Laparoscopic Inguinal Hernia Repair Research Articles

Trends and predictors of laparoscopic bilateral inguinal hernia repair in Spain: a population-based study

BackgroundInternational guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain.MethodsWe performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis.ResultsA total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p < 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p = 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient’s region of residence (OR 2.04, 95% CI 1.88–2.21). Other factors were age < 65 years (OR 1.65, 95% CI 1.52–1.79) and recurrent inguinal hernia (OR 1.31, 95% CI 1.15–1.49). The type of approach for BIHR was not independently associated with perioperative complications.ConclusionsDespite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient’s region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.Graphical abstract

Physiologic Cyclical Load on Inguinal Hernia Scaffold ProFlor Turns Biological Response into Tissue Regeneration

Surgical repair of groin protrusions is one of the most frequently performed procedures. Currently, open or laparoscopic repair of inguinal hernias with flat meshes deployed over the hernial defect is considered the gold standard. However, fixation of the implant, poor quality biologic response to meshes and defective management of the defect represent sources of continuous debates. To overcome these issues, a different treatment concept has recently been proposed. It is based on a 3D scaffold named ProFlor, a flower shaped multilamellar device compressible on all planes. This 3D device is introduced into the hernial opening and, thanks to its inherent centrifugal expansion, permanently obliterates the defect in fixation-free fashion. While being made of the same polypropylene material as conventional hernia implants, the 3D design of ProFlor confers a proprietary dynamic responsivity, which unlike the foreign body reaction of flat/static meshes, promotes a true regenerative response. A long series of scientific evidence confirms that, moving in compliance with the physiologic cyclical load of the groin, ProFlor attracts tissue growth factors inducing the development of newly formed muscular, vascular and nervous structures, thus re-establishing the inguinal barrier formerly wasted by hernia disease. The development up to complete maturation of these highly specialized tissue elements was followed thanks to biopsies excised from ProFlor from the short-term up to years post implantation. Immunohistochemistry made it possible to document the concurrence of specific growth factors in the regenerative phenomena. The results achieved with ProFlor likely demonstrate that modifying the two-dimensional design of hernia meshes into a 3D outline and arranging the device to respond to kinetic stresses turns a conventional regressive foreign body response into advanced probiotic tissue regeneration.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in China: A meta-analysis.

In China, laparoscopic inguinal hernia repair (LIHR) under the day surgery mode (DSM) has developed rapidly as an important surgical method for inguinal hernia repair, and it has unique advantages in many aspects. Compared with inpatient surgery mode (ISM), there are some differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction. Many studies have shown that LIHR in DSM can significantly shorten hospital stay, effectively reduce hospitalization costs, and improve patient satisfaction. Accordingly, this study aimed to compare the differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction of LIHR between DSM and ISM in China. The PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wan Fang databases were searched for randomized controlled trials, cohort studies from the establishment of the database to July 1, 2022. Odds ratio (OR), mean difference, standardized mean difference (SMD), and 95% confidence interval were selected as the effect scale indices for the evaluation of the difference in hospitalization costs, hospital stay, operation time, recovery time, complications, and patient satisfaction. All of these were compared using RevMan 5.3 Software (The Cochrane Collaboration, Copenhagen, Denmark). Nine studies involving 1176 patients, 590 in the DSM group and 586 in the ISM group, were included. The hospital stay (d) (SMD = -7.27, 95% confidence interval, CI: -8.68 to -5.87, P < .001), hospitalization costs (SMD = -7.89, 95% CI: -10.25 to -5.53, P < .001) in DSM group were significantly lower than the ISM group. Additionally, the patient dissatisfaction (OR = 0.05, 95% CI: 0.01-0.17, P < .001) in DSM group was significantly lower than the ISM group. Nevertheless, no significant differences were found in the operation time (minute) (mean difference = -0.32, 95% CI: -1.78 to 1.14, P = .67), recovery time (h) (SMD = -3.27, 95% CI: -6.95 to 0.41, P = .08), and postoperative complications (OR = 0.80, 95% CI: 0.47-1.36, P = .41) between the 2 groups. In China, compared with ISM, LIHR under DSM can significantly shorten hospital stay, greatly reduce hospitalization costs, and significantly improve patient satisfaction. There were no significant differences in operation time, recovery time and postoperative complications.

Unilateral Scrotal Swelling: Diagnosis and Management

A 58-year-old male presented with a 2-year history of a right scrotal swelling, which he noted to be progressively increasing in size and discomfort. He denied any significant past medical history. His surgical history was notable for a bilateral laparoscopic inguinal hernia repair with mesh approximately 10 years prior.

Is the use of antibiotic prophylaxis in pediatric laparoscopic inguinal hernia repair necessary?

PurposeThe use of surgical antibiotic prophylaxis (SAP) in pediatric laparoscopic inguinal hernia repair is controversial. The aim of this study was to evaluate the impact of SAP on the surgical site infection (SSI) rate after laparoscopic inguinal hernia repair in pediatric patients. MethodsWe conducted a retrospective review of pediatric patients who underwent laparoscopic inguinal hernia repair between January 2017 and June 2022. Patient characteristics, intraoperative characteristics, antibiotic use and SSI within 30 days after the operation were collected via chart reviews. All patients underwent laparoscopic percutaneous extraperitoneal closure. SSI was defined by the Centers for Disease Control and Prevention criteria. Fisher's exact test was used to determine the association between SAP and SSI. ResultsIn total, 365 patients were included in this study. Forty-nine percent (n = 179) received antibiotics, and 51% (n = 186) did not. There were five infection cases (1.4%) in this study. Two (1.1%) were in the SAP group and three (1.6%) were in the no SAP group (p = 1.0). All infections were superficial. There were no adverse events due to antibiotic use. ConclusionA low percentage of SSI after laparoscopic inguinal hernia repair in the pediatric population was found, with no significant difference between the SAP group and the no SAP group. Therefore, the routine use of SAP for pediatric inguinal laparoscopic inguinal hernia repair is not recommended.

SINGLE PORT LAPAROSCOPIC CONGENITAL INGUINAL HERNIA REPAIR

Aim and Objectives:The present study was undertaken to evaluate the effectiveness of single port laparoscopy incongenital inguinal hernia repair with respect to operative time, intra and postoperative complications, hospital stay and rate of recurrence. Materials And Methods: Total 30 patients of age between 2-15 years admitted with diagnosis of congenital inguinal hernia, unilateral or bilateral hernia, with reducible non obstructive, primary were included in the study. All cases were performed under general anaesthesia by using a modication of technique described by Ozgediz et al. Results: Among 30 patients, 25 (83.3%) were male and 5 (16.7%) were female. Maximum numbers of patients were in the age group of ≤5 years (56.7%) with mean age of patients was 6.39 ± 3.43 years. Most of the patients (17; 56.7%) had right inguinal hernia. Mean operative time required was 16.23±4.39 minutes. Only in one patient (3%) extra port placement needed to reduce the contents of hernia. Intra operatively, one patient (3.3%) had retro peritoneal hemorrhage and post operatively one patient (3.3%) had complained of nausea for some hrs. The mean hospital stay was 1.48±0.58 Day. There was no recurrence occur in any case. Conclusion: In the paediatric population, single port laparoscopic inguinal hernia repair can be performed safely. This enables extension of the advantages of reduced access surgery to patients with limited resources to be handled. It also incorporates the benet of being fast, shortened operating time and better cosmesis. The benet of limited instrumentation and the intracorporeal knotting avoidance makes this a feasible technique

Differences in in-hospital outcomes and healthcare utilization for laparoscopic versus open approach for emergency inguinal hernia repair: a nationwide analysis.

There has been a growing debate of whether laparoscopic or open surgical techniques are superior for inguinal hernia repair. For incarcerated and strangulated inguinal hernias, the laparoscopic approach remains controversial. This study aims to be the first nationwide analysis to compare clinical and healthcare utilization outcomes between laparoscopic and open inguinal hernia repair in an emergency setting. A retrospective analysis of the National Inpatient Sample was performed. All patients who underwent laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) between October 2015 and December 2019 were included. The primary outcome was mortality, and secondary outcomes include post-operative complications, ICU admission, length of stay (LOS), and total admission cost. Two approaches were compared using univariate and multivariate logistic and linear regression. Between the years 2015 and 2019, 17,205 patients were included. Among these, 213 patients underwent LIHR and 16,992 underwent OIHR. No difference was observed between laparoscopic and open repair for mortality (odds ratio [OR] 0.80, 95% CI [0.25, 2.61], p = 0.714). Additionally, there was no significant difference between groups for post-operative ICU admission (OR 1.11, 95% CI [0.74, 1.67], p = 0.614), post-operative complications (OR 1.09, 95% CI [0.76, 1.56], p = 0.647), LOS (mean difference [MD]: -0.02days, 95% CI [-0.56, 0.52], p = 0.934), or total admission cost (MD: $3,028.29, 95% CI [$-110.94, $6167.53], p = 0.059). Laparoscopic inguinal hernia repair is comparable to the open inguinal hernia repair with respect to low rates of morbidity, mortality as well as healthcare resource utilization.

Transabdominal preperitoneal versus hybrid procedures for treating irreducible inguinal hernias: A retrospective controlled study

BackgroundInguinal hernia is a common condition; however, irreducible inguinal hernias are rare. In this retrospective study, two laparoscopic procedures for irreducible inguinal hernia were compared. Materials and methodsThe study cohort comprised 88 patients who had undergone laparoscopic repair of primary irreducible inguinal hernias between 1 June 2011 and 31 December 2019. The patients were retrospectively divided into Hybrid (Group H) and Standard Transabdominal Preperitoneal (TAPP) Groups (Group S). Patient characteristics, hernia details, and intraoperative and postoperative complications were compared between study groups. ResultsThere were no significant differences between the two groups in baseline characteristics, including age, sex, body mass index, hernia type, operation time, hospital stay, cost, and duration of follow-up. No recurrence or surgical site infection occurred in either group. There were no significant differences between the two groups in incidence of spermatic vessel injury (0% vs. 2.04%, P = 0.370), vas deferens injury (0% vs. 6.12%, P = 0.116), epigastric vessels injury (0% vs. 4.08%, P = 0.202), scrotal hematoma (7.69% vs. 2.04%, P = 0.206), dysuria (5.13% vs. 8.16%, P = 0.575), fever (17.95% vs. 16.32%, P = 0.841), seroma (25.64% vs. 32.65%, P = 0.474), chronic pain (0% vs. 2.04%, P = 0.370), sensation of a foreign body (2.56% vs. 2.04%, P = 0.870), or pain on ejaculation (0% vs. 2.04%, P = 0.370). The incidence of acute pain was higher in Group H than in Group S (43.59% vs. 8.16%, P = 0.000). ConclusionThe hybrid TAPP procedure is a safe and feasible means of treating irreducible inguinal hernias. Though it is associated with a higher incidence of postoperative acute pain than the standard TAPP procedure, it may have advantages in avoiding injuries to the vas deferens and spermatic vessels.

Ultrasound-Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Laparoscopic Inguinal Hernia Repair and Appendicectomy Using Ropivacaine With Dexmedetomidine.

Background The present study aims to investigate the efficacy of ultrasound-guided quadratus lumborum (QL)block versus transversus abdominis plane (TAP) block for laparoscopic inguinal hernia repair and appendicectomy using ropivacaine with dexmedetomidine for quality and duration of postoperative analgesia. Settings and design This was a prospective, randomized, single-blind study conducted for one year (September 2020-August 2021) in the Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, after obtaining ethical clearance from the institutional ethics committee. Methods A total of 64 patients of American Society of Anesthesiologists (ASA) grades I-II and ages between 20 and 50 years undergoing laparoscopic inguinal hernia repair and appendicectomy were randomly allocated into two groups of 32 each; group A received ultrasonography (USG)-guided quadratus lumborum block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight, and group B was given USG-guided transversus abdominis plane block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight after the induction of general anesthesia and before surgical incision. Data were analyzed using Student's t-test, Mann-Whitney U test, and chi-square test as applicable. Results The duration of analgesia was statistically higher (P<0.001) in group A (21.00±3.73 hours) as compared to group B (14.44±2.99 hours).Group A had significantly less analgesic (P<0.001) at 12, 18, and 24 hours postoperatively. The visual analog scale (VAS) was significantly decreased in group A at rest and movement. The range of percentage changes in heart rate (HR) was significantly higher in group B as compared to group A at 12, 18, and 24 hours(group A: 7.23%-14.70%; group B: 6.41%-28.01%). The mean blood pressure (MBP) was significantly increased in group B at 12, 18, and 24 hours as compared to group A. The range of changes in baseline MBP in group A was less than in group B(group A: 0.73%-8.34%; group B: 0.73%-18.20%). Conclusion Quadratus lumborum block is effective and better than transversus abdominis plane block for providing postoperative analgesia during laparoscopic inguinal hernia repair and appendicectomy.

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.

SJLA_2024_A17: Use of Perioperative Tamsulosin to Prevent Postoperative Urinary Retention Following Day Case Laparoscopic Inguinal Hernia Repair

Postoperative urinary retention is one of the more common complications following laparoscopic inguinal hernia repair (LIHR). We hypothesized that the oral one adrenergic blocker Tamsulosin, (Flomax, Boehringer Ingelheim) could be used to decrease the incidence of urinary retention after LIHR. Data from all patients undergoing laparoscopic total extraperitoneal (TEP) inguinal hernia repair by a single surgeon from June 2012 through June 2017 were collected prospectively. Patients received Tamsulosin (Flomax) 0.4 mg/day orally for a total of 5 days beginning 2 days before surgery. All TEP procedures were done under general anesthesia without a urinary catheter in place. Patients were discharged home after voiding in the recovery area. Data are expressed as mean ± standard deviation; flomax was administered to 30 of 32 consecutive patients undergoing outpatient TEP inguinal hernia repair. The mean patient age was 51.3 ± 10.5 years (28–72 years). Ten (32.2%) patients were operated on for recurrent inguinal hernias, 14 (45.1%) had bilateral hernias repaired, and 4 (12.9%) had concomitant umbilical hernia repair. The average operative time was 60 ± 24 min. The mean amount of intraoperative fluids given was 998 ± 297 ml. Two patients were excluded from the study because they required a urinary catheter in the operating room for other reasons (one requiring concomitant cystoscopy and one with anticipated complicated repair in patients who had three prior open inguinal hernia repairs and did not take Flomax). None of the patients given Flomax perioperatively developed urinary retention and all were discharged home the same day of surgery. In contrast, the two patients undergoing TEP repairs who did not receive Flomax perioperatively both developed urinary retention that required catheter placement.

A Rare Presentation of Vesicocutaneous Fistula as Groin Abscess after 8 Years of Laparoscopic Mesh Repair of Inguinal Hernia

Laparoscopic mesh repair of inguinal hernia is common but rarely associated with vesicocutaneous fistula as a complication. The most common implications are mesh erosion and migration due to inappropriate strategies in the selection of the mesh type, size, and placement of mesh. This case study reports a 74-year-old man who suffered immense physical, mental, and cosmetic hardship due to a vesicocutaneous fistula postlaparoscopic mesh repair of an inguinal hernia performed 8 years ago. He presented with groin abscess secondary to vesicocutaneous fistula, diagnosed with high inflammatory markers and computed tomography abdomen pelvis. Groin abscess was drained and identified vesicocutaneous fistula which was managed conservatively.

Immediate Dialysis After Simultaneous Laparoscopic Peritoneal Dialysis Catheter Placement and Laparoscopic Inguinal Hernia Repair.

Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized. Thus, this study reported the outcomes of simultaneous laparoscopic peritoneal dialysis catheter (PDC) placement and transabdominal preperitoneal (TAPP) repair of inguinal hernia. Thirteen patients with chronic renal disease and inguinal hernia attending a tertiary hospital between May 1, 2016 and June 30, 2021 were evaluated for laparoscopic PDC placement. Concurrent laparoscopic inguinal herniorrhaphy and laparoscopic PDC placement were performed. Dialysate fluid was measured intraoperatively to the level below the incised peritoneum by 1 inch. The inflow and outflow was smooth without leakage. The amount was increased gradually in the two weeks after regular PD was obtained. Laparoscopic PDC was inserted for 13 patients. Ten patients had unilateral hernia and two had bilateral inguinal hernia. Associated paraumbilical hernia was discovered in two patients. The median follow-up was 30 months. The measured safe amount of dialysate fluid intraoperatively was 400 - 600 mL. There was no death, intraoperative complication, or dialysate leakage. Three PDCs were removed owing to noncompliance. No hernia recurrence was observed. Simultaneous laparoscopic PDC placement and laparoscopic repair of inguinal hernia with immediate dialysis is a safe and feasible surgical technique. Utilizing minimally invasive surgery affords PDC placement and inguinal hernia repair simultaneously.

Incidentally found Bilaterally Occult Femoral Hernia during Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report

Hernia is defined as an area of anatomical weakness or an abnormal protrusion of a viscous or a part of a viscous through an opening, covering it. Inguinal hernia is the most common hernia because of the presence of natural weakness like the deep ring and cord structures. The minimally invasive procedures for inguinal hernia repair include Intraperitoneal Onlay Mesh (IPOM) repair, Transabdominal Preperitoneal Repair (TAPP), and Total Extraperitoneal (TEP) repair. Laparoscopic inguinal hernia repair has the advantage of inspecting the entire myopectineal orifice, as it allows for the identification of bilateral or recurrent hernias. The principle behind laparoscopic repair includes strengthening of myopectineal orifice in all the above approaches. TAPP repair is mainly indicated for large indirect hernias or irreducible hernia. TEP repair is technically challenging to perform and has the advantage of avoiding interbowel adhesions as the peritoneum is not opened. IPOM repair is not routinely performed but has advantages in cases where there is an increased risk of spermatic cord injury seen in patients with a history of lower abdominal irradiation or a history of multiple recurrent hernia surgery. Occult contralateral inguinal hernia and the occult femoral hernia can be easily diagnosed and repaired with no extra incisions while performing TAPP repair. These hernias, if left untreated may present as recurrent hernias or as non resolution of symptoms posthernia surgery. A rare case of bilateral occult femoral hernia found during laparoscopic TAPP repair of an inguinal hernia was reported. The entire myopectineal orifice was repaired using the same mesh with no extra risk or cost.

Assessment of laparoscopic hernia repair in bubonocele

Back ground Inguinal hernias are one of the most common surgeries performed by a general surgeon. Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation. Laparoscopic inguinal hernia repair has gained popularity with good results in terms of early return to work, reduced postoperative pain, decline in mesh infection and minimal recurrence. However, the routine use of laparoscopic inguinal hernia repair for the unilateral, uncomplicated hernia is a more controversial issue. Objective Assess the laparoscopic hernia repair in bubonocele in terms of risks, ease of technique, advantages and postoperative outcome including recovery time, postoperative complications, and short-term recurrence rate. Patients and methods This is a prospective cohort study was conducted from June 2022 till September 2022 and performed on a total of 20 patients who had inguinal hernia in bubonocele and were candidates for laparoscopic hernia repair. Results In the current study 20% of cases had bilateral inguinal hernia. As regards operative characteristics, our study results showed that the operative time ranged between 50 and 80 min in 75% of cases. There were no significant intraoperative complications, however, a mild bleeding was recorded only in one (5.0%) case and was easily managed intraoperatively, operating surgeons reported satisfaction and operation ease in 55% of cases. As regards postoperative characteristics, our study results revealed that almost all cases (100.0%) had stayed in the hospital 1 day only, majority of cases (85.0%) had resumed their daily activity and work within 2–4 days after the discharge date with no significant postoperative complications. mild seroma was reported in one (5.0%) case only, mild port site wound infection in one (5.0%) case only, pain was reported in one (5.0%) case only, and all these complications were managed conservatively and completely resolved during the follow up period. Ultimately, laparoscopic transabdominal preperitoneal repair showed good cosmetic outcome with good patient satisfaction in 80% of cases with no short-term recurrence. Conclusion We concluded that transabdominal preperitoneal repair of inguinal hernia was a safe, effective, feasible, and successful with the advantages of less hospital stay and less operative time. Moreover, it is associated with minimal intraoperative and postoperative complications.

Paediatric laparoscopic inguinal hernia repair: Level of disconnection of peritoneal cuff - An observational study.

Inguinal hernia is a common surgical condition in children. Conventionally, the open approach for inguinal hernia repair has been considered the gold standard. However, in the past two decades, laparoscopic inguinal hernia repair has gained popularity among paediatric surgeons as an alternative to the open approach. Apart from good cosmesis and shorter stay at hospital, laparoscopy offers clear-cut advantages of visualising contralateral site and simultaneous repair if it is patent. Many techniques for laparoscopic inguinal hernia repair have been proposed. In this retrospective observational study, we are comparing outcomes between proximal and distal disconnection of hernia sac. Ninety-five patients with inguinal hernia were studied in two groups. Group A included 50 patients in which hernia sac was disconnected from the peritoneal cuff proximal to deep inguinal ring (DIR). Group B included 45 patients in which hernia sac was disconnected distal to DIR. Various sociodemographic parameters and intraoperative findings were compared. Outcomes were analysed in terms of post-operative pain, duration of stay at the hospital and recurrences. In group A, there were 46 males and four females with mean age of 4.01 years with standard deviation (SD) of 2.96. Group B included 37 males and eight females with mean age of 5.09 years with SD of 3.56. Excess post-operative pain was observed in 33 patients in Group A with proximal disconnection of hernia sac whereas it was seen in only three patients in Group B with distal disconnection of sac. The P was 0.001 which was highly significant. The duration of stay in the hospital was more in Group A (2.36 ± 1.22 days) as compared to Group B (1.8 ± 0.66 days) with a P of 0.0076 which was significant. Hernia recurrence was seen in four out of 50 patients in Group A (8%) as compared to no recurrence in Group B. However, the difference was not significant. The disconnection of hernia sac distal to DIR is associated with less post-operative pain and shorter duration of hospital stay. There is less recurrence seen in distal disconnection of hernia sac as compared to proximal disconnection; however, to achieve the level of significance, a large cohort study is required.

Comparison of open and laparoscopic inguinal hernia surgery based on chronic pain, paraesthesia and recurrence

Aim: To assess the preoperative and operative findings and postoperative early and late complications in patients who were operated on electively and to compare the factors affecting these results through open and laparoscopic hernia techniques. Materials and Methods: In this retrospective study, the patients were initially divided into two groups as open inguinal hernia repair (OIHR) and laparoscopic inguinal hernia repair (LIHR); then the LIHR group was divided into two subgroups as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) groin hernia repair with respect to the operation techniques. Preoperative, operative, and early and sixth-month late-period complications of the patients were statistically analyzed. Results: In a total of 241 patients included in the study, 170 patients were included in the OIHR group, and 71 patients were included in the LIHR group (TAPP=20, TEP=51). No statistically significant difference was noted between the OIHR and LIHR groups and between the TAPP and TEP subgroups in terms of chronic pain, paraesthesia, and recurrence. Conclusions: We believe that there is no difference in long-term results between open and laparoscopic elective inguinal hernia surgery.

Advantages and disadvantages of laparoscopic procedures in relation to the open method in pediatric surgery

There are many studies which present advantages and disadvantages of the use of both minimally invasive and open method procedures in pediatric sur¬gery. This paper highlights the advantages of minimally invasive surgery and the resulting conclusions for use in clinical practice (e.g. the use of laparoscopy in children is associated with significantly less postoperative stress). The disadvantages of the described surgical techniques and other possible complica¬tions observed after the use of laparoscopic techniques and the open method are also presented. It was emphasized that surgical trauma, regardless of the surgical method used, causes not only a post-traumatic immune-inflammatory response of the body, but is often associated with the risk of developing infections (local or generalized) and the occurrence of recurrences. The study focuses on summarizing the current state of knowledge on minimally invasive pediatric surgery, in particular on the effectiveness of laparoscopic appendectomy, laparoscopic inguinal hernia repair and laparoscopic procedures used in pediatric oncology, taking into account postoperative immune response disorders. Moreover, progress was analyzed in the use of minimally invasive robotic surgery, which becomes an increasingly common method of treatment of many typical surgical diseases in children.

Laparoscopic Inguinal Hernia Repair in a Young Female with Associated Multiple Congenital Defects: A Rare Case

Groin hernias are most common among patients presenting with hernia. Males have more predisposition mainly due to anatomy. However, females with groin hernia present with varied abdominal contents including ovaries and fallopian tubes. The worrisome feature of inguinal hernia with ovaries/fallopian tubes as content is torsion. Uncomplicated groin hernia with ovaries as content is managed with conventional laparoscopic or open hernia repair. Young females with groin hernias need to be evaluated thoroughly for features of androgen insensitivity syndrome or any underlying genetic disorder. A 12 years young female presented to our OPD with chief complaints of swelling in the right inguinal region for 6 months. Patient had not achieved menarche yet, however development milestones were found to be normal. On general physical examinations, deformities were noted in the right ear and left upper limb. On local examination, swelling of approximately 3x3 cm was noted in the right inguinal region. An ultrasonography scan of whole abdomen and pelvis which was suggestive of right inguinal hernia containing right ovary with malposition of the right kidney in the pelvis. Consequently, MRI whole abdomen with pelvis confirmed the findings of USG. Patient was taken for laparoscopic inguinal hernia repair. There was right sided indirect inguinal hernia with right ovary as content and a solid mass was also noted in the right pelvic region suggestive of right pelvic kidney. Right ovary was reduced back to the abdomen with transection of the right round ligament and the defect was closed back with interrupted 3’0 Vicryl sutures. Postoperative course was uneventful. Patient was counselled for genetic analysis to rule out any syndrome association. Uncomplicated groin hernia in young females and paediatric age groups with ovarian content can be easily managed with laparoscopic repair. Early intervention should be advised to prevent ovarian torsion and hence long term morbidity.