Primary Hernia Research Articles

Spigelian hernias: A high volume institutional review

PurposeThe objective of this study was to evaluate a high-volume hernia center's experience with primary Spigelian hernias. IntroductionSpigelian hernias are rare entities presenting a diagnostic dilemma for clinicians that often lead to a delay in treatment or need for emergency surgery. Given this low incidence true patient and hernia characteristics are unknown. MethodsThis was a retrospective chart review evaluating patients who underwent a Spigelian hernia repair between 2005 and 2019. Descriptive statistics were utilized. ResultsThe incidence of Spigelian hernias at our institution was 0.14 %. There were 141 patients with 143 spigelian hernias (two patients had bilateral hernias) repaired at our institution during the study period, the majority of these were in male patients, left sided and repaired under conscious sedation with or without the use of mesh. ConclusionThis study adds a large dataset to the paucity of literature that exists in the context of Spigelian hernias and alerts the clinician that these hernias are not exclusive to the older female population. Furthermore, this study provides the need for a high index of suspicion in patients presenting with vague abdominal pain who may not fit the typical Spigelian hernia mold.

Minimally invasive approach to incisional hernia in elective and emergency surgery: a SICE (Italian Society of Endoscopic Surgery and new technologies) and ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) online survey.

Minimally invasive abdominal wall surgery is growing worldwide, with a constant and fast improvement of surgical techniques and surgeons' confidence in treating both primary and incisional hernias (IH). The Italian Society of Endoscopic Surgery and new technologies (SICE) and the ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) worked together to investigate state of the art in IH treatment in elective and emergency settings in Italy. An online open survey was designed, and Italian surgeons interested in abdominal wall surgery were invited to fill out a 20-point questionnaire on IH surgical procedures performed in their departments. Surgeons were asked to express their points of view on specific questions about technical and clinical variables in IH treatment. Preferred approach in elective IH surgery was minimally invasive (59.7%). Open surgery was the preferred approach in 40.3% of the responses. In emergency settings, open surgery was the preferred approach (65.4%); however, 34.5% of the involved surgeons declare to prefer the laparoscopic/endoscopic approach. Most respondents opted for conversion to open surgery in case of relevant surgical field contamination, with a non-mesh repair of abdominal wall defects. Among those that used the laparoscopic approach in the emergent setting, the majority (74%) used the size of the defect of 5cm as a decisional cut-off. The spread of minimally invasive approaches to IH repair in emergency surgery in Italy is gaining relevance. Code-sharing through scientific societies can improve clinical practice in different departments and promote a tailored approach to IH surgery.

Issues and challenges in the surgical treatment of anterior abdominal wall hernias. Review

The literature review discusses contentious issues and challenges that arise in the surgical treatment of anterior abdominal wall hernias. The author identified the causes of hernia formation and examined the dynamics of change in the pattern of hernia incidence. An analysis of the factors that contribute to the development of incisional ventral hernias was given special consideration. The causes of hernia recurrence were also studied. The entire spectrum of existing classifications of primary and incisional ventral hernias was reviewed, along with their advantages and disadvantages. Evaluation of current recommendations regarding the use of additional imaging methods for the examination of patients with ventral hernias was carried out. In the study, considerable attention was paid to surgical methods for hernia treatment. The advantages and disadvantages of “open” and minimally invasive laparoscopic hernioplasty techniques were critically evaluated. The difficulties in selecting an intervention method for certain types of hernias, including large ones, were highlighted, as was the importance of preventing hernia recurrence.
 It has been established that there are still many unsolved problems in the surgical treatment of anterior abdominal wall hernias. The author justified the need for a standardized approach to determining the characteristics of anterior abdominal wall hernias and their further classification. It is necessary to study the effectiveness of using imaging methods (ultrasound, computed tomography) for ventral hernias, depending on their size and location. There is a need for wider implementation of laparoscopic hernioplasty techniques, and the degree of the hernial defect should be taken into account when determining the indications for surgical intervention. The possibility of using laparoscopic hernioplasty for large hernias, as well as for hernias associated with rectus abdominis diastasis, requires further investigation. Improving management strategies for patients with anterior abdominal wall hernias is critical in order to reduce the risk of hernia recurrence and complications.

MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION Anna Faris, Zachary Eisner, Krishnan Raghavendran, and John Stoffel Anna FarisAnna Faris More articles by this author , Zachary EisnerZachary Eisner More articles by this author , Krishnan RaghavendranKrishnan Raghavendran More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following urinary diversion, a challenging complication is parastomal hernia formation, termed here as urostomal hernia. We examine patients who underwent urostomal hernia repair and describe their outcomes. METHODS: For individuals who underwent urostomal hernia repair, we collected retrospective demographic data, perioperative variables, surgical technique, and tracked hernia recurrence events. Kaplan Meier methods were used to estimate time from hernia repair to hernia recurrence. Cox proportional hazards modeling assessed risk factors for hernia recurrence. RESULTS: Thirty patients had a urostomal hernia repair between 2009 and 2022. Urinary diversion was initially performed for benign (37%) or malignant (63%) pathologies. Median age was 68.5 [IQR: 57.5,73.8], 57% male, and a median Charleston comorbidity index of 8 [IQR: 6,10]. Primary indications for urostomal hernia repair were bowel obstruction or incarceration (n=10, 33%), obstructive uropathy (n=6, 20%), pain (n=5, 16%), pouching difficulty (n=5, 16%), and recurrent urinary tract infections (n=4, 13%). Follow up period was a median of 2.5 [IQR: 1,5] years. Repair techniques included primary repair (n=15, 50%), stomal relocation without mesh (n=5, 17%), mesh placement without stomal relocation (n=7, 23%), and mesh with stomal relocation (n=3, 10%). Nearly a third (30%) had a concurrent procedure at the time of hernia repair (eg, nephrectomy, ureteral reimplant, ventral hernia, new ileal loop). Urostomal hernia recurrence rate was 67%, occurring at a median of 13 [IQR: 8,26] months from initial repair. Kaplan Meier analysis of time to urostomal hernia recurrence is depicted in Figure 1. Twelve (40%) individuals had a second urostomal hernia repair and three (10%) had a third repair. No associations found within the Cox proportional hazards model which was limited by sample size. At last follow up, the primary urostomal hernia complications that prompted hernia repair had resolved in 22 individuals (73%). CONCLUSIONS: Recurrence following urostomal hernia repair is common (67%) even in the hands of experienced urology and general surgery teams. For these complex patients, perhaps a more important metric of success is resolution of primary hernia complications following repair, which is 73% in this cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e890 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Faris More articles by this author Zachary Eisner More articles by this author Krishnan Raghavendran More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...

Novel Approach for Umbilical Hernia Repair Using Mesh Strips.

Two-centimeter-wide strips of macroporous polypropylene mesh were passed through the abdominal wall and tied as simple interrupted sutures to achieve umbilical hernia repair. A retrospective review of all elective umbilical hernia repairs performed by a single surgeon using the mesh strip technique between 2016 and 2021 was conducted, and patient-reported outcomes were assessed via a telephonic survey. Thirty-three patients underwent an elective, open mesh strip repair of a primary umbilical hernia and met criteria for inclusion in the study. Of these patients, 60% responded to a patient-reported outcomes telephone survey. Ninety percent of survey responders reported a pain score of 0 of 10. Additionally, 90% reported being unable to feel or palpate the knot, and 80% reported an improvement in quality of life. Mean follow-up at 3 years revealed one recurrence in the setting of ascites, yielding a recurrence rate of 3%. Primary mesh strip repair of umbilical hernias combines the simplicity of suture repair with the advantageous force distribution properties of mesh, and constitutes a safe, efficient, and effective method of repair with a low recurrence rate at long-term follow-up that is comparable to planar mesh repair.

Современные методы хирургического лечения пупочных грыж: обзор литературы

INTRODUCTION: In this review, methods of open and laparoscopic surgery of the umbilical hernia are described. Use of particular methods is substantiated depending on the size of the hernial orifice, the presence of hernia strangulation, diastasis of the abdominal rectus muscles, comorbidity, available technical equipment. Statistical data of complications, recurrences and of their prevention available in the literature are evaluated. The search for information was performed in electronic libraries: Pubmed, Cyberleninka. The inclusion time interval is 10 years. The keywords used in the search: umbilical hernia, IPOM, eTEP, (E)MILOS, SCOLA, tension method of hernioplasty, complications. The most important modern methods using endovideosurgical access are: laparoscopic IPOM(+), eTEP, (E)MILOS, SCOLA. Use of tension plasty can be justified in case of strangulation, but, here, recurrences are more common. The IPOM method has a number of disadvantages (adhesions, chronic pain, chronic seroma, recurrences), which make its use controversial and needing additional research. The eTEP-TAR, eTEP-RS methods are used in pronounced diastasis of the rectus muscles. The eTEP-RS method is convenient in simultaneous surgery of inguinal hernias. The eTEP-TAR method is used in case of large diameter of hernial orifice (5–12 cm), and suggested width of the retromuscular space less than 5 cm. The MILOS, EMILOS methods are used in case of primary, postoperative umbilical and epigastric hernias. With this, the frequency of complications is less relative to Sublay, IPOM. CONCLUSION: Each method of umbilical hernioplasty is based on certain factors taken into: diastasis of rectus muscles, size of hernial orifice, existence of strangulation, availability of equipment and materials, comorbid pathologies. The variety of manipulations determines personal approach in surgery of umbilical hernias. The modern tendencies in this field are minimization of injury rate in surgical approach in use of endovideosurgical access and attempts to perform simultaneous recovery of the muscular aponeurotic apparatus of the abdominal wall through elimination of diastasis of rectus muscle. Potentials of the modern high-tech medicine permit to significantly reduce the frequency of complications and recurrences in case of large, medium and complicated umbilical hernias.

RETRACTED ARTICLE: Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women

PurposeThe processing of the round ligament of uterus in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia in women has contended. This study aimed to explore whether there is any difference in the surgical outcome and postoperative complications between the two processing modalities, preservation, and transection of the round ligament of uterus, in adult female inguinal hernia patients undergoing TAPP.MethodsRetrospective analysis of 84 female patients (117 sides) who underwent TAPP in XXX Hospital from July 2013 to August 2022. Patient characteristics and technical details of the surgical procedure were collected and divided into two groups according to whether the round ligament of uterus was severed intraoperatively or not. There were 52 cases (77 sides) in the group with preservation of the round ligament of uterus and 32 cases (40 sides) in the group with transection of the round ligament of uterus, comparing the general condition, surgical condition, and the occurrence of postoperative related complications between the 2 groups.ResultsThe operative time for unilateral primary inguinal hernia was (129.2 ± 35.1) and (89.5 ± 42.6) minutes in the preservation and transection groups, respectively. There were no statistical differences between the two groups in terms of age, length of hospital stay, ASA, BMI, history of lower abdominal surgery, type and side of hernia, intraoperative bleeding, and time to surgery for primary bilateral hernia (P > 0.05). In addition, there was likewise no statistical difference in the occurrence of postoperative Clavien–Dindo classification, VAS, seroma, mesh infection, labia majora edema, chronic pain or abnormal sensation in the inguinal region, and hernia recurrence in the two groups as well (P > 0.05).ConclusionThere is no evidence that the transection of the round ligament of the uterus during TAPP has an impact on postoperative complications in patients. However, given the important role of the uterine round ligament in the surgical management of patients with uterine prolapse and the high incidence of uterine prolapse in older women, hernia surgeons should also be aware of the need to protect the round ligament of uterus in older women.

COMPARATIVE ANALYSIS OF CONVENTIONAL AND MINIMALLY INVASIVE TECHNIQUES IN THE TREATMENT OF FEMORAL HERNIAS

Despite the advances in medicine regarding diagnosis and therapeutic options, the treatment of femoral hernias remains a challenge for the surgeon. In the past, this type of hernia was repaired with conventional surgery. Today, mini-invasive techniques are preferred method of choice by many surgeons. The aim of our study is to compare the results of open and minimally invasive surgery in patients with femoral hernias.In the present study we include patients with primary unilateral femoral hernias operated in the Surgical Department of EUROHOSPITAL- Plovdiv and the Department of General Surgery of University Hospital “St. George” for the period January 2018 to December 2022. The patients were divided into two groups - conventional and minimally invasive operations. Comparative analysis was performed regarding sex, age, duration of operative intervention, postoperative pain, hospital stay and complications.33 patients in total were diagnosed and operated for femoral hernias for a period of 5 years. Of these, 16 patients were operated conventionally and 17 underwent laparoscopic surgery. Patients in the minimally-invasive group had a significantly shorter hospital stay (2.1 vs 3.0 days) and less postoperative pain (1.8 vs 3.6 on the 1 to 5 scale). The incidence of the postoperative complications was similar in both groups.Surgery is the only method of treatment of femoral hernias. Nowadays, minimally invasive techniques became a method of choice compared with conventional surgery. We believe that laparoscopic operations for femoral hernia, performed by experienced surgeon, are effective and safe and could be applied to all type of patients.

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

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

Trends in Incisional and Ventral Hernia Repair: A Population Analysis From 2001 to 2021.

Background Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for population was 182 per 100,000; this increased by 9.578 per year during the study period (95%CI = 8.431-10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year (95%CI = 0.654-1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95%CI = 0.510-0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Intraperitoneal mesh open repair without dissection technique for large ventral hernia repair: an alternative to component separation technique.

Incisional hernias (IH) are one of the major complications following abdominal surgery and the treatment of large abdominal hernias represents a challenge for the surgeon. We present our own modified open intraperitoneal mesh technique, named "IPOW technique" (intra-peritoneal mesh open repair without dissections). We analyzed early postoperative complications (seroma, wound infection, hematoma) and the late ones (recurrence, chronic pain), in 50 unselected patients treated for IH and primary hernia (PH) larger than 5 cm using the proposed laparotomic technique. From January 2019 to September 2021, 50 unselected patients with, at least, one year of follow-up, with hernias ranging from 5 to 25 cm in width, were surgically repaired using IPOW technique. Mean Body Mass Index (BMI) was 29 (range 22-44). In our series, we report 2 (4%) complications and, after a mean follow-up of 847 days (range 481-1357), 2 (4%) recurrences. No patients reported chronic pain. In our experience, we consider IPOW technique easily reproducible, ensuring excellent results with a reduction of invasiveness, comparing to other techniques. Anyway, definitive conclusions require a larger number of patients.

A Novel Polypropylene Mesh (T-Line®) for Abdominal Wall Repair: Early Experience at Three Centers in the United States.

Mesh suture was initially developed and investigated to overcome suture pull-through in hernia repair. It has a large area compared to standard suture which distributes the load in tissue, reducing stress at the suture/tissue interface and preventing suture from cutting through tissue or the mesh. This report describes our early experience using the new T-line® mesh (Deep Blue Medical Advances, Durham, NC, USA) in patients with incisional and primary ventral hernia repairs. This is a descriptive, retrospective study in 18 patients who underwent abdominal wall repair with T-Line® mesh from November 2020 to November 2021 in three academic centers. T-Line® is a novel moderate-weight macroporous, polypropylene mesh with extensions that are 29 times the cross-sectional area of #0 polypropylene suture. They can be sewn into fascia to anchor the mesh with no need for suture tackers or other devices to fixate the mesh. The median age of the patients was 56.5 years (range 25-83) and the median BMI was 31.7 kg/m2 (range 23.6-51). Twelve patients (66.7%) had primary hernias, and 11 (61.1%) had a recurrent hernia. The median defect area was 117.5 cm2 (range 4-390) and the median mesh area was 449.5 cm2 (range 130-600). The mesh position was onlay in 16 cases (88.9%) and sublay in 2 cases (11.1%). The median operative time was 247 minutes (range 104-395). The median length of stay was six days (range 0-21) with no significant in-hospital complications. One patient had a surgical site infection (5.5%) and two patients developed seromas (11.1%). There were no early hernia recurrences with a median follow-up of 28 days (range 8-307). The T-Line® mesh was shown to be safe and effective for patients with ventral hernia in the short term.

Surgical technique for primary perineal hernia repair: a systematic scoping review.

A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias. This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course. Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful. Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful.

Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry.

Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry. Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP. After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02). This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

Surgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum. To assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists. This nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority's Online Register via surgeons' unique authorization ID. The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral. Hernia repairs performed by supervised residents vs specialists. Reoperation for recurrence, analyzed separately for all 4 groups. A total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048). The findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

Total extra-peritoneal inguinal hernia repair: experience in a tertiary care hospital of Bangladesh

Background: Open hernioplasty, a traditional procedure, is practiced for decades all over the world, for inguinal hernia repair and the newer procedure of total extraperitoneal (TEP) inguinal hernia repair is the current trend. Aim of this study was to share the experience of TEP inguinal hernia repair.&#x0D; Methods: This retrospective observational study was done from April, 2012 to March, 2021 at BIRDEM General Hospital, Dhaka, Bangladesh. Patients with inguinal hernia reporting to BIRDEM outpatient department (OPD) were counseled for TEP repair. Those who consented were treated electively with a TEP repair for a unilateral or bilateral hernia defect, either direct or indirect. All procedures were completed with patients under general anaesthesia. Polypropylene mesh was placed in preperitoneal space. Followed up records were noted at one week, one month, one and two years after surgery. Patients’ age, hernia types and locations, complications, length of stay in hospital, return to work and recurrence were noted.&#x0D; Results: Total patients were 118 including one female. Patients were between 22 and 72 years. All of them had primary hernias and 72% of them underwent unilateral repairs. One of the cases required conversion to transabdominal preperitoneal procedure. In five patients (4.2%) intraoperative complication occurred and postoperative courses were complicated in 8 patients (6.7%). Patients were able to resume their daily activities after a mean period of 7 days (3 to 10 days). There was no mortality.&#x0D; Conclusion: In patients with uncomplicated inguinal hernias, TEP is associated with a very low overall risk of serious complications and recurrence with a very good functional outcome. It is equally applicable with bilateral inguinal hernias without added risk.&#x0D; BIRDEM Med J 2023; 13(1): 44-48

Reoperation for Recurrence is Affected by Type of Mesh in Laparoscopic Ventral Hernia Repair: A Nationwide Cohort Study.

To compare the reoperation rate for recurrence between different mesh types in laparoscopic ventral hernia repair. Ventral hernia repair has improved over the last decades. Nevertheless, recurrence rates are still high, and one type of mesh was recently found to increase it even more. A nationwide cohort study based on prospectively collected data from the Danish Ventral Hernia Database. We included adult patients that had undergone a laparoscopic ventral hernia repair for either an incisional or a primary hernia. The primary and incisional hernias were analyzed in separate cohorts. The mesh-group with the lowest reoperation for recurrence curve was used as the reference. The outcome was reoperation for recurrence. Study population comprised 2874 patients with primary hernias and 2726 with incisional hernias. For primary hernias, Physiomesh [HR = 3.45 (2.16-5.51)] and Proceed Surgical Mesh [HR = 2.53 (1.35-4.75)] had a significantly higher risk of reoperation for recurrence than DynaMesh-IPOM. For incisional hernias, Physiomesh [HR = 3.90 (1.80-8.46), Ventralex Hernia Patch (HR = 2.99 (1.13-7.93), Parietex Composite (incl. Optimized) (HR = 2.55 (1.17-5.55), and Proceed Surgical Mesh (HR = 2.63 (1.11-6.20)] all had a significantly higher risk of reoperation for recurrence than Ventralight ST Mesh. For primary hernias, Physiomesh and Proceed Surgical Mesh had a significantly higher risk of reoperation for recurrence compared with DynaMesh-IPOM. For incisional hernias, the risk was significantly higher for Physiomesh, Parietex Composite, Ventralex Hernia Patch, and Proceed Surgical Mesh compared with Ventralight ST Mesh. This indicates that type of mesh may be associated with outcomes, and mesh choice could therefore depend on hernia type.

Primary upper lumbar hernia repaired by transabdominal preperitoneal approach technique using a self-expanding mesh with a memory-recoil ring, report of a case

BackgroundUpper lumber hernia is a rare entity which can cause obstruction and strangulation. Laparoscopic technique has been considered effective for such hernia repairs; however, there is no report of use of the self-expanding mesh.Case presentationA 77-year-old woman visited to our hospital complaining of a bulge of about 5 cm in the left lumbar dorsal region while standing. Abdominal CT and MRI scans showed a fascial defect in the left lumbar abdominal wall and confirmed the presence of a hernia, in which retroperitoneal fatty tissue and the descending colon protruded. Transabdominal preperitoneal repair (TAPP) was performed and the operative findings revealed the hernia orifice, 3 × 2.5 cm in diameter, between two intercostal nerves. To avoid nerve injury or entrapment, the number of mesh fixation was desirable minimum; therefore, a self-expanding mesh with a memory-recoil ring was used. The mesh, 9.5 × 13 cm in diameter, was placed and tacked to the abdominal wall at two points, 1 cm ventral and dorsal to the hernia orifice. The postoperative course was uneventful and no pain or recurrence was observed with follow-up of 6 months.ConclusionWe herein present a case of upper lumber hernia successfully repaired by TAPP with a self-expanding mesh.

Endoscopic totally extraperitoneal repair for groin hernia: Experience from a tertiary care centre.

Totally extra-peritoneal (TEP) and transabdominal preperitoneal (TAPP) repair are two established minimal access techniques of groin hernia surgery. TEP offers the advantage of avoiding violation of the peritoneal cavity. This study aims to describe the decade-long experience of TEP in groin hernia repair in a tertiary care teaching institute and the feasibility of the same in difficult scenarios. Retrospective analysis of the database of patients undergoing TEP repair for inguinal hernia in a single surgical unit at a tertiary teaching hospital between January 2008 and December 2019 was performed. Detailed pre-operative clinical details, operative duration, intraoperative and post-operative complications, including pain, length of post-operative hospital stay and hernia recurrence data were analysed. Over 12 years' duration, 511 patients underwent endoscopic TEP mesh repair and the total number of hernias repaired was 614. Majority (97.45%) of patients were male. The mean age of the patient population was 51.3 years. Primary hernia was seen in 490 patients. The mean operating time for unilateral inguinal hernia repair was 56.8 ± 16 min and for bilateral repair 80.9 ± 25.2 min. TEP in previous lower abdominal/suprapubic surgical scars was attempted in 17 (3.3%) patients, with only one requiring conversion. The intraoperative peritoneal breach was the most common documented complication (34.8%). Seroma was seen in 9.4% of patients. Seventeen patients required conversion (14 TAPP and 3 open). Recurrence was seen in 4 (0.7) patients. TEP repair is an effective method of groin hernia repair and can be attempted in the majority of patients groin hernia, including patients with previous lower abdominal incisions.

Intraperitoneal onlay mesh versus laparoscopy-assisted ventral hernia patch mesh repair in small primary ventral hernias

Aims: The aim of this study is to compare and evaluate short-term outcomes of laparoscopy-assisted composite patch mesh repair versus laparoscopic intraperitoneal onlay mesh in small primary midline ventral hernias. Materials and Methods: Eighty consecutive patients with small (&lt;2 cm) midline ventral hernia admitted to the Department of General and Laparoscopic surgery at Sir Ganga Ram Hospital, New Delhi, from January 2017 to May 2019 were included in the study and randomised into two groups. Group A included patients who underwent laparoscopic intraperitoneal onlay mesh repair with the classical barrier flat mesh and Group B patients underwent laparoscopy-assisted ventral hernia patch-mesh repair. Parameters assessed at the follow-up were early post-operative pain by Visual Analogue Scale score, wound complications, early recurrence and hospital stay. Results: Early post-operative pain was more in the laparoscopic intraperitoneal onlay mesh group and the difference was statistically significant. Usage of additional analgesia in the post-operative period was required only in the laparoscopic intraperitoneal onlay mesh group. There was a statistically significant difference between the two groups in terms of hospital stay. Conclusion: For primary midline ventral hernia, with defect size &lt;2 cm, laparoscopy-assisted composite patch mesh repair is feasible and safe. It causes less pain and necessitates less usage of additional analgesia enabling patients to be discharged earlier.