Method For Inguinal Hernia Repair Research Articles

Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.

The Shouldice method for inguinal hernia repair remains the gold standard for prosthesis-free repairs. Nonetheless, international guidelines have favored posterior mesh reinforcement as the standard of care for inguinal hernia repair due to lower risk of recurrence and chronic pain, avoidance of general anesthesia, and favorable biomechanical properties. Recent publications have shown the benefits of an open approach to posterior repairs. Herein, we use the Abdominal Core Health Quality Collaborative (ACHQC) registry to compare patient-reported outcomes after a Shouldice no-mesh repair versus open preperitoneal (OPP) mesh repair. We performed a propensity score matched analysis to compare patient-reported quality of life (QoL) and peri/postoperative outcomes after a Shouldice repair versus OPP. Data from 2012 to 2022 were obtained from the ACHQC, and 1:1 optimal matching was performed. EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts. Matching resulted in 257 participants in each, Shouldice and OPP cohorts. OPP was associated with a better QoL score compared to Shouldice at 30days after surgery (Median (IQR) 7.75 (2.0-17.0) vs 13.0 (4.0-26.1); OR 0.559 [0.37, 0.84]; p = 0.003). This difference persisted at 6 months and 1 year postoperatively (OR 0.447 [0.26, 0.75] and 0.492 [0.26, 0.93], respectively). We did not observe any significant differences in hernia recurrence risk at 1-year, or rates of 30-day SSOs/SSIs, postoperative bleeding, peripheral nerve injury, DVTs, or UTIs. Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.

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.

Quality of Life after Desarda Technique for Inguinal Hernia Repair-A Comparative Retrospective Multicenter Study of 120 Patients.

Inguinal hernia repair, according to Desarda, is a pure tissue surgical technique using external oblique fascia to reinforce the posterior wall of the inguinal canal. This has provided an impetus for the rethinking of guideline adherence toward minimally invasive and mesh-based surgery of inguinal hernia. In this study, a retrospective analysis of this technique was conducted in two German hospitals. Between 6/2013 and 12/2020, 120 operations were performed. Analysis included patient characteristics, duration of operation, length of hospital stay, and perioperative complications. Data were used to achieve a matched-pair analysis comparing Desarda to laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Propensity scores were calculated based on five preoperative variables, including sex, age, American Society of Anesthesiology classification, localization, and width of the inguinal hernia in order to achieve comparability. Additionally, we assessed pain level and quality of life (QoL) 12 months postoperatively. The focus of our study was a comparison of QoL to a reference population and TAPP cohort. The study population consisted of 106 male and 14 female patients, and the median age was 37.5 years. The median operation time was 50 min, and the median length of hospital stay was 2 days. At a follow-up of 17 months, the median recurrence rate was 0.8%, and two cases of chronic postoperative pain were recorded. Postoperative QoL does not significantly differ between Desarda and TAPP. In contrast, Desarda patients had a significantly higher QoL compared with the reference population. In summary, Desarda's procedure is a good option as a pure tissue method for inguinal hernia repair.

A Comparative Study of Desarda's Technique with Lichtenstein Mesh Repair in Treatment of Inguinal Hernia

Introduction: European hernia society (EHS) published a guideline that recommended Lichtenstein method for inguinal hernia repair. Currently Lichtenstein method is considered the most popular method. Desarda repair technique was used for the first time in 2001 which is still not considered as a standard tissue-based technique for inguinal hernia repair. We compared Desarda's technique with Lichtenstein mesh repair technique in treatment of inguinal hernia repair. Objectives: To compare the outcome of standard mesh-based Lichtenstein technique with the tissue based Desarda technique in terms of pain. Materials and Methods: After taken approval from hospital ethical committee, 250 patients were enrolled in the study. Enrolled patients were divided into two group. Group A underwent hernia repair through Desarda technique &amp; group B will underwent hernia repair through Lichtenstein technique. Post-operative pain was assessed on day 7 and 30 by using visual analogue scale. All information was recorded on a pre-designed Proforma. The collected data from the patients through Proforma’s was entered in SPSS. Results: 250 patients were included in our study with mean age distribution 42.18+10.34 year. 82.8% patients were males while 17.2% were females. Mean SD of operative time for both groups (Desarda Group vs Lichtenstein Technique) were 23.41+ 0.17 vs 24.18 + 0.66. 111) patients (89%) 92 felt mild post-operative pain who were subjected to Group A while 14 (11%) patients suffered moderate post-operative pain with Mean SD 2.46+0.30. 88% patients felt post-operative pain who were subjected to Group B while 15 patients (12%) felt moderate post-operative pain with Mean SD 2.46+0.18 thus giving us almost same results as found in Group A. Conclusion: The results of inguinal hernia treatment with both Desarda and Lichtenstein technique are similar. So, we conclude the Desarda repair is as effective as the standard Lichtenstein procedure, allowing successful hernia repair without mesh in terms of pain. Keywords: Desarda's technique, Lichtenstein mesh, inguinal hernia

Curative effect of different drainage methods on laparoscopic inguinal hernia repair: A meta-analysis.

Background:Laparoscopic inguinal hernia repair has developed rapidly as an important surgical method for inguinal hernia repair; however, postoperative complications, especially postoperative seroma, are becoming an important factor hindering its development. Many studies have shown that placing a negative-pressure drainage tube in the preperitoneal space can effectively reduce postoperative seromas. Accordingly, this study aimed to compare differences in postoperative seroma between surgical procedures with drainage tubes (DRG) and those without drainage tubes (nonDRG).Methods:PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from the establishment of the database to May 1, 2021. Odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were selected as the effect scale indices for the evaluation of the difference in seroma, operation time, hospital stay time, blood loss, and recovery time. All of these were compared using RevMan 5.3 Software.Results:Sixteen studies involving 4369 patients, 2856 in the DRG group and 1513 in the nonDRG group, were included. The incidence of seroma in the DRG group was lower than that in the nonDRG group (OR = 0.16, 95% CI: 0.07–0.35, P < .001). Additionally, the operation time (min) in the DRG group was longer than that in the nonDRG group (MD = 3.67, 95% CI: 2.18–5.17, P < .001). Nevertheless, no significant differences were found in hospital stay (days) (SMD = 0.22, 95% CI: −0.10–0.54, P = .17), blood loss (mL) (MD = 0.28, 95% CI: −0.14–0.69, P = .19), and recovery time (h) (SMD = 0.54, 95% CI: −0.60–1.69, P = .35) between the 2 groups.Conclusion:Despite the slightly prolonged operation time, negative pressure drainage in the preperitoneal space during laparoscopic inguinal hernia repair can significantly reduce the occurrence of postoperative seroma without increasing blood loss, recovery, and hospital stay.

An analysis of laparoscopic inguinal hernia repair by various methods in a teaching institute

Background / Aim: Laparoscopic repair of inguinal hernia has come a long way now since its popularity and more and more young surgeons are also learning this procedure at an early age so that they can master it and fulfill the wishes of people requesting for minimal access surgery. This study aims to study various methods of inguinal hernia repair over a span of 3 years in a teaching hospital.Methods: All the patients operated electively for uncomplicated inguinal hernia from June 2019 to June 2021 were selected for the study. They were operated by various laparoscopic methods and followed till June 2022. Results: There were total 100 cases of inguinal hernia repair during study period. 51 cases were operated by TEP, 27 by TAPP and 22 by eTEP method. Conclusion: TEP, TAPP and eTEP methods have similar efficacy. It is found that TEP, TAPP and eTEP all methods are safe and can be done after a learning curve.

Caesar Alphonse RU - Professor, founder of reconstructive surgery of the gastrointestinal tract. To the 165th of birthday

Cesar Alfonce Roux was born on March 23, 1857 in the Swiss Republic, in the town of Mont-La-Ville, canton of Vaud. He did not belong to the medical elite of that time, as he grew up in a poor family, having been accustomed to work since childhood and endowed with a sense of responsibility. His father worked as a school inspector, and Caesar himself was the oldest among his eleven brothers and sisters. After graduating from a local school and college, on the instructions of a family friend a rural doctor - he decides to enter the medical faculty. Due to the fact that Caesar Roux's family was from among the French Huguenots, which excluded the possibility of studying at the universities of Lausanne or Geneva, he chose the faculty in Bern. In it, Caesar, in addition to studying, also combined work as a laboratory assistant at the departments of anatomy, physiology and, finally, pathological anatomy. Being an extraordinary person and a great workaholic, by the end of his studies he was noticed by one of the "masters" of surgery at that time Theodor Kocher, who offered him an internship at the clinic "Hpital de l'Isle". At this time, Caesar also managed to visit Vienna and get acquainted with the works of advanced surgeons of his time. In 1884, he began working as a doctor in the city of Lausanne. Due to his professional qualities, great humanism and mercy, Caesar is gaining popularity relatively quickly and already in 1887 he headed the surgical department. After 3 years, the Faculty of Medicine opens in Lausanne, where Caesar Roux receives a professorship. Over time, he brought his department to an unattainable level and Lausanne became one of the centers of European surgery.It is necessary to note the huge range of surgical areas in which there are author's innovations of Caesar Ru, but he considered abdominal surgery and surgical gastroenterology to be his most favorite sections of medicine. It was the achievements in the latter field that immortalized his name. The technique of turning off the loop of the small intestine has firmly taken its place in surgery and is widely used in our time. The famous Y-shaped anastomosis performed during gastric resection according to Billrot-II in the Ru modification is still showing good long-term results. Among the achievements of the great surgeon are operations for prethoracic plastic surgery of the esophagus with a small intestine. In 1883, Caesar Roux first applied the method of surgical treatment of acute appendicitis appendectomy, and already in 1888 the operation became officially recognized. He proposed a huge number of author's surgical interventions not only in abdominal, but also in thoracic surgery, urology, and even in operative endocrinology, because Caesar Ru continued the work of Emil Theodor Kocher, developing surgical treatment of goiter. Under the leadership of Caesar Ru, 126 scientific studies were defended (almost all of them doctoral dissertations) and a large number of students were trained, who later became famous surgeons. Among them is Peter Alexandrovich Herzen, the founder of oncology in Russia, one of the world's first female surgeons in the world, Vera Ignatievna Giedroyts, who defended her doctoral dissertation, proving the high efficiency of the method of inguinal hernia repair using the Ru method.Caesar Roux worked as a professor in Lausanne until 1926, when he had to retire due to deteriorating health, but even after that he still continued to operate, work in the clinic. On December 21, 1934, during a patient's consultation, the surgeon's heart, weakened by long-standing angina, could not stand it.Caesar Ru has left us a magnificent legacy among the author's operations, talented students, and in the memory of his contemporaries he is imprinted as a great professional in his field, a man with a big soul, mercy and simplicity.

Comparison of Two Laparoscopic Techniques in Management of Pediatric Inguinal Hernias.

Introduction: Many studies focus on comparing outcomes of the open method for inguinal hernia repair (IHR) and the laparoscopic method. However, few studies compare different laparoscopic techniques. With over a dozen different techniques described in the literature for laparoscopic IHR, significant opportunities exist to study the efficacy of each technique. We investigated outcomes of a subcutaneous endoscopically assisted transfixion ligation (SEATL) technique and a percutaneous internal ring suturing (PIRS). Materials and Methods: After receiving institutional review board approval, we completed a retrospective chart review of IHR performed at our pediatric tertiary care center between September 2015 and May 2020. We included all patients under the age of 18 years. We separated laparoscopic repairs from total repairs. Laparoscopic repairs were further divided into their respective techniques. Factors involving patient demographics, operative details, and postoperative complications were statistically analyzed using SPSS. Results: There was a total of 131 IHRs performed with SEATL and 124 IHRs performed with PIRS. Median operative time (minutes) differed significantly (P = .001) with SEATL at 49 (28-66) and PIRS at 55 (37-76)] minutes. Significantly more incarcerated hernias were repaired with PIRS (n = 13) than with SEATL (n = 3, P = .006). SEATL had a higher number of postoperative complications; the most significant were granulomas (n = 3, P = .09) and recurrent hernias (n = 12, P < .001). Conclusion: SEATL had a significantly higher number of postoperative complications. This may be a result of multiple factors including but not limited to the absence of electrocautery, a shorter median operative time, and utilization of absorbable suture. Modifications have been made to this technique to reduce risk of postoperative complications.

CHOICE OF INGUINAL HERNIA REPAIR PROCEDURE

Although many surgeons now prefer the Lichtenstein operation, the optimal technique for inguinal hernia repair remains controversial. Although many studies have compared Lichtenstein, TAPP and TEP operations, there is no single solution. Therefore, in our work, we considered and analyzed the effectiveness of the treatment of inguinal hernias with these three currently recommended methods.&#x0D; Aim. To compare TAPP, TEP, and Lichtenstein based on analysis of immediate treatment outcomes.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. All of them underwent tension-free hernia repair using a prolene prosthesis. Lichtenstein procedure was performed in 65 patients (Lichtenstein group), TAPP (TAPP group) in 81 patients and TEP (TEP group) in 65 patients.&#x0D; Results. The time of operation in patients of different groups differed improbably, although this indicator was the highest in the TEP group. Length of hospital stay was lowest in the Lichtenstein group and highest in the TEP group, although no statistical significance was observed. The terms of outpatient treatment were improbably the lowest in the TAPP group and the highest in the TEP group. The lack of statistical probability between these analyzed indicators allowed us to state that all procedure for inguinal hernia did not differ in terms of operation time and terms of postoperative medical, social and physical rehabilitation. The frequency of inguinal hematoma, subcutaneous emphysema, and seroma was probably (p&lt;0.05) highest in the TEP group. Shoulder scapular pain syndrome occurred more often in the TAPP group (p&lt;0.001). The frequency of development of other complications between patients of all three groups differed improbably. When TAPP was performed, in comparison with only TEP, shoulder scapular pain syndrome probably developed more often (OR 10.06, 95 %, CI 1.26–80.10, p = 0.019; χ2 = 5.43), however, the frequency of subcutaneous emphysema (OR 0.57, 95 %, CI 0.24–1.36, p=0.29; χ2=1.10) and hernia recurrence (OR 1.62, 95%, CI 0.14–18.28, p = 0.84; χ2 = 0.04) differed improbably.&#x0D; Conclusions. We did not notice significant differences in the duration of the operation, the frequency of postoperative complications, the length of stay in the hospital, and the recovery of work capacity and quality of life when using the currently recommended methods of inguinal hernia repair. This makes it possible to choose a method of hernia treatment, focusing more on anesthetic contraindications and concomitant diseases.

Percutaneous Internal Ring Suturing (PIRS) - The Benefits of Laparoscopic Inguinal Hernia Repair.

IntroductionThe laparoscopic inguinal hernia repair in children using the PIRS technique is a well-established method. However, there are still opinions that this method does not bring more benefits than open surgery.PurposeThe study aims to demonstrate the benefits of laparoscopic technique over conventional, open techniques.Patients and MethodsWe conducted a retrospective study that included children aged 0–18 treated using the PIRS technique in 2008–2016. The control group consisted of patients treated with the traditional, open method of inguinal hernia repair. A total of 276 children were qualified for laparoscopic surgery, and there were 274 patients in the control group. A full laparoscopic procedure was performed on 247 patients. Assessment of the pathology of the internal inguinal ring was done in all patients during the laparoscopic procedure. Intraoperatively 79 children had bilateral inguinal hernia diagnosed, 133 right-sided inguinal herniae, and 57 left-sided inguinal herniae. The occurrence of hernia was not confirmed in 7 children, whereas 53 patients had open contralateral patent processus vaginalis. In a case of contralateral patent processus vaginalis, the repair was performed using the PIRS method.ResultsThe recurrence of the inguinal hernia was observed in 10 children in the laparoscopic group and in 5 cases in control group. The duration of the procedure was noted and compared to open inguinal hernia repair. There was a statistically shorter duration of the laparoscopic method. In the control group, there were 16 patients with a metachronous contralateral inguinal hernia.ConclusionThe laparoscopic inguinal hernia repair was associated with a better assessment of hernia pathology, shorter operative time, and lower risk of contralateral hernia repair.

Percutaneous Internal Ring Suturing is a Safe and Effective Method for Inguinal Hernia Repair in Young Adolescents.

Background: Percutaneous internal ring suturing (PIRS) is a laparoscopic procedure that has demonstrated its safety and efficacy as a method of hernia repair in younger children but without evidence among the adolescent population. The aim of this study was to determine the success of PIRS outcomes for hernia repair in the adolescent population. Methods: All adolescents who were operated on using the PIRS method for inguinal repair during the 5-year study period in a single center were included in a prospective cohort study. The main outcome of the study included treatment outcomes in a term of recurrence rate. The secondary outcomes include other treatment outcomes such as complications, conversion to an open procedure, and reoperation rates, as well as duration of anesthesia and surgery, duration of hospital admission, and the level of carbon dioxide pneumoperitoneum. Results: In 51 adolescents (72.5% males) with a median age of 13 years and median follow-up of 44 months, a total of 57 PIRS procedures were performed. There were 30 (58.8%) right hernia repairs, 15 (29.4%) left hernia repairs, and 6 (11.8%) bilateral hernia repairs. The median surgical time was 10 minutes for unilateral and 18 minutes for bilateral hernia repair. The median length of hospital stay was 24 hours. Only one (1.95%) intraoperative complication occurred during surgery, an inferior epigastric vein injury. No complications or recurrences were observed during the follow-up period. Conclusions: PIRS has proven to be simple, safe, and effective method for groin hernia repair in adolescent population. This method provides excellent overall and cosmetic outcomes. There is a low incidence of complications and recurrences. According to our results, PIRS could be considered to become a possible approach for groin hernia repair in adolescents.

Laparoscopic phelps approach in children with inguinal hernia: a retrospective comparative study

To evaluate the effectiveness of a new method of inguinal hernia repair in children (PHELPS) first proposed by the authors compared to another laparoscopic method (SEAL). The study demonstrated the results of laparoscopic treatment of 729 patients with inguinal hernias. Of these, 255 patients underwent PHELPS procedure. Other 474 patients underwent SEAL procedure. The difference between both methods is that hernial ligature is passed around the hernial sac in case of PHELPS. SEAL procedure implies capture of tissues of anterior abdominal wall (muscles and aponeurosis) into this knot. We analyzed whether this factor can lead to less incidence of recurrence and hydrocele. Both groups were comparable by age, body weight and gender. Median of surgery time including correction of unilateral and bilateral hernia was similar (20.0 [10.0; 20.0] min versus 15.0 [15.0; 20.0] min; p=0.666). We found faster patient recovery after PHELPS procedure for inguinal hernia including much less doses of postoperative analgesia (1.0 [1.0; 1.0] versus 1.0 [1.0; 2.0]; p<0.001) and shorter hospital-stay (8.0 [8.0; 8.0] hours versus 8.0 [8.0; 9.0] hours; p=0.010). There were no significant differences in the incidence of postoperative hydrocele (0 versus 6; p=0.097). Nevertheless, recurrence rate differed significantly (0 versus 17; p=0.001). PHELPS procedure is characterized by lower incidence of recurrence and accelerated postoperative recovery compared to SEAL technique.

Preperitoneal Prosthetic Repair (Open Tep) for Inguinal Hernias

Background: Inguinal hernia is repaired by placing a polypropylene mesh in the preperitoneal space. The entire procedure is perfomed through a small 3-4 cm incision made in the midline above the pubic symphysis. Pre peritoneal space created by simple digital dissection and retraction. Clear visualisation of the operative site is maintained throughout the procedure with proper dissection. Materials and Methods: One hundred Inguinal Hernia patients including direct, indirect and recurrent inguinal hernias operated under spinal/ epidural anaesthesia by placing polypropylene mesh in the preperitoneal space which is created by digital dissection by giving small incision (3-4 cm) in the lower midline above the pubic symphysis. Results: We found open TEP is beneficial in terms of less operative time. Open TEP also has the advantage of direct visualisation of anatomy, decreasing the learning curve for laparoscopic TEP, avoiding damage to the nerves and less incidence of seroma and hematoma formation and lesser incidence of recurrence. Conclusion: It is an efficient inguinal hernia repair method having all the advantages of Stoppas GPRVS and Laparoscopic TEP with good cosmosis, less cost and better patient compliance.

O12 OPEN PREPERITONEAL INGUINAL HERNIA REPAIR, TREPP VERSUS TIPP IN A RANDOMIZED CLINICAL TRIAL

Abstract Aim The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding Chronic Postoperative Inguinal Pain (CPIP) with low recurrence rates. Two open preperitoneal techniques, the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal (TIPP) technique, were compared in a randomized clinical trial with the hypothesis of less patients with CPIP after TREPP due to complete avoidance of nerve contact. Materials and Methods Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Prior to the trial’s start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events and Health related Quality of Life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months and 1 year. Results Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but the CPIP at rest at 1 year was comparable 1.9% after TREPP vs 1.4% after TIPP, p = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, p = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, p = 0.591). Conclusions both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1 year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.

Clinical and anatomical rationale for the use of simple methods of inguinal hernia repair

Despite significant advances in the field of surgical treatment of inguinal hernias, its results cannot be considered completely satisfactory. This is evidenced by the damage to the intestines, bladder, testicular atrophy and relapses arising from hernia repair.

Comparison of self fixating mesh with Lichtenstein tension free mesh hernioplasty in open inguinal hernia repair

Aims and Objectives: differences in two methods of inguinal hernia repair in terms of operative time, chronic pain at 3 months and recurrence at 6 months. Materials and Method: This study conducted in the department of Surgery, Indira Gandhi Medical College, Shimla from 1st June 2013 to 31st May 2014 included 40 patients admitted in department with inguinal hernia who were fit for surgery. Patients were randomized to self-fixating/gripping Mesh hernioplasty and Lichenstein tension free/ sutured mesh Hernioplasty groups randomly in groups of 20 each. Results: Self-fixating mesh group was associated with significantly decreased operative time (mean 27 minutes) as compared to sutured mesh hernioplasty (mean 44.7 minutes). However, no significant difference was found in post-operative pain (VAS score), analgesia requirement, chronic pain at 3 months, postoperative hospital stay or recurrence at 6 months in either group.Conclusion: The only benefit of using self-fixating of using self-fixating/self-gripping mesh is decreased operative time.

COMPARATIVE ANALYSIS OF THE RESULTS OF PLASTIC INGUINAL HERNIA LAPAROSCOPIC AND TRADITIONAL METHODS

Purpose of the study. Conduct a retrospective comparative analysis of the results of laparoscopic and traditional methods of inguinal hernia repair, patients treated at the surgical departments at “A.N. Syzganov National Scientific Center of Surgery”, Almaty, Kazakhstan. Materials and methods. In the period from January 2017 to December 2020 137 patients were operated at the “A.N. Syzganov National Scientific Center of Surgery” in a planned manner for inguinal hernia and all patients were divided into 2 main groups: operated by traditional methods and laparoscopic method. Results.The data of the analysis suggests that the laparoscopic method of hernioplasty has an advantage over the traditional methods. Conclusion. Based on a comparative analysis of the indicators of patients in both groups, it can be concluded that the duration of the operation for laparoscopic hernia repair is 92.3 minutes, significantly more than with traditional methods, which is 79.4 minutes. Despite this, the duration of analgesic therapy in the postoperative period with laparoscopic hernia repair is 2.4 days, and the duration of hospital stay after surgery is 3 days, much less than with traditional methods, in which the duration of analgesic therapy in the postoperative period is 3, 3 days, and the duration of hospital stay after surgery is 4.6 days. This analysis suggests that laparoscopic hernioplasty has an advantage over traditional methods.

The investigation survey of inguinal hernia operation techniques preferred by pediatric surgeons in Turkey

In inguinal hernia, standard procedure has been considered open repair for a long time, the number of pediatric surgeons who prefer laparoscopic techniques is increasing day by day. In this study, it was aimed to determine how pediatric surgeons in our country approach patients with inguinal hernia and manage the treatment process. Controversial issues on inguinal hernia repair were identified and a questionnaire was prepared to reveal the current situation. The questionnaire was delivered to members of Turkish Association of Pediatric Surgery on the official website of the association. The survey was directed to 420 people, 92 people returned with the answers to the questionnaire. Thirty-six of the surgeons prefer the laparoscopic method for inguinal hernia repair. The reason for choosing open surgery was questioned, the most frequent answer was to be more experienced and to have more cumulative knowledge on open repair method. According to survey, the greatest advantage of laparoscopy was stated to be the better evaluation of the contralateral inguinal canal (n=16, %44.4). Twelve of surgeons who performed laparoscopic treatment in the selection of patients stated that gender is important and prefer laparoscopic surgery for female patients. Thirty percent (n = 11) of the participants stated that they prefer laparoscopy in patients between 3 months and 13 years old, while the rest prefer laparoscopy at all ages. In conclusion thirty nine percent of surgeons in Turkey prefer laparoscopic repair. Open repair is still preferred in our country. There is still no consensus on perfect method and patient selection yet.

Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a Randomized Clinical Trial.

Objective:The aim of this study was to compare chronic postoperative inguinal pain (CPIP) in patients with an inguinal hernia after the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal Technique (TIPP).Background:The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding CPIP with low recurrence rates. Two open preperitoneal techniques, TREPP and TIPP, were compared in a randomized clinical trial with the hypothesis of fewer patients with CPIP after TREPP due to complete avoidance of nerve contact.Methods:Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Before the trial's start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events, and health-related quality of life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months, and 1 year.Results:Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but CPIP at rest at 1 year was comparable: 1.9% after TREPP vs 1.4% after TIPP, P = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, P = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, P = 0.591).Conclusion:Both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1-year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.Trial Registration:ISRCTN18591339

Laparoscopic versus Open Inguinal Hernia Repair: A SystematicReview

AbstractBackground: Inguinal hernia repair is the most frequentlyperformed operation in general surgery. However, the questionabout the most appropriate technique still confuses the com-munity of surgeons. The standard method for inguinal herniarepair had changed little over a hundred years until theintroduction of synthetic mesh. This mesh can be placed byeither using an open approach or by using a minimal accesslaparoscopic technique.Aim of Work: The purpose of this review was to comparelaparoscopic techniques with open mesh technique for inguinalhernia repair.Material and Methods: All published randomized andnon randomized controlled trial, meta-analysis, case-controltrial & NICE guidelines comparing laparoscopic inguinalhernia repair with open inguinal hernia repair were eligiblefor inclusion. All published trials between 1994 to 2019. Trialswere included only published in English. All data collectedin 2018 to 2020. Participants were adults diagnosed withinguinal hernia either males or females. The following dataitems were sought for all trials: Duration of operation (min),vascular injury, visceral injury, length of hospital stay (days),time to return to usual activities (days), time to return to work (days), post-operative pain, chronic persisting inguinal pain (defined as inguinal pain of any severity as near 12 monthsafter the operation as possible provided this was at least after 3 months), hernia recurrence, cost effectiveness, learning curve, quality of life.Results: Overall, recurrence rates were higher amongpatients whose hernias were repaired by the laparoscopictechnique (3.6%) compared to open group (1.9%) (p < 0.001).In five studies concerning the treatment of recurrent hernias,the recurrence rate varies between 0.4% and 8.3% for lapar-oscopic techniques and between 1% and 15.6% for the Lich-tenstein procedure. However, the recurrence rate differs greatlybetween hospitals and individual surgeons, especially forthose that perform laparoscopic procedures. For those thathave passed an educational program with specific regard tolaparoscopy, the recurrence rate is low. Open mesh repair iseconomical, easy to teach and learn without any steep learningCorrespondence curve. Open hernia repair does not need any specializedtraining and results are same in both specialist and non-specialist center. Open hernia repair does not carry any riskof serious visceral or bowel injuries.Conclusion: Laparoscopic hernia repair is more costly;difficult to learn with a steep learning curve, our resultsprovide evidence that after a laparoscopic repair return tousual activity is faster and persisting pain is reduced. However,operation times are longer and there appears to be a higherrate of serious complication rate in respect of visceral andvascular injuries. The complication rate reduces as the surgeonsbecome more experienced in this procedure comparable withthat of open repair. Laparoscopic repair is associated withless post-operative morbidity and faster recovery and satis-faction as documented by less post-operative pain, earliermobilization and discharge from the hospital, as well as earlyreturn to work.