Left Indirect Inguinal Hernia Research Articles

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

Laparoscopic Totally Extraperitoneal (TEP) Left Indirect Inguinal Hernia Repair with Mesh

ANGIOEMBOLISATION OF CREMASTERIC ARTERY FOR SCROTAL HAEMATOMA FOLLOWING HERNIAL REPAIR

Cremasteric artery is a branch of inferior epigastric artery supplying the cremaster muscle and coverings of the cord. The possible consequence of injury to this artery is scrotal haematoma. We present a case of haemorrhage from unexpected cresmastric artery injury post-hernioplasty treated with angioembolisation. To the best of our knowledge, this has not been reported in literature.
 A 66-year-old gentleman with left indirect inguinal hernia underwent a left inguinal hernioplasty in our institution with no immediate complications. However he presented to the emergency department the day after the procedure with complaints of rapidly worsening painful left scrotal swelling accompanied with symptoms of intestinal obstruction. Emergency laparotomy and re-do left hernioplasty was performed, revealing a strangulated inguinoscrotal hernia. Post-operatively, there was non-resolving scrotal swelling with a drop in the haemoglobin level; from 11.9g/dl to 8.5g/dl requiring packed cell transfusion. CT angiogram revealed active contrast extravasation from the left cremasteric artery. Angiographic run confirmed the finding and the left cresmatric artery was superselectively cannulated with a 1.9Fr microcatheter and embolization done with 0.5mm microcoil. Ultrasound scan 24-hour post-procedure showed patent proximal vessel. Clinically there was a reduction of the left scrotal swelling and the haemoglobin remained stable. 
 Cremasteric artery courses laterally deep into the fascia transversalis entering the cord deep to the internal spermatic fascia to supply the cremaster muscle and coverings of the cord. This course renders the artery to be prone for injury during procedure such as hernioplasty; one of the possible consequences is scrotal haematoma. This artery is usually small in caliber and its identification is important for efficient and effective treatment.
 Angioembolisation is able to treat this injury with superior precision owing to its ability for localization and selective cannulation of the offending vessel.

Simultaneous resection of a neuroendocrine tumor in an incidental Meckel’s diverticulum with transabdominal preperitoneal hernial repair: a case report

BackgroundAs laparoscopic surgery becomes more prevalent worldwide, Meckel’s diverticula are increasingly being discovered incidentally during surgery. There is no consensus on whether to follow up or resect such diverticula, which are usually asymptomatic. In cases of transabdominal preperitoneal inguinal hernia repair, resection of such a diverticulum might add the risk of mesh infection. Thus, it is unclear whether simultaneous intestinal resection is advisable.Case presentationA 64-year-old man diagnosed with a left indirect inguinal hernia underwent laparoscopic inguinal hernia repair, during which a 2-cm Meckel’s diverticulum located contralateral to the mesentery of the ileum approximately 30 cm from Bauhin’s valve was detected incidentally. Because of the potential risk of future complications such as hemorrhage, diverticulitis, or tumor development, wedge resection of the ileum was performed extracorporeally through an extended umbilical port site after completion of the hernia repair. Pathological examination revealed a neuroendocrine tumor (G1) in Meckel’s diverticulum, which was successfully resected without any mesh infection or postoperative complications.DiscussionOur patient’s clinical course raises two important issues. First, a Meckel’s diverticulum detected incidentally during laparoscopic surgery should be resected promptly because malignant tumors within such diverticula have frequently been reported. Second, simultaneous resection with hernia repair using mesh seems to be as safe as other clean-contaminated surgery.ConclusionsManagement of incidental Meckel’s diverticula should be selected by appropriate assessment for the risk of malignancy and complications.

Management of a very rare case of polyorchidism: a case report

BackgroundPolyorchidism is a rare genetic anomaly characterized by the patient having more than two testicles. In the literature, only around two hundred cases have been reported. We present an unusual new case which does not conform to the traditional classifications of polyorchidism or previously reported cases. We discuss our diagnostic techniques as well as management decisions for this case and aim to raise awareness about the management choices available.Case reportA 3-year-old male presented to the clinic by his parents due to concern of a painless swelling in the left inguinal region. Physical examination revealed features of a left indirect inguinal hernia. Furthermore, scrotal examination revealed a firm, non-compressible painless mass in the left scrotum which was inferior to the left testis. Ultrasonography suggested the mass as an extra testis, and MRI was followed which showed no signs of malignancy. Due to the reassuring nature of these findings, a conservative approach was taken, with the patient referred for regular follow-up.ConclusionWhen facing cases of polyorchidism, physicians should move away from considering surgical excision and biopsy as exclusive first-line management. Instead, we place emphasize and raise awareness about the option of conservative management if imaging shows no abnormalities. Ultimately, the aim of this paper is to raise awareness among the paediatric surgeon community that while excision may be a valid option, it is not the only treatment.

Laparoscopic identification of a direct inguinal hernia with bladder involvement in an infant

Inguinal hernias are a common problem in premature infants, with incidence increasing as the gestational age decreases. Direct inguinal hernias are rare in infants with minimal documentation in the medical literature. We present the case of a premature infant who was found to have a direct inguinal hernia containing bladder during laparoscopic inguinal hernia repairs. The patient was a premature 25-week gestational age infant admitted to the neonatal intensive care unit. At 3-months old, pediatric surgery was consulted for bilateral inguinal hernias. Intraoperatively, laparoscopic visualization of the hernias demonstrated a typical left indirect inguinal hernia; however, on the right side, we found a direct inguinal hernia, medial to the right medial umbilical ligament that contained a large portion of the bladder. The left indirect hernia was successfully repaired laparoscopically, while the right was repaired with conversion to an open Bassini repair. The postoperative course of the infant was unremarkable.

A case of bilateral inguinal hernia associated with Marfan syndrome

Marfan syndrome, a connective tissue disease, is associated with a high incidence and recurrence rate of inguinal hernia. We herein report a three-year-old boy with bilateral inguinal hernia associated with Marfan syndrome. While preoperative contrast-enhanced computed tomography (CT) revealed a left indirect inguinal hernia and a right direct inguinal hernia, laparoscopy showed bilateral patent processus vaginalis (PPV) and vulnerability of the abdominal wall at the bilateral medial inguinal fossae. In addition to laparoscopic percutaneous extraperitoneal closure (LPEC), open iliopubic tract repair was also performed. To our knowledge, this is the first report of a therapeutic strategy for pediatric inguinal hernia with Marfan syndrome. • Children with Marfan syndrome may develop direct inguinal hernias. • Computed tomography while awake in the prone position led to the diagnosis. • Combined laparoscopic and open hernia repair were useful.

Laparoscopic repair of femoral hernia involving the bladder with coexisting indirect inguinal hernia in a young man: a case report

BackgroundBladder hernias are rare conditions that are difficult to diagnose preoperatively; many cases are diagnosed intraoperatively or postoperatively due to bladder injury. Most bladder hernias are direct inguinal hernias that involve the bladder in obese men older than 50 years old. We describe a rare case of a left femoral hernia involving the bladder in a young man.Case presentationA 32-year-old man with a bulge in the left inguinal region underwent laparoscopic transabdominal preperitoneal repair. Laparoscopy revealed a left indirect inguinal hernia. When the preperitoneal space was dissected toward the Retzius space along the vesicohypogastric fascia, the bladder was found to be protruding into the femoral ring and adhere to the hernial orifice severely. The bladder was reduced carefully without causing injury. After dissection, we repaired the left myopectineal orifice with a mesh. The patient was discharged on postoperative day 1 without complications. No recurrences or symptoms were noted at the 12-month follow-up.ConclusionsA femoral hernia involving the bladder in a young man is rare. This case demonstrated that dissection along anatomical landmarks is important for preventing injuries to the bladder because even young men may have bladder hernias.

Initial Experience with Percutaneous Internal Ring Suturing for Indirect Inguinal Hernia in Pediatric Patients.

PurposeThe aim of this study is to review our experience in treating indirect inguinal hernia in pediatric patients.MethodsWe retrospectively studied a total of 43 patients who underwent percutaneous internal ring suturing (PIRS) for indirect inguinal hernia from January 2016 to September 2018. The participants included 29 boys and 14 girls. There were cases of bilateral internal inguinal hernia (n=12), right indirect inguinal hernia (n=16), and left indirect inguinal hernia (n=15). Their mean age was 3.8±2.9 years, and mean body weight was 16 kg. Clinical features and surgical outcomes were analyzed.ResultsMean operating time was 35 min for unilateral inguinal hernia and 40 min for bilateral inguinal hernia. There were five cases of intraoperative bleeding (12%) during needle insertion. In two cases, stress test resulted in escape of gas into the hernial sac and a second suture was inserted. The contralateral patent processus vaginalis was present in six (14% of cases) and closed. Follow-up was 6~30 months. Mean postoperative hospital stay was 1.2 days. No recurrence hernia and postoperative complications were reported.ConclusionAlthough this study investigated a small number of cases and the surgical experience was rather limited, the PIRS technique was shown to have advantages such as a short learning curve and its aid in detecting contralateral hernias. In this study, there were no reports of recurrence, metachronous inguinal hernias, and postoperative complications.

Inguinal herniotomy in a patient with progeria

Abstract Hutchinson–Gilford progeria syndrome or progeria is a rare finding, Herein, we report a 4-year- old boy with progeria who underwent herniotomy and herniorrhaphy for left indirect inguinal hernia. The hernial sac was large and thick with surrounding adhesion. Tissue had an adult texture with very thick vas deference.

Detection and Treatment of Persistent Mullerian Duct Syndrome With Transverse Testicular Ectopia

The coexistence of persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE) is extremely rare. Due to a lack of distinctive clinical features in the early stages, PMDS coexists with TTE is usuallydiagnosed when patients are examined for other diseases,including cryptorchidism and inguinal hernia. We present a case of a 51-year-old man who presented with a recurrent left indirect inguinal hernia for 2 years and right congenital cryptorchidism. The patient was diagnosed as PMDS with TTE by preoperative magnetic resonance imaging and underwent laparoscopic resection of the right transverse ectopic testis and Mullerian duct residues.

A RARE CASE OF INDIRECT INGUINAL HERNIA WITH OVARY AS CONTENT AT A HOSPITAL OF VISAKHAPATNAM

A hernia is the protrusion of the small intestines or omentum or other organs through a defect in the abdominal wall. Inguinal herniain females is very rare and occurs in <5% of women. Here, we report the case of a 25-year-old female who presented with swellingin the left groin associated with dragging pain in the left iliac fossa. She was investigated and diagnosed as a left indirect inguinalhernia. Hernioplasty was planned and intraoperatively ovary along with fimbria was identified as content. An inguinal ovary mayoccur if the gubernaculum fails to attach to the uterus in fetal life or if the canal of Nuck remains open after birth.

Overexpression of Metallothionein in the Endothelium of Varicocele Veins—A Study Using Confocal Laser Scanning Microscopy

Objective Metallothionein (MT), a metal-binding protein, protects cells against apoptosis under hypoxia. Hypoxic stress causes pathophysiologic changes in the internal spermatic vein (ISV) of patients with varicocele. The use of confocal microscopy and fluorescent compounds permits visualization of the vascular wall organization and molecular changes that may occur. We studied MT expression and distribution in the ISV using confocal laser scanning microscopy. Materials and Methods The study group consisted of 20 patients with grade 3 left varicocele. The control group consisted of 10 volunteers with left indirect inguinal hernia. Through a left inguinal incision, a 1-cm section of the ISV was resected from each patient to detect MT expression by immunohistochemical stain and confocal microscopy. Results Immunohistochemical analysis of MT in the ISV sections showed stronger staining in the varicocele group than in the control group. The use of confocal microscopy provided a detailed vascular wall structure, and also revealed that the MT protein was distributed significantly in the endothelium. Conclusion The hypoxic conditions induced the overexpression of MT, which is deposited in the endothelial layer of varicocele veins, as determined by confocal microscopy. MT has the function to protect vascular cells from apoptosis, and this may be a mechanism for the thickened wall of the ISV that is present in varicocele patients.

Dysregulated Apoptosis Through the Intrinsic Pathway in the Internal Spermatic Vein of Patients With Varicocele

Apoptosis plays a critical role in various physiological processes. Varicocele is the most common cause of male infertility in adults. The dilated and thickened wall of the internal spermatic vein (ISV) in varicocele is considered similar to that in varicose veins. We investigated apoptotic protein expression in the ISV of varicocele, including Bcl-2, Fas, caspase-8 and caspase-9, to determine the intrinsic or extrinsic pathway. The study group consisted of 10 patients with grade 3 left varicocele. The control group consisted of 10 patients with left indirect inguinal hernia. A 1-cm section of ISV was resected, using left inguinal incision, from each patient in both groups. The ISV sections were used to detect the mediators that regulate the intrinsic (Bcl-2 and caspase-9) and extrinsic (Fas and caspase-8) apoptotic pathways, by immunoblotting and immunohistochemical staining. Results were analyzed using Student's t tests. Bcl-2, Fas, caspase-8 and caspase-9 immunoblots from both groups revealed a single band. The relative intensities of the Bcl-2 and caspase-9 protein bands differed significantly between the varicocele and control groups. Thickening of the smooth muscle layer of the ISV was found in patients with varicocele compared with the control group. Bcl-2 overexpression and downregulation of caspase-9 expression were noted in the varicocele group. There was no significant difference in Fas or caspase-8 expression in either group. We showed overexpression of Bcl-2 and downregulation of caspase-9 expression in the ISV under hypoxic stress. This indicated dysregulated apoptosis through the intrinsic pathway in the ISV of patients with varicocele. To the best of our knowledge, this is the first study of the apoptotic pathway in the human ISV. Additional studies are needed to establish whether adjunctive hyperbaric oxygen therapy reduces the recurrence rate after varicocelectomy.

Bcl-2 Overexpression in the Internal Spermatic Vein of Patients with Varicocele

Varicocele is characterized by dilatation and tortuosity of the internal spermatic vein (ISV). Cross sections of ISV showed marked thickening of smooth muscle layer under microscopy. This study examined Bcl-2 (anti-apoptotic protein) expression in the ISV of patients with varicocele. The study group consisted of eight patients with left varicocele, grade 3. The control group consisted of six volunteers with left indirect inguinal hernia. Using a left inguinal surgical incision, a 1-cm section of ISV was resected from each patient in both groups as specimens for immunoblotting and immunohistochemical staining of Bcl-2. Results were analyzed using Student's t test. Bcl-2 immunoblots from both groups revealed one single band. alpha-tubulin was used as loading control. The average relative intensity of the Bcl-2 was 25.82 +/- 10.53 in the control group and 113.49 +/- 27.49 in the varicocele group. Hematoxylin staining revealed a thickening ISV in the patients with varicocele, predominantly in the muscle layer, which was not found in the control group. Moreover, the intensity of Bcl-2 immunostaining was markedly higher in the study group than in the control group. This study showed Bcl-2 overexpression in the ISV of patients with varicocele. Additional studies are necessary to clarify the molecular mechanisms of varicocele formation and recurrence.

Increased Expression of Hypoxia-Inducible Factor-1α in the Internal Spermatic Vein of Patients With Varicocele

Varicocele is recognized as a cause of male infertility. Testis hypoxia may be one of the possible mechanisms of varicocele. We examined whether tissue hypoxia occurred in the ISV of patients with varicocele by detecting the expression of HIF-1alpha. The study group consisted of 8 patients with grade 3 left varicocele. The control group consisted of 6 volunteers with left indirect inguinal hernia. Using a left inguinal surgical incision, a 1 cm section of ISV was resected from each patient in both groups as specimens for immunoblotting and immunohistochemical staining of HIF-1alpha. Results were analyzed using Student's t test. HIF-1alpha immunoblots from both groups revealed a single band. The relative intensity of the HIF-1alpha protein band was 10.92 +/- 2.70 in the control group and 73.15 +/- 8.93 in patients with varicocele (ie 7-fold higher). HIF-1alpha expression in the ISV of patients with varicocele was significantly higher than in the control group. This directly shows that hypoxia related pathophysiological changes have occurred in the ISV of patients with varicocele and that hypoxia may have also occurred in the testicular tissue. Thus, it would be of interest to investigate whether decreasing HIF-1alpha activation and testis hypoxia could reduce the recurrence of varicocele. To our knowledge, this is the first report on HIF-1alpha expression in human ISV. Additional studies will be necessary to clarify the relationship between testis hypoxia and male infertility in patients with varicocele.

Migrating Mesh Plug: Complication of a Weil-Established Hernia Repair Technique

The mesh plug technique for repair of inguinal hernia has become one of the standard procedures in general surgery. The evolution of the technique of occluding the fascial defect with a foreign body has extensively been described in the surgical literature. The associated complications are also well described. We find only two published reports describing complications related to migration of a mesh plug. We present a case of a 50-year-old man with vague left lower quadrant pain approximately 18 months after left indirect inguinal hernia repair with the PerFix plug (Bard, Murray Hill, NJ) and overlay patch method. Laparoscopic exploration determined that the plug had migrated away from the left internal ring in the preperitoneal space and was involved with significant adhesions. The plug was removed, and his hernia was repaired laparoscopically with GORE-TEX mesh (W.L. Gore, Tempe, AZ). The patient's symptoms were relieved, and he remained pain free through follow-up at 6 months.

A CASE OF FORMATION OF A FOREIGN BODY GRANULOMA CAUSED BY MESH PERFIX PLUG®

A case of formation of a foreign body granuloma caused by Mesh PerFix Plug® (mesh plug) after tension free mesh plug hernia repair is reported with some bibiographical comments. A 66-year-old man, who had received a tension free mesh plug repair for left indirect inguinal hernia in March 1998, was seen at the hospital because of a left groin mass with tenderness in March 1999. On examination a mass was palped deep to the lateral side of the healed scar from his prior hernia surgery. An ultrasonography visualized a mass with an acoustic shadow, and results of an aspiration biopsy were Class I. We guessed it a foreign body granuloma and performed an operation on him in March 1999. Dissection in the deep revealed the tumor including the mesh plug which had been placed into the internal ring. Microscopic examination of the specimen revealed cicatrizant foreign body granuloma with rejection. This case is quite unusual and has not been reported so far.

The Role of The Spermatic Cord Layers in The Development of Varicoceles

The theory that insufficiency of the spermatic cord layers could be the etiological factor in the development of varicocele is reviewed critically. A prospective study of 40 patients operated upon for a left indirect inguinal hernia was done. The spermatic cord layers were excised as a routine part of the operation but combined manual and Doppler examinations revealed no postoperative reflux into the pampiniform plexus. We conclude that the spermatic cord layers probably do not have a major role in the pathogenesis of varicocele.

Agglutination studies in visceral larva migrans.

VISCERAL larva migrans, recently described by Beaver and his associates, presents an origin for a group of the extreme eosinophilias found in children. 1 The actual demonstration of larvae or ova in a liver biopsy appears necessary to make the diagnosis. 2 Since such a procedure is necessarily limited, an alternative method of diagnosis would be advisable. The following case is presented to show a probable relation between such an eosinophilic condition and lung infiltrations with serological evidence of parasitic infection. REPORT OF CASE K. C., a 28-month-old white boy, was first seen on Sept. 19, 1952, referred from the surgical service for an evaluation prior to surgery on a left indirect inguinal hernia. The routine blood cell count revealed a leucocyte count of 49,200, with 75% eosinophiles in the differential count. This boy was the third of four children. The mother's preportal course was uneventful and delivery was normal.

Eosinophilic Granuloma of Rib

EOSINOPHILIC granuloma of bone has been regarded as a disease that occurs in children and young adults and locally has a rapidly progressive course. A recently observed case has directed attention to the fact that the disease occurs in the older age groups and that its course can extend over a period of years.Case ReportA 46-year-old laborer entered the hospital on November 14, 1939, for the repair of a left indirect inguinal hernia. A routine roentgenogram of the chest revealed an area of decreased density posteriorly in the medullary portion of the left tenth rib. The area was . . .