Mesh Repair Of Inguinal Hernia Research Articles

Mesh-related visceral complications following inguinal hernia repair: an emerging topic.

The use of meshes in inguinal hernia repair (IHR) has gained popularity but new complications have been observed. Mesh-related visceral complications (MRVCs) are generally considered rare and hence are not studied in depth. We carried out a thorough literature search and collected 101 clinical reports published from 1992 to 2018. The reported complications seem to have tripled in the last decade. Ninety-seven cases met the inclusion criteria and they were subdivided into four groups (group A-onlay IHR, group B-3-D IHR, group C-preperitoneal IHR, group D-laparoscopic IHR) to be analyzed, according to the herniorraphy technique. Every prosthetic IHR can be followed by MRVCs but, according to the present review, the highest incidence is related to laparoscopic repairs, the lowest to Lichtenstein technique. Time-to-event was shorter in case of preperitoneal position of the prosthesis than when the mesh was implanted over the transversalis fascia. Urinary bladder involvement predominantly occurred after laparosopic IHR. A pathogenic correlation between the most frequently complained clinical signs and the previous mesh herniorraphy was rarely reported. The diagnosis was generally made at laparotomy, which was usually performed asan emergency. Removing the infected mesh and resecting or suture repairing the involved viscera was the challenging surgical treatment. Prevention of MRVCs after inguinal hernia repair appears to be an important significantissue. It is important to pay attention to the choice of a proper implantation site, avoiding direct contact between the mesh and viscera, and to select a proper device.

Trans Abdominal Pre-Peritoneal (TAPP) mesh for Inguinal Hernia Repair with External Fixation [Abdelhamid Technique], Outcome Assessment

Trans Abdominal Pre-Peritoneal (TAPP) mesh for Inguinal Hernia Repair with External Fixation [Abdelhamid Technique], Outcome Assessment

Evaluation of sutureless mesh repair for inguinal hernia: A prospective study

Background and Aims: Hernias are among the oldest known affliction of humankind. Many procedures have been developed till date to minimize or abolish tissue tension during repair of inguinal hernia. In present study we aimed to evaluate sutureless mesh repair for inguinal hernia. Material and methods: The present study was conducted on 50 consecutive male patients between 20-50 years of age and having uncomplicated inguinal hernia. Patients were operated upon using sutureless mesh repair technique. During the follow up patients were evaluated in terms of post-operative complications, hospital stay, operative time and recurrence if any. Results: We found that mean operative time was 39.36 (2.96) minutes and mean total duration of stay in hospital was 1.06 days. There were no complications in the immediate period. At one week postoperatively, seroma formation, wound infection and scrotal swelling were seen in 3 (6%) cases, 2 (4%) cases and 1 (2%) case respectively. Conclusion: Sutureless tension free mesh repair for the treatment of inguinal hernia cases is an effective technique in terms of decreased time of operative procedure and hospital stay, and decreased postoperative complications.

Open mesh versus laparoscopic mesh repair of inguinal hernia

Introduction Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh which can be placed by either using an open or a laparoscopic approach. The cause of groin hernia is probably multifactorial, with one or more factors applying in any particular case. Among the factors predisposing to groin hernia are persistence of the processus vaginalis, weakness of the shutter mechanism of the inguinal canal, raised intraabdominal pressure, heavy physical exertion, loss of integrity of the fascia transversalis, metabolic factors leading to the production of abnormal collagen fibers, cigarette smoking, genetic influences, spontaneous or iatrogenic abdominal wall trauma, aging, and general factors causing weakness of the abdominal wall muscles and fascia. Aim To compare the merits and potential risks between cases subjected to open mesh repair versus cases subjected to laparoscopic mesh repair of inguinal hernia. Patients and methods The patients were selected from those attending the surgical outpatient clinics of Al-Azhar University Hospitals (El-Hussein and El Sayed Galal), during the period from January 2017 till January 2019. Results This study includes 100 patients with inguinal hernias, where 50 of them were repaired laparoscopically by the transabdominal preperitoneal technique whereas the other 50 were repaired through the Lichtenstein tension-free repair. Patients were followed up by routine clinical examination for 6–18 months (with mean 12 months of follow-up) to calculate the incidence of postoperative complications and recurrence rate during the relatively short period of follow-up. Conclusion The Lichtenstein tension-free hernioplasty is the gold standard of groin hernia repair owing to the simplicity of the technique, the short learning curve, the low incidence of recurrence, and the low incidence of easily controllable postoperative complications as well as the relative low price and less expensive instruments required. However, transabdominal preperitoneal repair should be reserved for bilateral and recurrent inguinal hernias as long as the case is fit for general anesthesia or it is best suited to the younger patients in good general health who cannot afford an extended time away from work or who are suspected for a contralateral inguinal defect, and that it should be performed by an experienced surgeon to decrease the risk of complications and the operative time as well as the recurrence rates.

Cost-Effectiveness Analysis of Mesh Repair for Inguinal Hernia During a Humanitarian Surgical Mission in Rural Nigeria

Background: Humanitarian short-term surgery missions remain under debate, even though the proportion of the burden of surgical diseases around the world that could be treated based on surgery is constantly rising. The primary objective of this study was to prove the cost-effectiveness (CE) of a hernia repair–teaching mission in the rural setting of Nigeria. Methods: We present a CE analysis (CEA) of a 2-week surgery mission performing inguinal hernias with mesh repair according to the Lichtenstein maneuver. All data were collected prospectively. The contribution to the local health system was measured based on the disability-adjusted life years (DALYs). Further on, the CEA was analyzed and separated for surgeons from Nigeria and Europe, respectively. Results: During this mission a total of 107 patients with 123 hernias were treated. An average of 6,61 DALYs per patient were averted. The total costs for the mission team amounted to $8485.26, with a total of $19,210.73 from a societal perspective. Single-procedure costs amounted to $198.87 per patient, with $39.35 per procedure from a patient perspective. The CEA showed $31.04/DALY averted from a societal perspective, $13.71/DALY averted from a provider perspective, and $6.81/DALY averted from a patient perspective. This was well below the threshold of $2790 (gross domestic product per capita). Sensitivity analysis showed robust results. Conclusion: With these results we proved CE and remained about 90 times below the threshold of the gross domestic product per capita.

Cost effective use of mosquito net mesh in inguinal hernia repair

Mesh hernia repair is one of the commonest open techniques of inguinal hernia repair. The main limiting factor in the use of new meshes is the cost. We carried out a prospective randomized double blind study and comprising of a hundred patients with 100 inguinal hernias admitted consecutively for elective surgery, divided into the polypropylene mesh (PPM) group and the mosquito net mesh (MNM) group each containing fifty patients. All cases were completed successfully and results revealed no difference in two groups. The results of the present study, in consistent with the published literature, reveal that the cheap indigenous mosquito mesh, which has similar properties of an imported mesh, can be safely used for tension-free inguinal hernia repair in adults. Further trials with a larger number of patients and longer follow-ups are justified and recommended.

Prophylactic antibiotic for open mesh repair of inguinal hernia; from principe to nécessité

PURPOSE: The use of prophylactic antibiotics (PAs) in open mesh repair (MR) of inguinal hernia (IH) is controversial. Clean surgeries do not require PA. However, prosthetic implants may require PA. As a part of quality improvement project, “guideline-based treatment for IH” where the European Hernia Society guidelines were adapted and PA was administered only if necessary, not as a routine for open MR of IH since May 1, 2015. The aim of this study was to assess the practice in the use of PA in open MR of IH and the outcome at a single surgical unit. METHODS: This is a retrospective analysis of health records of all the male patients who underwent open MR of IH at a single surgical center, during the period from May 1, 2015 to May 1, 2016, where it was considered not to administer PA routinely, but to only when required (de necessite). Data of patients who underwent open MR of IH during the period May 1, 2014–April 30, 2015, where PA was administered routinely (de principe) for open MR of IH, were collected for comparison. Demographic, immune-compromised status, operation techniques, PA, and surgical site infections data were analyzed. RESULTS: There were 62 and 78 male patients who underwent open MR of IH during PA de principe and PA de necessite periods, respectively. The mean ages were 38.32 (range 21–74) and 35.51 (range 21–70) years, respectively, during PA de principe and PA de necessite. There were no patients with immunocompromised status. PA usage has reduced from 96.8% (n = 60) during the PA de principe to 11.5% (n = 9) during PA de necessite period. Surgical site infection rate was 1.6% and 1.3%, respectively, during PA de principe and PA de necessite periods. CONCLUSION: In a low-risk environment, open MR of IH can be carried out without PA in a majority of patients.

Open mesh repair of a voluminous recurrent inguinal hernia complicated by strangulation and intestinal obstruction

Open mesh repair of a voluminous recurrent inguinal hernia complicated by strangulation and intestinal obstruction

A Randomized Trial. Comparing Herniorrafia Modifield Desarda Repair and Hernioplastia Lichtenstein Repair for Inguinal Hernia (Study of 1242 Patients)

Introduction: The objective of this study is to compare the outcomes of Modified Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Patients and Methods: This is a prospective randomized controlled trial study of 1242 patients having 1313 hernias operated from January 2008 to December 2018. 640 patients were operated using Lichtenstein repair and 602 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 52 minutes in Modified Desarda group and 42 minutes in the Lichtenstein group that is significant (p<0.05). The recurrence was 0.0 % in Modified Desarda group and 0.3 % in Lichtenstein group. But, there were 8 cases of infection to the polypropylene mesh in the Lichtenstein group, 2 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (7,0 %) as compared to Modified Desarda group (3.6 %). The mean time to return to work in the Modified Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. in Modified Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Modified Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Modified Desarda repair is a better choice as compared with Lichtenstein repair.

The role of antibiotic prophylaxis in the prevention of surgical-site infection after hernioplasty in Menoufia University Hospital

Objective The aim of this paper was to evaluate the effectiveness of prophylactic antibiotics in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. Background Inguinal hernia is one of the most common conditions encountered in clinical practice. Mesh repair is becoming the most popular technique for the repair of inguinal hernia. A surgical-site infection is defined as an infection that occurs at or near a surgical incision within 30 days of the procedure or within three months if an implant is left in place. The decision of perioperative antibiotic prophylaxis is made according to a number of risk factors, in particular, in aseptic interventions. The use of antibiotic prophylaxis for clean surgical procedures such as inguinal hernia surgery is controversial. Patients and methods Between November 2014 and November 2015, this prospective randomized-controlled study included 40 patients who presented with inguinal hernia. Patients were randomized into two groups. Group A was administered an antibiotic at the induction of anesthesia. Group B was administered sterile normal saline. After Lichtenstein inguinal hernioplasty, patients were followed up at 7–10 and 28–35 days to assess surgical-site infection. Results Of a total of 40 patients (37 men and three women), 20 in each group, one (2.5%) patient developed wound infection in group A and two (5%) patients developed wound infection in group B. Conclusion There is no benefit of an intravenous single-dose antibiotic prophylaxis in the prevention of wound infection following Lichtenstein inguinal hernioplasty in patients with no other co-morbid conditions.

Comparative study of prophylactic ilioinguinal neurectomy and preservation of ilioinguinal nerve in open mesh repair of inguinal hernia

Background: Inguinal hernia is one of the most common surgery done in any hospital. Complaints of Chronic inguinal pain is one of the common problem these patients. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine ilioinguinal nerve division, compared to nerve preservation when performing Lichtenstein’s tension free inguinal hernia repair. Methods: The present study is a randomized controlled trial of 80 cases of inguinal hernias admitted in General Surgery Department in ESIC Medical College, Kalaburagi from January 2017 to June 2018. The patients were randomly chosen into Lichtenstein hernia repair with ilioinguinal neurectomy or Lichtenstein hernia repair with nerve preservation. After surgery, all patients were monitored carefully for pain and paraesthesia. Pain was assessed using visual analogue scale. Paraesthesia was assessed by the monofilament test and evaluated after comparison with the opposite side. Results: In the present study, the incidence of pain as well as the severity of pain is far higher in the nerve preservation study group as opposed to the neurectomy study group. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient. Conclusions: Prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following Lichtenstein inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.

Amyand’s hernia with healthy looking vermiform appendix, treatment of three cases with review of literatures

The term Amyand’s hernia refers to an incarcerated inguinal hernia containing the vermiform appendix, which may be completely healthy, inflamed or perforated. (1) In almost 1% of all inguinal hernias Amyand’s hernia is detected and acute appendicitis in Amyand’s hernia cases accounts only for 0.1% “ 0.07-0.13”. (5)Amyand’s hernia is named after Claudius Amyand, who on December, 6,1735 performed the 1st successful appendectomy during the treatment of 11 years old boy presented with right inguinal hernia . During the surgery Amyand found a pin within the appendix which was encrusted with stone the appendix was found within the inguinal hernia sac. (2) It should not be confused with the incidental findings of cecal appendix within the femoral hernia sac “ de Garengeot’s hernia” which is first described by Rene de Garengeot in 1731(3.4)&#x0D; The reported mortality rate of Amyand’s hernia ranges from 5.5%- 30%.&#x0D; This variation occurs due to the effect of early diagnosis, giving proper treatment, preventing intra abdominal sepsis, and good postoperative care. (6) It is generally accepted that surgical treatment of Amyand’s hernia includes both appendectomy and hernia repair. (5,6.7)&#x0D; However, appendectomy in the absence of an inflamed appendix and the use of mesh in cases of appendectomy remain to be controversial.&#x0D; Some authors offer not to perform prophylactic appendectomy when non inflamed appendix is incidentally found in the hernial sac. (6)&#x0D; Others believe that appendectomy should be performed in all cases to prevent future reherniation and appendicitis. (8.9) It has been thought that it is impossible to reach sufficient number of Amyand’s hernias cases to get evidence- based data due to its rarity. Therefore it is logical to revise the classification and surgical treatment of Amyand’s hernia based on the case reports from different institutions. The aim of this study is to review the experience of mesh inguinal hernia repair without performing appendectomy in patients with Amyand’s hernia with healthy looking vermiform appendix with close postoperative follow up to detect recurrence or other postoperative complications.

فتق " أمياند" المحتوي على زائده دوديه غير ملتهبه, علاج ثلاث حالات مع مراجعة البحوث السابقه

The term Amyand’s hernia refers to an incarcerated inguinal hernia containing the vermiform appendix, which may be completely healthy, inflamed or perforated. (1) In almost 1% of all inguinal hernias Amyand’s hernia is detected and acute appendicitis in Amyand’s hernia cases accounts only for 0.1% “ 0.07-0.13”. (5)Amyand’s hernia is named after Claudius Amyand, who on December, 6,1735 performed the 1st successful appendectomy during the treatment of 11 years old boy presented with right inguinal hernia . During the surgery Amyand found a pin within the appendix which was encrusted with stone the appendix was found within the inguinal hernia sac. (2) It should not be confused with the incidental findings of cecal appendix within the femoral hernia sac “ de Garengeot’s hernia” which is first described by Rene de Garengeot in 1731(3.4) The reported mortality rate of Amyand’s hernia ranges from 5.5%- 30%. This variation occurs due to the effect of early diagnosis, giving proper treatment, preventing intra abdominal sepsis, and good postoperative care. (6) It is generally accepted that surgical treatment of Amyand’s hernia includes both appendectomy and hernia repair. (5,6.7) However, appendectomy in the absence of an inflamed appendix and the use of mesh in cases of appendectomy remain to be controversial. Some authors offer not to perform prophylactic appendectomy when non inflamed appendix is incidentally found in the hernial sac. (6) Others believe that appendectomy should be performed in all cases to prevent future reherniation and appendicitis. (8.9) It has been thought that it is impossible to reach sufficient number of Amyand’s hernias cases to get evidence- based data due to its rarity. Therefore it is logical to revise the classification and surgical treatment of Amyand’s hernia based on the case reports from different institutions. The aim of this study is to review the experience of mesh inguinal hernia repair without performing appendectomy in patients with Amyand’s hernia with healthy looking vermiform appendix with close postoperative follow up to detect recurrence or other postoperative complications.

A prospective study comparing preservation of ilioinguinal nerve with neurectomy in open mesh repair of inguinal hernia

Background: Postoperative pain after open mesh repair of inguinal hernia is an important challenge. Such type of pain sometimes does not respond to medical treatment including non-steroidal anti-inflammatory drugs and opiates. The objective of the present study was to evaluate the effect of preservation or division of the Ilioinguinal nerve on pain and post-operative symptoms, after open mesh repair of inguinal hernia.Methods: All patients undergoing surgery for tension free Lichtenstein mesh repair over a period of 1 year were included. Patients below the age of 18 years and patients with bilateral or recurrent hernias were excluded.Results: In present study of 42 patients, early mean postoperative pain at day 1 was 1.8 on VAS scale in ilioinguinal neurectomised patient compared to 1.5 in nerve preserved group (P=0.1408). Postoperative pain at week 1 was 1.25 in neurectomised patients compared to 1.32 in nerve preserved group (P=0.7161). Late Postoperative pain and chronic groin pain was 0.6 and 0.25 at 1 and 3 months respectively in ilioinguinal neurectomised patients as compared to 1.05 and 0.77 at 1 and 3 months respectively in nerve preserved group (P=0.0184 at 1month and P=0.0335 at 3 months).Conclusions: The difference in postoperative pain at day 1 and at week 1 was not significant and both groups had equal pain. Late postoperative pain (at 1 month) and chronic groin pain (at 3 months) was significantly low in ilioinguinal neurectomised patient compared to nerve preserved group.

Lower Incidence of Postoperative Pain after Open Inguinal Hernia Surgery with the Usage of Synthetic Glue-Coated Mesh (Adhesix®)

Chronic groin pain after inguinal hernia mesh repair is a common problem. Mesh fixation without sutures has been suggested to have several advantages over the traditional suture fixation. The aim of this study was to compare two self-adhering meshes, the glued Adhesix® (AH) and the gripping Parietene ProGrip® (PP), and evaluate their impact on postoperative chronic pain and overall recovery. Two consultant surgeons performed altogether 393 open inguinal hernia operations at the Helsinki University Hospital during 2014 to 2015. The two groups, AH (n = 169) and PP (n = 224) were similar and comparable in terms of demographic data. The data were collected and analyzed from the patients' medical records in the hospital's register. The patients were followed up for a period of 19 months (5-31 months). The number of patient contacts due to postoperative pain was significantly less common in the AH group than in the PP group, 4/169 (2.4%) versus 19/224 (8.5%) patients, respectively (P = 0.011). The duration of pain was under three months for most patients, only two patients in the PP group had pain for over one year. The pain was treated most patients with anti-inflammatory painkillers, whereas injections of a local anesthetic and corticosteroid, and chronic pain medication was needed in some cases. It seems that the use of glue-coated mesh (Adhesix®) was associated with less postoperative visits due to pain compared with the self-fixating mesh with absorbable anchoring system (ProGrip®). Further studies with long-term follow-up are needed to confirm these results.

Safety and Efficacy of Bupivacaine HCl Collagen-Matrix Implant (INL-001) in Open Inguinal Hernia Repair: Results from Two Randomized Controlled Trials.

IntroductionSurgical site infiltration with bupivacaine results in short-lived analgesia. The MATRIX-1 and MATRIX-2 studies examined the efficacy and safety of the bioresorbable bupivacaine HCl collagen-matrix implant (INL-001) for postsurgical pain after open inguinal hernia repair. INL-001, designed to provide early and extended delivery of bupivacaine, provides prolonged duration of perioperative analgesia.MethodsIn two phase 3 double-blind studies [MATRIX-1 (ClinicalTrials.gov identifier, NCT02523599) and MATRIX-2 (ClinicalTrials.gov identifier, NCT02525133)], patients undergoing open tension-free mesh inguinal hernia repair were randomized to receive 300-mg bupivacaine (three INL-001 100-mg bupivacaine HCl collagen-matrix implants) (MATRIX-1 n = 204; MATRIX-2 n = 213) or three placebo collagen-matrix implants (MATRIX-1 n = 101; MATRIX-2 n = 106) during surgery. Postsurgical medication included scheduled acetaminophen and as-needed opioids.ResultsPatients who received INL-001 in both studies reported statistically significantly lower pain intensity (P ≤ 0.004; primary end point) and opioid analgesic use (P < 0.0001) through 24-h post-surgery versus those who received a placebo collagen-matrix. Patients who received INL-001 reported lower pain intensity through 72 h (P = 0.0441) for the two pooled studies. In both studies, more of the patients (28–42%) who received INL-001 used no opioid medication 0–24, 0–48, and 0–72 h post-surgery versus those who received a placebo collagen-matrix (12–22%). Among patients who needed opioid medication, patients receiving INL-001 used fewer opioids than those who received a placebo collagen-matrix through 24 h in both studies (P < 0.0001) and through 48 h in MATRIX-2 (P = 0.0003). Most adverse events were mild or moderate, without evidence of bupivacaine toxicity or deleterious effects on wound healing.ConclusionThese findings indicate that INL-001 results in post-inguinal hernia repair analgesia that is temporally aligned with the period of maximal postsurgical pain and may reduce the need for opioids while offering a favorable safety profile.Trial RegistrationClinicalTrials.gov identifiers, NCT02523599; NCT02525133.FundingInnocoll Pharmaceuticals.Plain Language SummaryPlain language summary available for this article.

Is laparoscopic totally extra peritoneal repair of hernia (TEP) superior than trans-abdominal preperitoneal (TAAP) mesh repair of inguinal hernia- our experience from a tertiary care hospital, Kolkata

Background: The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP a mesh is placed through peritoneal incision over possible sites of hernia by going into peritoneal cavity, where as in TEP the peritoneal cavity is not entered and a mesh is used to seal the hernia from outside the peritoneum.Aims and Objectives: The aim of the current study was to compare the outcome of Total Extra- peritoneal (TEP) versus Trans-abdominal Pre-peritoneal (TAPP) repair of inguinal hernia, where both can be done.Materials and Methods: The current randomized control study was conducted among eighty patients of inguinal hernia. Of these, the sampling was done through random allocation of patients for TEP (Group-I) and TAPP (Group-II), comprising forty patients in each group. All patients irrespective of group were observed for pain (by VAS Score), mean operative time, duration of hospital stay, days taken to resume their normal activities, intra-operative and early post-operative complications and recurrence if any.Results: The pain in both groups was insignificant until one day but highly significant differences (p&lt;0.0001) were observed by end of day 2 and 1 month, showing higher degree of pain in TAPP with respect to TEP procedure. The differences in mean operative time for surgery was highly significant (p&lt;0.0001) with mean time of 86.72 min (TAPP) and 99.72 (TEP). The duration of hospital stay was higher in TAPP (5.2 days) compared to TEP (2.6 days). The mean time to return to normal activities was 10.8 days (TAPP) and 6.2 days (TEP) which was highly significant (p&lt;0.0001). The recurrence though occurred only in one patient in TEP group which was negligible. The other post-operative complications was seroma (8 cases; TAPP) versus (1 case; TEP) and it was highly significant (p&lt;0.0001). The port site infection was in 20 % patients (8/40) in TAPP compared to 2.5% (1/40) in TEP group.Conclusion: The TEP is comparatively superior than TAPP procedure in terms of post-operative complications, duration of hospital stay and return to normal activities.Asian Journal of Medical Sciences Vol.9(6) 2018 20-24

Male Fertility After Inguinal Hernia Mesh Repair

To determine whether patients who receive an inguinal hernia repair father the same number of children as the background population. Although the effect of inguinal hernia repair on male fertility has previously been investigated through indirect measures, no previous studies have evaluated the final measure of male fertility, which is the number of children fathered by patients. Prospectively collected data on 32,621 male patients between the ages of 18 and 55 years who received 1 or more inguinal hernia repairs during the years 1998 to 2012 were found in 5 comprehensive Danish linked registers. Patients were matched with 97,805 controls, and the number of fathered children was recorded as the primary outcome. Patients who were operated unilaterally fathered more children than controls (156 vs 147 children per 1000 individuals, P = 0.02), whereas patients who were operated bilaterally fathered the same number of children as controls. Unilateral Lichtenstein operation resulted in an increase in number of children fathered by patients (161 vs 151 children per 1000 patients, P = 0.009). No difference in the number of children fathered was found for any year following operation. Meanwhile, time between operation and first child was longer among controls than patients (log-rank P = 0.003). The youngest (18-30 years of age) bilaterally operated patients fathered the same number of children as controls. Patients who underwent inguinal hernia repair using Lichtenstein technique or laparoscopic approach did not father fewer children than expected. Thus, inguinal hernia repair using Lichtenstein or laparoscopic approach did not impair male fertility.

Comparison of early postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Background: Laparoscopic hernia has all the benefits of a tension free repair. The aim of this study was to compare the early postoperative outcome of laparoscopic and open inguinal hernia mesh repair.Methods: This is a prospective study conducted at Ramaiah hospital Bangalore from June 2016 to July 2017. 70 cases of inguinal were included in the study hernia diagnosed clinically and radiologically who fulfilled the inclusion &amp; the exclusion criteria. The principal operative techniques were laparoscopic hernioplasty (LH) and open inguinal mesh hernioplasty (OH).Results: 35 patients each were allotted to two group (LH and OH). The mean age was 50.53. LH group had significantly less postoperative pain than the OH group on 12, 24 and 72 hrs (P &lt;0.05). Although the vas pain scores of LH group were also comparatively lower on postoperative day 14, these differences were not statistically significant. Than mean operative time was significantly higher for LH group (131.86 vs 80.29 min) although in bilateral cases the difference was considerably less but was still significant (138 vs 107 min). The mean hospital stay after surgery was less for LH group (2.68 vs 3.25 days) but was not statistically significant. (p = 0.073). Chronic pain persisted for 2 patients (5.7%) in OH group whereas none had chronic pain in LH group.Conclusions: Laparoscopic hernioplasty is equivalent to open repair in the treatment of inguinal hernia, with less post-operative pain, lower risk of wound infection, shorter duration of hospital stay, and less incidence of chronic pain however requires a long learning curve and is more expensive.

The use of mesh for inguinal hernia repair in northern Ghana

BackgroundDespite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. Materials and methodsA retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed. Multivariate logistic regression was used to determine predictors of mesh use. ResultsEight thousand eighty male patients underwent IH repair. The range of IH repair in each region was 96 to 295 (overall 123) per 100,000 population. Most cases were performed at district hospitals (84%) and repaired nonurgently (93%) by nonsurgeon physicians (66%). Suture repair was most common (85%) although mesh was used in 15%. The strongest predictor of mesh use was when a surgeon performed surgery (odds ratio [OR] 3.13, P <0.001), followed by surgery being performed in a teaching hospital (OR 2.31, P <0.001). Repair at a regional hospital was a negative predictor of mesh use (OR 0.08, P <0.001) as was the use of general anesthesia (OR 0.40, P = 0.001). ConclusionsMost IH repairs are performed in district hospitals, by nonsurgeon physicians, and without mesh. Rates of repair and the use of mesh are higher than previous estimates in Ghana and Sub-Saharan Africa but not as high as high-income countries.