Mesh Repair Of Hernia Research Articles

Preoperative Abdominal Muscle Elongation Facilitated Laparoscopic Intraperitoneal Onlay Mesh Repair of Complex Ventral Hernia.

Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.

Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study

PurposeStoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model.MethodsWe performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction.ResultsOne hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH.ConclusionsBased on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.

Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Low incidence of recurrence and chronic pain after groin hernia repair in adolescents: a systematic review and meta-analysis

PurposeThe best operative management of groin hernia in adolescents is uncertain. The aim of this systematic review was to assess recurrence and chronic pain after mesh versus non-mesh repair for groin hernia in adolescents.MethodsA systematic search was done in PubMed, EMBASE, and Cochrane CENTRAL in May 2022 for studies reporting postoperative chronic pain (≥6 months) or recurrence after groin hernia repair in adolescents aged 10–17 years. We included randomized controlled trials and observational studies on primary unilateral or bilateral groin hernia repair. Risk of bias was assessed with the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Meta-analysis of the incidence of recurrence was conducted. This review is reported according to PRISMA guideline.ResultsA total of 21 studies including 3,816 adolescents with groin hernias were included comprising two randomized controlled trials, six prospective, and 13 retrospective cohort studies. For non-mesh repairs, the weighted mean incidence proportion of recurrence was 1.6% (95% CI 0.6–2.5) after 2,167 open repairs and 1.9% (95% CI 1.1–2.8) after 1,033 laparoscopic repairs. For mesh repairs, it was 0.6% (95% CI 0.0–1.4) after 406 open repairs while there were no recurrences after 347 laparoscopic repairs (95% CI 0.0–0.6). Across all surgical techniques, the rate of chronic pain after 1,153 repairs ranged from 0 to 11%. Follow-up time varied and was reported in various ways.ConclusionThe incidences of recurrence after groin hernia repair in adolescents were low for both open and laparoscopic mesh and non-mesh repairs. Rates of postoperative chronic pain were low.Trial registrationPROSPERO: CRD42022130554.

Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair.

Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657.One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.

Mesh infection after umbilical hernia repair in a pregnant female

Introduction: Acute abdominal findings occur in about 1 in 500 pregnancies. Diagnosis of acute abdominal findings in pregnancy can be difficult due to the physiologic and anatomic changes that are intrinsic to pregnancy. In pregnancy, the presence or recurrence of umbilical hernia is common and should be included in the differential diagnosis for acute abdominal findings. Few cases have been reported of complications post-hernia repair during subsequent pregnancies. Case Report: We report the case of a 31-year-old female with a history of an umbilical hernia repair who presented with acute abdominal findings at 22 weeks gestation attributed to delayed infection of surgical mesh. Conclusion: This patient’s presentation of acute abdominal findings during pregnancy with a history of umbilical hernia repair one year prior required exclusion of both obstetric and non-obstetric causes to determine diagnosis. There is little published evidence to guide Ob/Gyn physicians in counseling patients on the impact of pregnancy on prior umbilical hernia mesh repair. This case emphasizes the need for surveillance for mesh related complications during subsequent pregnancies in women with a history of mesh umbilical hernia repair.

P-021 DELAYED ENTEROCUTANEOUS FISTULA AND ENCAPSULATING MESH INFECTION AFTER COMPOSITE MESH REPAIR OF AN ABDOMINAL MIDLINE INCISIONAL HERNIA - COMPLICATIONS 12 YEARS LATER

Abstract Aim Mesh infection is a well-recognised complication of incisional hernia repair, however, is usually encountered within months after mesh insertion. Only a few cases have been published where an enterocutaneous fistula has presented many years after mesh repair of an incisional hernia. Here we describe a complicated case of enterocutaneous fistula and mesh infection 12 years after the primary surgery. Material &amp; Methods A 44 year-old gentleman presented acutely with a worsening 4 month history of an umbilical discharging sinus with associated fever, intermittent abdominal pain and nausea. There was also an associated hard lump and skin erythema. He previously had a laparotomy, small bowel resection for tuberculosis and ileostomy formation 13 years ago, followed by ileostomy reversal and intraperitoneal incisional hernia repair with composite mesh 1 year later. Results Cross-sectional imaging showed a large volume of gas within the mesh with underlying small bowel and collection within anterior abdominal wall, suggesting an enterocutaneous fistula. The patient initially underwent ultrasound guided aspiration of the collection followed by nutritional optimisation prior to another laparotomy, mesh excision and small bowel resection. The mesh was found to have a thick biofilm initially thought to be encased in mycobacterium but further testing was negative for this. Conclusions Delayed mesh infection over more than a decade after mesh insertion is rare. It is likely that pre-existing risk factors such as previous TB and small bowel resection with adhesions increased the risk of enterocutaneous fistulation.

P-097 FEMORAL AND OBTURATOR HERNIA INCARCERATED: A CASE REPORT

Abstract Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case. A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours. On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia. Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful. Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.

OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL

Abstract Aim A remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is raising evidence that biological meshes could be advantageous concerning occurrence of chronic pain without the disadvantages of a life-long implant. The BIOLAP trial compares synthetic and biological meshes in laparoendoscopic inguinal hernia repair. To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other. Materials and Methods In 21 German hernia centres, 982 hernias were treated using TEP or TAPP techniques. In addition to the study endpoints (recurrence rate within 2 years, pain intensity after 6 months), demographic and perioperative data as well as intraoperative and postoperative complications were recorded. Results Recruitment was successfully completed in February 2021. Six month after laparoendoscopic hernia repair there is no significant difference in pain occurrence comparing biological to synthetic mesh implants. Furthermore general demographics of the patients with bilateral primary inguinal hernias are evaluated. Conclusion The study provides data from 982 hernia operations dependent of the mesh material used. According to the study protocol, at the current time pain intensity after 6 months comparing both mesh materials has been evaluated as the first endpoint. Further study endpoints will be evaluated after completion of the two-year follow-up phase.

Outcomes of Laparoscopic TAPP Inguinal Hernia Repair without Mesh Fixation

Inguinal hernia repair is one of the commonest general surgical procedures performed worldwide. Laparoscopic repair is associated with faster recovery, less post operative pain and comparable rates of recurrence. Using the stapling devices increases post TAPP chronic groin pain. We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 43 patients in which we did not fix the mesh. The primary purpose of this study was to examine the rate of recurrence and chronic groin pain in patients undergoing TAPP mesh hernia repair for inguinal hernia. We observed that our rates of recurrence and chronic groin pain are comparable to those described previously in the literature. We concluded that laparoscopic inguinal hernia repair by TAPP approach can be done with acceptable rates of recurrences and decreased rates of post operative chronic groin pain.

COMPARATIVE STUDY BETWEEN OPEN AND LAPAROSCOPIC VENTRAL HERNIA REPAIR

Introduction: In today's era laparoscopy has gained quite popularity still there is debate on its use for ventral hernia. The main challenges in hernia management lie in deciding the surgical approach and type of repair procedure to perform, that is, laparoscopic or open surgery. A prospective observational comparative study was Material and methods: carried which included 90 patients out of which 45 patients underwent open mesh repair for ventral hernia and 45 patients underwent Laparoscopic mesh repair for ventral hernia were included in the study. Patients were follow up on post operative day 1, day 2, day 10, day 30 and day 60. The average duration of Results: surgery was slightly higher for the patients who underwent laparoscopic repair (95.11 vs 78.26 mins) with a P value of &lt;0.0001 suggestive of statistically signicant difference. The intraoperative blood loss was slightly lower lap repair group but the difference was not signicant statistically (P=0.1347). The mean VAS post operative pain scores were higher for the patients who underwent open hernia repair. Conclusion: The study concluded that laparoscopic repair took more time than compared to the open group of patients. However, the laparoscopic group of patients had a much better post operative outcome in terms of reduced intra operative blood loss and post operative pain

A PROSPECTIVE COMPARATIVE STUDY BETWEEN ONLAY AND RETRO-RECTUS MESH REPAIR IN VENTRAL HERNIA CASES IN A TERTIARY CARE CENTER

Ventral hernia, a commonly dealt surgical problem in clinical practice, is dened as an abnormal protrusion of a viscus or a part of the viscus through a defect or weakness in the anterior abdominal wall. Various risk factors such as old age, history of previous surgery, obesity, COPD, diabetes mellitus, smoking &amp; alcoholism lead to the formation of ventral hernias. Mesh hernioplasty has become the gold standard in the management of ventral hernias. There are various procedures in the management of ventral hernias based on the placement of mesh. In this study, we compare the traditional onlay and retro-rectus mesh repair in ventral hernias in terms of postoperative complications, hospital stay &amp; feasibility

"Fascial defect closure versus bridged repair in laparoscopic ventral hernia mesh repair: a systematic review and meta-analysis of randomized controlled trials. Author's reply".

"Fascial defect closure versus bridged repair in laparoscopic ventral hernia mesh repair: a systematic review and meta-analysis of randomized controlled trials. Author's reply".

Modification of polypropylene mesh by titanium compound: An in Vivo and in Vitro study

Objective: Previous basic studies on the use of titanized polypropylene meshes in abdominal external hernia repair are not only limited, but also highly controversial. This study aims to investigate the modification effect of titanium compounds on polypropylene materials and compare the performance of two kinds of meshes both in vivo and in vitro.Methods: Human peritoneal mesothelial cells (HMrSV5), human epidermal fibroblasts (HSF), and human monocytic cells (THP-1) were cultured in vitro to simulate the abdominal external hernia environment. Titanized polypropylene meshes (Ti) and polypropylene mesh (Non-Ti) were co-cultured with the cells respectively. The effects of titanium compounds on cell growth were determined by cell activity and apoptosis, and the growth of cells on the mesh surface was assessed using a scanning electron microscope and a confocal microscope. In vivo experiments, different sizes titanized polypropylene meshes and polypropylene meshes were placed between the external oblique abdominal muscle and the internal oblique abdominal muscle, the parietal peritoneum, the serous layer of the descending colon, and the underside of the femoral nerve in rabbits. The effects of titanium compounds were evaluated by observing the anti-adhesion, anti-contraction, anti-fibrotic properties, and effects on nerves of the mesh.Results: Titanium compounds effectively reduced the effects of polypropylene material on cell growth, and improved the fixation and adhesion of HMrSV5, HSF and THP-1 (M0) on the surface of titanized polypropylene meshes. Furthermore, titanium compounds improved the adhesion, contraction and fibrosis of polypropylene material, as well as reduced nerve damage. This improvement demonstrated a regular trend with the type of titanized polypropylene meshes.Conclusion: The titanium compounds improved the biocompatibility of the polypropylene material, which was conducive to the fixation and adhesion of cells on the surface of the meshes, and alleviated the adhesion and contraction of the meshes, and the degree of tissue fibrosis, as well as the influence on nerves.

COMPARATIVE STUDY OF “ONLAY” AND “INLAY” MESH REPAIR IN TERMS OF EARLY AND LATE COMPLICATIONS IN SELECTED VENTRAL HERNIA (INCISIONAL, UMBILICAL, PARAUMBILICAL).

Objectives: This case study aimed to compare early and late complications in Onlay and Inlay mesh repair of ventral hernia in terms of demography, post op pain, seroma, bleeding, SSI, recurrence. 50 patients Methodology: operated by open mesh repair in our surgical unit of IMS &amp; SUMH HOSPITAL in last 3 years and complications evaluated prospectively for 6 months in each patient. Two groups 25 each formed as Onlay (“O” group) and Inlay (“I”group) and clinical data recorded postoperatively for pain, seroma, bleeding, SSI, recurrence. Data was analyzed through 16th version of SPSS software. chi-square test was applied and a p-value&lt; 0.05 was considered as signicant. There are 50 patients in the study with age ranging from Results- 20 to 60 years. Females are more than male patients. There are no differences in terms of demography and clinical characteristics. The duration of surgery in “I”group is longer. The length of hospital stay has no difference, although drains are kept longer in “I”group. Recurrence and infection are more in “O” group when compared to “I” group. Conclusion-In this study Inlay meshplasty had better out comes than Onlay meshplasty in ventral hernia repair. Retrorectus(Sublay) mesh repair has good results,but it requires more expertise, time taking, laparoscopic and robotic platform which is not available in all places

Frequency of Surgical Site Infection in Mesh Repair for Inguinal Hernias

OBJECTIVES To determine the frequency of surgical site infection in mesh repair for inguinal hernias. METHODOLOGY This Descriptive observational study was carried out at the Surgical B unit of Hayatabad Medical Complex Peshawar from November 2021 to October 2022. A total of 179 patients were included in the study were given a single dose of antibiotics, i.e.1, gm Ceftriaxone, one hour before inguinal hernia mesh repair.RESULTS A total of 179 patients aged between 30-60 years with a mean age of 45 years were enrolled. There were 98(54.7%) male while 81(45.3%) females. The frequency of wound infection was noted in 23 (12.8%) patients following mesh repair for inguinal hernia. Out of 23, most of the patients, 10(43.5%) had Medical redness &amp; tenderness, 8(34.8%) patients had pus discharge from the wound side, and 5(21.7%) patients had wound site abscesses.CONCLUSION Surgical site infection after mesh repair was higher than the internationally reported incidence. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in these

Biologic versus synthetic mesh in open ventral hernia repair: A systematic review and meta-analysis of randomized controlled trials.

Ventral hernia repair is one of the most common operations performed worldwide, and using mesh is standard of care to decrease recurrence. Biologic meshes are increasingly used to minimize complications associated with synthetic mesh, but with significantly higher cost and unclear efficacy. Until recently, most of the evidence supporting the use of biologic meshes was from retrospective cohorts with high heterogeneity and risk of bias. We aimed to report a meta-analysis of randomized controlled trials comparing the outcomes of synthetic and biologic mesh in elective open ventral hernia repair. A literature search of PubMed, Embase, and Cochrane Library databases was performed to identify randomized controlled trials comparing biologic and synthetic mesh in elective open ventral hernia repairs. The postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. A total of 1,090 studies were screened, and 22 were fully reviewed. Four randomized controlled trials and 632 patients were included in the meta-analysis. Fifty-eight percent of patients had contaminated wounds (Wound Classification II-IV). Hernia recurrence (odds ratio 2.75; 95% confidence interval 1.76-4.31; P < .00001; I2= 0%) and surgical site infections (odds ratio 1.53; 95% confidence interval 1.02-2.29; P= .04; I2= 0%) were significantly more common in patients with biologic mesh. The rates of seroma, hematoma, and mesh removal were similar in both groups. As compared to synthetic mesh, biologic meshes resulted in increased hernia recurrences and surgical site infections. Current evidence supports macroporous, uncoated synthetic mesh as the implant of choice for elective open ventral hernia repair, and its use should be considered even in contaminated cases.

A comparative study on short term surgical outcome between laparoscopic inguinal hernia mesh repair vs. open inguinal hernia mesh repair for primary unilateral inguinal hernias

Background: Current study was performed to compare the short-term surgical outcome of laparoscopic (TAPP) and open inguinal hernia mesh hernioplasty (Lichtenstein) in primary unilateral inguinal hernias such as time taken by patients to return to routine daily activities and return to work. Methods: This is a prospective, comparative study done in Apollo Main Hospital, Chennai comparing surgical outcomes between laparoscopic and open primary unilateral inguinal hernia mesh repair in a total of 60 patients with 30 patients in each arm. Results: Return to Job is 8 median days in laparoscopic group and 9 median days in open group which is significant with a p value of 0.000. Pain score at 12th hour is significantly lesser in laparoscopic group with a VAS score of 3 compared to open group with a VAS score of 4 with p value of 0.015. VAS score at POD 1 in laparoscopic group is 2 and in open group is 3 which is significantly lesser in laparoscopic group with a p value of 0.026. Pain score at POD 3 and 4 is significantly lesser in laparoscopic group with a p value of 0.001 and 0.008 respectively. laparoscopic group takes analgesia for a lesser number of days than the open group with a p value of 0.019. Conclusions: This study concludes laparoscopic repair for primary unilateral inguinal hernias is superior to Lichtenstein tension free mesh hernioplasty in terms of postoperative pain, early return to job and less consumption of postoperative analgesia.

CT-measured hernia parameters can predict component separation: a cross-sectional study from China.

Currently, there are no reliable preoperative methods for predicting component separation (CS) during incisional hernia repair. By quantitatively measuring preoperative computed tomography (CT) imaging, we aimed to assess the value of hernia defect size, abdominal wall muscle quality, and hernia volume in predicting CS. The data of 102 patients who underwent open Rives-Stoppa retro-muscular mesh repair for midline incisional hernia between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into two groups: ''CS group'' patients who required CS to attempt fascial closure, and ''non-CS'' group patients who required only Rives-Stoppa retro-muscular release to achieve fascial closure. Hernia defect width, hernia defect angle, rectus width, abdominal wall muscle area and CT attenuation, hernia volume (HV), and abdominal cavity volume (ACV) were measured on CT images. The rectus width to defect width ratio (RDR), HV/ACV, and HV/peritoneal volume (PV; i.e., HV + ACV) were calculated. Differences between the indices of the two groups were compared. Logistic regression models were applied to analyze the relationships between the above CT parameters and CS. Receiver operator characteristic (ROC) curves were generated to evaluate the potential utility of CT parameters in predicting CS. Of the102 patients, 69 were in the non-CS group and 33 were in the CS group. Compared with the non-CS group, hernia defect width (P < 0.001), hernia defect angle (P < 0.001), and hernia volume (P < 0.001) were larger in the CS group, while RDR (P < 0.001) was smaller. The abdominal wall muscle area in the CS group was slightly greater than that in the non-CS group (P = 0.046), and there was no significant difference in the CT attenuation of the abdominal wall muscle between the two groups (P = 0.089). Multivariate logistic regression identified hernia defect width (OR 1.815, 95% CI 1.428-2.308, P < 0.001), RDR (OR 0.018, 95% CI 0.003-0.106, P < 0.001), hernia defect angle (OR 1.077, 95% CI 1.042-1.114, P < 0.001), hernia volume (OR 1.002, 95% CI 1.001-1.003, P < 0.001), and CT attenuation of abdominal wall muscle (OR 0.962, 95% CI 0.927-0.998, P = 0.037) as independent predictors of CS. Hernia defect width was the best predictor for CS, with a cut-off point of 9.2cm and an area under the curve (AUC) of 0.890. The AUCs of RDR, hernia defect angle, hernia volume, and abdominal wall muscle CT attenuation were 0.843, 0.812, 0.747, and 0.572, respectively. Quantitative CT measurements are of great value for preoperative prediction of CS. Hernia defect size, hernia volume, and the CT attenuation of abdominal wall muscle are all preoperative predictive indicators of CS.

The Impact of Body Mass Index on Local Anaesthetic Inguinal Hernia Repair.

Open mesh repair of inguinal hernia is acceptable and can be performed under local anaesthesia (LA). Individuals with high BMI (Body Mass Index) have often been excluded from LA repairs for varying reasons including safety concerns. Open repair of unilateral inguinal hernia (UIH) amongst individuals with different BMI groups was studied. Its safety profile was investigated using LA volume and length of operation (LO)asendpoints. Operative pain and patient satisfaction were also evaluated. A total of 438 adult patients were studied having excludedunderweight patients, those requiring any additional intra-operative analgesia, multiple procedures, or records with incomplete data.Operative pain, patient satisfaction, LO and LA volume were retrospectively studied from the existing data from clinical and operative notes. It was a predominantly male population (93.2% males) with an age range of 17-94 years peaking in the 60-69 years age group. BMI ranged 19-39 kg/m2 with BMI above normal at 62.8%. LO was 13-100 minutes (average 37 mins {SD = 12})utilising an average LA volume of 45 ml (SD = 11) per patient. Across BMI groups, no significant difference in LO (P = 0.168) or patient satisfaction (P = 0.388) was seen. AlthoughLA volume (P = 0.011) and pain score (P<0.001) demonstrated statistically significant differences, these did not appear to be clinically relevant.Over 90% in each BMI group experienced mild or no pain and with severe pain reported in only one patient in the entire population. Overall, LA volume required per patient was low and dosage was safe in all BMI groups with significant proportion (89%) of patients evaluated for satisfaction rating their experience ≥ 90 out of 100. LA repair is safe and well tolerated irrespective of BMI.BMI is not a viable reason for exclusion of obese/overweight individuals from LA repair.