large hiatus hernia (&amp;gt; 5 cm defect) remains challenging due to high recurrence rates. Mesh augmentation in laparoscopic hiatal hernia repair has been used to reduce recurrences but carries risks such as mesh erosion, contraction, infection, and reaction to the foreign body. Introducing biosynthetic meshes offers a promising adjunct to primary suture repair of hiatal defects with enhanced tissue integration and reduced risk of infection. Phasix™ ST mesh is a biosynthetic mesh made of Poly-4-Hydroxybutyrate (P4HB). This study evaluates early patient outcomes following laparoscopic hiatal hernia repair with Phasix™ ST mesh, including its safety and efficacy profile. Methods This study was to evaluate outcomes of laparoscopic hiatus hernia repair using Phasix™ ST mesh in adult patients (&amp;gt;18 years) at our institution. All patients undergoing this procedure between September 2020 to April 2023 were identified from a prospectively maintained database. Our standardised technique involved on-lay crural reinforcement with Phasix™ ST mesh after primary closure of the hiatal defect, followed by partial fundoplication. Patient records were reviewed retrospectively to assess these end-point measures: postoperative mortality and morbidity at 30 days, functional results reported during the follow-up period, and recurrence rates of hiatus hernia. Results Conclusions This is the first study in the United Kingdom demonstrating that laparoscopic hiatus hernia repair with the use of Phasix™ ST mesh for crural reinforcement has low-rate complications, with most patients reporting symptom improvement and discontinuing PPI use in the early-term follow–up. Further long-term studies are needed to validate these findings.

OGBN P31 Laparoscopic versus open repair of giant paraoesophageal herniae: a 4-year retrospective study

Abstract Background Although laparoscopic repair of giant paraoesophageal hernia (PEH) has known advantages over open repair including a reduced post-operative length of stay (LOS) and reduced post-operative pain, there has been concern amongst surgeons regarding the recurrence rate. We sought to further analyse differences in outcomes in a retrospective series of patients with giant hiatus hernia in a single tertiary centre. Methods All giant PEH receiving operative repair at a tertiary referral centre (UCLH) were reviewed retrospectively over a one-year period from July 2019-July 2022. Diagnosis was made on gastroscopy and computer tomography (CT). A giant PEH was defined as one in which the hernia contained at least 50% of the stomach. If the patient was symptomatic post-operatively they were investigated for recurrence with gastroscopy and CT. Results The laparoscopic cohort (n=14, median age of 72 years, ASA 2) had similar demographics to those receiving open repair (n=21, median age of 68 years, ASA 2.5). Median length of stay was shorter in the laparoscopic cohort compared to the open cohort (3.5 days (1-7) versus 7 days (5-9)). The laparoscopic and open cohorts had similar rates of minor complications (42.8% (6=2, Clavien Dindo 2) versus 47.6% (n=10, Clavien Dindo 2))respectively. Recurrence of reflux or dysphagia symptoms was higher in those who had a laparoscopic repair (28.6% versus 14.3%). One radiologically confirmed recurrence occurred in the open group (4.7%). Conclusions Although the benefits of a faster post-operative recovery with a shorter LOS were clear in the cohort following laparoscopic repair, a higher rate of recurrence of symptoms was evident within those receiving a laparoscopic repair. Large, controlled, prospective studies with long-term follow-up are required in order to further establish differences in outcomes between laparoscopic and open repair of giant PEH.

Comparative effectiveness of hybrid and laparoscopic techniques for repairing complex incisional ventral hernias: a systematic review and meta-analysis

BackgroundThe recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH.MethodsAn exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.ResultsThe final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.ConclusionsThe HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.

The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair.

A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.

Parahiatal hernia: A rare type of hernia and the answer to an anatomical challenge

Parahiatal hernias are rare. They are difficult to diagnose preoperatively, as the clinical symptoms may be similar to hiatal and paraoesophageal hernias. Here, we report two cases of parahiatal hernia that were preoperatively diagnosed and successfully repaired laparoscopically; using the particular anatomic characteristics of this hernia, we also review the controversial oesophageal hiatal anatomy, as the surgical community often refers to the left bundle of the right crus as the left crus. There is no consensus on the indication or surgical technique to repair them. The first case is a 59-year-old woman with non-specific abdominal symptoms, in whom the preoperative gastroscopy and computed tomography (CT) raised the suspicion for parahiatal hernia. The second case is a 68-year-old woman who presented to the emergency department with abdominal distention and nausea, but no vomiting. Preoperative CT raised the suspicion of an incarcerated parahiatal hernia. Both patients underwent laparoscopic repair of the parahiatal hernia and a Toupet fundoplication. They had an uneventful postoperative course. After more than 4 years of follow-up, they are both asymptomatic. Parahiatal hernias are a rare form of diaphragmatic hernia that occur through a diaphragmatic defect lateral to an anatomically normal oesophageal hiatus, with herniation of contents between the left portion of the right crus and the left crus. Up to five different anatomical variations have been described. The knowledge of these anatomical variations has an impact on the type of surgical repair that will need to be performed if a parahiatal hernia is found.

Effects of TAPP Combined with Biological Mesh on Reproductive Function in Male Inguinal Hernia Patients of Reproductive Age: A Single-Center Retrospective Study

Objective. To explore the effect of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) combined with biological mesh on the reproductive function of male inguinal hernia patients during the reproductive period. Methods. Sixty male inguinal hernia patients during the reproductive period admitted to our department from October 2015 to October 2021 were selected for retrospective analysis. All patients were treated with TAPP combined with biological mesh by the same team. Bilateral testicular volume, testicular temperature, testicular blood perfusion, peripheral serum testosterone concentration, and semen analysis were examined before surgery, 3 months after surgery, 6 months after surgery, and 12 months after surgery. Results. The preoperative testicular volume, temperature, and blood perfusion were compared between the healthy side and the affected side; the testicular volume, temperature, blood perfusion of the affected side, peripheral blood testosterone concentration, and semen analysis were compared among the four time points, which were before operation, 3 months after operation, 6 months after operation, and 12 months after operation. All p values were &gt;0.05. Conclusions. The presence of inguinal hernia had no significant effect on the volume and blood perfusion of male testis. In addition, TAPP combined with biological mesh has no negative effect on postoperative reproductive function of male inguinal hernia patients of childbearing age, which manifested as a safe and feasible surgical method.

Comparison of Laparoscopic Needle-Assisted Extra-Corporeal Inguinal Hernia Repair with Intracorporeal Inguinal Hernia Repair in Terms of Postoperative Recurrence

Objective: To compare laparoscopic needle-assisted extra-corporeal hernia repair regarding recurrence in children with intracorporeal repair. Study Design: Retrospective longitudinal study. Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2019 to Dec 2020. Methodology: Retrospectively, all patients who underwent laparoscopic herniotomy were searched through hospital records.Ninety-seven patients matched the inclusion criteria out of 148 laparoscopic surgeries. All patients were diagnosed with inguinal hernia based on history and clinical examination. Fifty-one patients underwent laparoscopic needle-assisted repair (LNAR) with extra-corporeal knotting, whereas 46 underwent repair with intracorporeal knotting of the deep inguinal ring. Pneumoperitoneum was created in all cases by open method. All patients were followed up for six months outdoors for recurrence. Results: The age of patients ranged from 1-12 years; the mean age of study patients was 5.29±3.17 years. Regarding the inguinal hernia site, 45(46.4%) had a right-sided hernia, and 52(53.6%) had a left-sided hernia. All operations were completed laparoscopically. There were no intraoperative complications. A total of 2(3.53%) patients developed recurrence, one from each group, 2.17% in Group-A and 1.96% in Group-B, with no statistically significant difference between the two groups after six months of follow-up (p-value=0.942). Conclusion: Extra-corporeal knotting in children with inguinal hernia is an effective, quick and safe technique. It is comparable to the standard intracorporeal knotting technique in terms of recurrence.

Pre-peritoneal Plus Portal Infiltration Versus Bilateral Transversus Abdominis Plane Block in Laparoscopic Hernia Repair.

Background and objective The role of the pre-peritoneal infiltration of local anesthetic (PILA) in laparoscopic hernia repair has been equivocal. Ultrasound-guided transversus abdominis plane (TAP) block has been extensively studied. However, studies comparing these two methods are very scarce. Hence, this study was undertaken to compare the efficacy of pre-peritoneal plus portal infiltration with TAP block in this population. Materials and methods This double-blinded randomized comparative study was conducted on a total of 32 patients by allotting 16 patients in each group. Group A patients were given pre-peritoneal plus portal infiltration of 15 mL of 0.5% ropivacaine for each technique by the operating surgeon, while Group B patients were administered bilateral TAP block with 0.5% ropivacaine, 15 mL on each side under ultrasound guidance by the anesthesiologist. Results The demographic variables and duration of surgery were comparable between the two groups. Also, the postoperative requirement of fentanyl between the two groups was insignificant. However, the duration of anesthesia was significantly longer in Group B attributing to the extra time taken for the administration of the TAP blocks. Conclusion Both ultrasound-guided TAP block and the PILA plus portal infiltration are effective techniques for pain relief after laparoscopic hernia repair. Either of these two techniques can be chosen depending on the availability of resources, expertise, etc.

Laparoscopic IPOMPLUS repair-current outcomes and complications

Purpose: The study aims to assess the current outcomes and complications of laparoscopic ventral hernia repair using intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique by use of dual-sided synthetic mesh. Material and methods: Retrospectively clinical data for 27 patients with umbilical, paraumbilical, incisional, ventral, and primary hernia, operated in the Department of General, Visceral and Emergency Surgery “Pirogov” from 01.06.2022 to 01.06. 2022 was analyzed. The diagnosis was based on history, physical examination(mainly), ultrasound, and CT. Of the hospitalized, women were 16 (59.26%) men 11 (40.74%). Results: Of the selected group, 13 patients had umbilical defects, 3 with an epigastric hernia, 7 with a paraumbilical hernia, and 4 with incisional defects. Adhesiolysis was needed in 18 cases, while others were performed straight with hernia closure. The operating time varied between 49 and 127 minutes (average 57.4 minutes). The hospital stay ranged from 1 day to 4 days (average 1.7 days). We had noticed complications in three of the cases (11.11%). Conclusion: IPOM PLUS repair is safe, practicable, and advantageous over a standard IPOM or open repair as reported in the literature. Accordingly, we prefer this approach with the closure of the fascial defect first while repairing ventral abdominal wall hernias.