Inguinal Hernia Repair Research Articles

Little influence of the abandoned sac on seroma formation following laparoscopic transabdominal preperitoneal repair of lateral inguinal hernia.

The impact of completely reducing or transecting a hernia sac on seroma formation in laparoscopic surgery for lateral inguinal hernias remains debated. To date, no studies have compared the incidence of seroma in hernia sacs left untouched versus other surgical approaches. Abandoning the hernia sac involves avoiding manipulation of the inguinal canal, unlike the manipulation required for transection or reduction of the hernia sac. This study aimed to determine whether manipulation of the inguinal canal contributes to seroma formation following transabdominal preperitoneal (TAPP) repair. A retrospective cohort study was conducted, including 476 of the 584 lateral inguinal hernia lesions treated with TAPP during the study period. Seroma occurrence 4 weeks post-surgery was assessed in the unmanipulated group (n = 233) and the manipulated group (n = 243). Risk factors were analyzed using univariable and multivariable methods, and findings were validated based on hernia classification and estimated hernia volume. Seroma was observed in 23 cases (9.9%) in the unmanipulated group and 28 cases (11.5%) in the manipulated group, without statistically significant differences. Bendavid staging emerged as the strongest predictor of seroma risk in both univariable (odds ratio 7.1, 95% CI 4.0-12.6, p < 0.001) and multivariable analyses (odds ratio 5.2, 95% CI 3.6-7.6, p < 0.001). The likelihood of seroma increased with advancing Bendavid stage (p < 0.001). Lesions complicated by seroma had significantly larger estimated hernia volumes across stages (Stage 2, p < 0.01; Stage 3, p < 0.01). The abandoned sac does not appear to influence seroma formation following laparoscopic repair of lateral inguinal hernias. Key determinants of seroma formation include hernia stage and volume.

Inguinal hernia mesh infections: Chronic challenges, atypical pathogens and lessons in sterilisation.

Chronic mesh infections after inguinal hernia repair present significant clinical challenges due to biofilm-mediated resistance, involvement of multidrug-resistant and atypical pathogens, and gaps in preventive strategies. Our case series of four patients highlights critical research gaps, including the overlooked role of atypical pathogens such as Mycobacterium tuberculosis, diagnostic challenges in detecting slow-growing or resistant organisms and perioperative sterilisation lapses, especially inconsistent Glutaraldehyde use during late-day operations. Many patients suffered with persistent sinuses and recurrent hernias months after surgery. Microbiological analyses identified Pseudomonas aeruginosa, Klebsiella pneumoniae, Mycobacterium tuberculosis and mixed flora. Complete mesh removal and culture-directed antimicrobial therapy resolved all cases within 8-12 months. Our study underscores the need for robust sterilisation protocols, advanced diagnostic measures and biofilm-resistant biomaterials.

Do transversus abdominis plane (TAP) blocks improve pain after laparoscopic bilateral inguinal hernia repairs beyond the recovery unit? A randomized control trial.

While surgeons agree that perioperative field blocks should be performed for open inguinal hernia surgery, there lacks consensus in the minimally invasive context. Prior small-scale randomized trials study pain scores only up to 24h postoperatively. Thus, we sought to investigate the analgesic benefits of a bupivacaine transversus abdominis plane (TAP) block in the first 4 postoperative days. This is a prospective single-institution randomized control trial involving patients undergoing elective totally extraperitoneal inguinal hernia repairs, who received either a TAP block with bupivacaine 0.25% or saline placebo. Postoperatively, patients completed a pain survey (based on a 0-10 visual analog score) and an opioid/non-opioid pain medication log. Differences were detected using a Wilcoxon rank sum test for continuous variables, and a Fisher's exact test or chi-squared for categorical variables. A total n = 90 patients were included in the per-protocol analysis, of which n = 46 received TAP blocks with bupivacaine versus n = 44 placebo. Patient characteristics were similar between the groups, including recurrent hernias and number of tacks placed (p > 0.05). All cases were bilateral. Postoperatively, pain scores (at rest and with movement) and pain medication use were similar for all postoperative days 1-4. Our study shows no significant difference in pain or opioid requirement within the first 4days postoperatively, suggesting that the analgesic benefits of plain bupivacaine TAP blocks in totally extraperitoneal inguinal hernia repairs do not exist beyond the recovery unit. This will help inform anesthesiologists and patients in discussing risks and benefits of a TAP block in their surgical context.

Preferences for Inguinal Hernia Repair in Infants: A Survey of the Eastern Pediatric Surgery Network.

Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population. A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate. Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10ys of experience, 26 (27.1%) had 10-20ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P<0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference. The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.

Quality of life post laparoscopic repair of inguinal hernia: a prospective study at a tertiary care centre in Nepal

Quality of life post laparoscopic repair of inguinal hernia: a prospective study at a tertiary care centre in Nepal

Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients.

Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA. Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005-2021. Patients with a Modified Frailty Index (mFI)≥2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA. Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, P=0.04), superficial surgical site infection (aOR 0.450, P=0.03), and discharge not to home (aOR 0.792, P<0.01). In addition, frail patients who underwent LA had shorter operation time (58.42±25.26 vs 67.60±37.17 mins, P<0.01) and a shorter length of stay (0.45±2.30 vs 0.57±2.96 days, P<0.01). Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs.

Navigating the Pediatric Inguinal Hernia Repair Conundrum: Occult Bilaterality of Patent Processus Vaginalis as an Indication for Laparoscopy

Navigating the Pediatric Inguinal Hernia Repair Conundrum: Occult Bilaterality of Patent Processus Vaginalis as an Indication for Laparoscopy

Defect width as a percentage of transverse abdominal diameter: An index to predict the requirement for component separation in incisional hernia repair.

Preoperative decision making prior to incisional hernia repair brings benefits but also presents challenges. Defect width (DW) is the key index in hernia staging but does not precisely indicate the requirement for component separation (CS). DW as a percentage of transverse abdominal diameter (TAD) determined by CT imaging was investigated for its capacity to indicate the necessity of CS for successful defect closure under physiological tension. A total of 116 patients treated for incisional hernia by surgery between April 1st, 2015 and September 30th, 2020 were enrolled and clinical data retrospectively analyzed. All hernias were repaired with defect closure and mesh reinforcement. 82 patients received Rives-Stoppa repair (RS group) and 34 Rives-Stoppa repair with CS (CS group). Preoperative CT images were reviewed to measure maximum DW and TAD at umbilical level and the DW/TAD percentage (DTP) calculated. Accuracies of DW and DTP in predicting necessity of CS were compared through statistical analysis. Mean RS DW was 59.41±18.70mm and CS DW 105.76±13.47mm (p=0.000). Mean RS DW/TAD percentage was 21.25±6.48 and CS DW/TAD 38.56±6.26 (p<0.05). Area under the curve (AUC) for receiver operating characteristic (ROC) curves gave values of 0.798 for DW and 0.825 for DTP (p<0.05). DTP is a reliable index with greater accuracy than DW for prediction of the necessity of CS in incisional hernia repair.

Efficacy of transversus abdominis plane block in postoperative pain management of laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis

Efficacy of transversus abdominis plane block in postoperative pain management of laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis

Comparison between fibrin glue vs mechanical mesh fixation in laparoscopic inguinal hernia repair, A Prospective study

Comparison between fibrin glue vs mechanical mesh fixation in laparoscopic inguinal hernia repair, A Prospective study

Modified Percutaneous Internal Ring Suture PIRS Technique for Inguinal Hernia Repair in Girls, Can It Be Even Better?

Modified Percutaneous Internal Ring Suture PIRS Technique for Inguinal Hernia Repair in Girls, Can It Be Even Better?

COMPARATIVE STUDY: LICHTENSTEINS TENSION-FREE MESH REPAIR VS. STOPPAS REPAIR FOR BILATERAL INGUINAL HERNIAS

Our study investigates the viability of Giant prosthetic reinforcement of the visceral sac (GPRVS) Stoppas repair as an alternative to Lichtenstein Tension-Free Mesh Repair for Bilateral Inguinal Hernias. With a focus on patient satisfaction and outcomes, the research aims to compare the two techniques based on postoperative complications, chronic groin pain, and postoperative pain assessed by the Visual Analogue Scale(VAS). In a sample of 70 cases, randomized into two groups, the study employs a single-incision bilateral approach. Results indicate that Stoppas repair offers comparable effectiveness to Lichtenstein, demonstrating a reduction in postoperative complications, chronic groin pain, and postoperative pain. The study concludes that GPRVS Stoppas repair is a promising alternative, emphasizing enhanced patient satisfaction and similar procedural success concerning Early Recurrence and Duration of Hospital Stay.

Efficacy of Minimally Invasive Techniques versus Open Surgery for Recurrent Inguinal Hernias: A Meta-Analysis

Background: Recurrent inguinal hernias present difficult tasks in surgical approaches to address the issue and enhance patient prognosis. Laparoscopic and other forms of obsolete, less invasive surgery are increasingly being preferred to traditional open surgery. Objective: This meta-analysis aims to synthesize the effectiveness of minimal approach strategies compared with the open approach for recurrent inguinal hernia repair. Methods: The present study adhered to the PRISMA flowchart and databases search was conducted in PubMed, Cochrane, Embase, and Scopus. A total of 29 articles were used from the literature published between 2000 and 2024, which compared minimally invasive techniques and open surgery. Meaningfully, assessment parameters drawn from the study were recurrence rates, post-surgery pain, lengths of hospital stay, complications, and, satisfaction. Structural analysis was performed and combined ordinal data were analyzed for comparison of relative effectiveness. Results: It can be seen that, over the different parameters, minimally invasive approaches provided better results. Repeat rate was smaller (6.06% versus 11.14%), early postoperative pain (3.1 versus 5.4 days); shorter hospital stay (2.5 versus 4.8 days). In the following analysis we observed that the complication rate was significantly less in the minimally invasive group (4.2% vs 8.9%) and patient satisfaction index was slightly higher (89.4 vs 76.3). Further, cross-sectional analysis demonstrated cost effectiveness of laparoscopic techniques and precision in complicated cases offered by robotic operations. Conclusion: The results of the present study showed that minimally invasive approaches are superior to open surgery in treating recurrent inguinal hernias in terms of postoperative recurrence, recovery, and patient satisfaction. Patient and surgery based tailored treatment planning should be vital for promoting best treatment results.

Challenges in Diagnosis and Management of Non- Tuberculous Mycobacterial infection: Report of three cases

Non-tuberculous mycobacteria (NTM) can cause a wide range of infections, from affecting the lungs (pulmonary) to the other parts of the body (extrapulmonary) like skin, soft tissue, surgical wounds, and areas around catheters and implants. A significant challenge is that NTM infections are often misdiagnosed as tuberculosis. This case series highlights these difficulties by exploring three patient experiences. The first case involves a 48-year-old man who developed a prolonged fever following coronary artery bypass grafting (CABG) surgery. He also presented with enlarged liver and spleen (hepatosplenomegaly). Imaging studies revealed a large saccular aortic ascending aneurysm. While surgery (ascending aortic and proximal arch replacement) addressed the aneurysm, the definitive diagnosis came later. Histopathological and microbiological examinations ultimately revealed the culprit to be NTM. In second case, a 56-year-old male underwent a laparoscopic bilateral total extraperitoneal inguinal hernia repair. However, he experienced persistent serous drainage from the incision site post-surgery. To investigate the cause, discharge was collected and subjected to various tests. Therefore, a PCR test for Non-tuberculous Mycobacteria (NTM) was performed. This test returned positive, confirming the diagnosis of NTM infection rather than tuberculosis. And our third case was post operative endophthalmitis following cataract surgery due to NMT. Through these case reports, our Aim is to raise awareness among healthcare professionals. Bangladesh J Medicine 2025; 36: 66-70

A Comparison between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Inguinal Hernia Repair

A Comparison between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Inguinal Hernia Repair

A Study on Safety and Efficacy of Zigzag Skin Incision in General Surgery Among Elective Cases of Acute Appendicitis, Inguinal Hernia and Soft Tissue Tumour - Randomized Controlled Trial

Background: Straight line, the conventional incision technique, is against the principle of plastic surgery when it is not along the minimal line of tension on body. This incisional technique is widely practiced by general surgeons whilst zigzag incision if used, would be advantageous as it facilitates in enhanced exposure to surgical field and aesthetically better scar. In this study zigzag incisional technique was evaluated in terms of safety and efficacy in elective surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Methods: Stratified randomization done for the patients included in cases of general surgery like acute appendicitis, inguinal hernia and soft tissue tumor. These patients were divided in the two groups, conventional incision group and zigzag incision group. Exposure to the surgical field was recorded as qualitative- bad, good and excellent according to operating surgeon. Scar assessment was done after 1 week, 1 month and 6 months. Results: Upon comparison of result, it was observed with zigzag incision, the exposure to surgical field was better than conventional straight-line technique. Additionally, the surgical scar was aesthetically better compared to the straight incision used in general surgery cases like appendectomy, inguinal hernia repair, soft tissue tumor excision but there was no significant difference in case of hernia and appendicitis cases. Conclusion: Zigzag incision can be used safely in place of traditional incision in the elective general surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Zigzag incision provides better exposure of surgical field although this is subjective measure of surgeon’s experience, shows statistically significant difference. Zigzag incision heals better than straight line and gives aesthetically better scar, it can be used in cases such as open appendectomy, open inguinal hernia repair and excision of soft tissue swelling. Keywords: Zigzag incision, Straight incision, aesthetic scar, exposure of surgical field.

Outcomes from 306 consecutive robotic ventral hernia repairs in the community setting

Robotic assisted laparoscopy is increasingly popular for primary ventral and incisional hernia repair. A variety of robotic techniques have been described. More data is needed to evaluate the indications and benefits of these approaches. This is a retrospective analysis of patients who underwent robotic hernia repair over a 2-year period in the community setting. Techniques included: intraperitoneal onlay mesh repair with fascial defect closure (IPOM +), ventral transabdominal preperitoneal repair (vTAPP), and retrorectus (RR) repairs with or without transverse abdominis release (TAR). Follow up was obtained at minimum 6 months postoperatively. Outcomes data included complications, readmissions, reoperations, and hernia recurrences. This study included 306 consecutive robotic ventral hernia repairs: 63 IPOM + , 199 vTAPP, and 44 RR of which 25 (57%) required TAR. Average console times were similar between IPOM + and vTAPP groups (63 vs. 62 min, p = 0.71) and longer for RR repairs without vs. with TAR (107.8 vs. 184.4 min, p < 0.001). There were few intraoperative (0.6%) and immediate postoperative (0.3%) complications. Same day discharge was feasible in most patients (95%). Follow up was completed in 81.0% of patients with an average follow up time of 13.3 months (range 6–27 months). Rates of complications (1.3%), readmissions (1.0%), and reoperations (1.0%) were recorded. There were no hernia recurrences. Robotic ventral hernia repair is a safe and effective strategy for treatment of most abdominal wall hernias with low complication and recurrence rates in medium term follow up.

Anatomical recognition of dissection layers, nerves, vas deferens, and microvessels using artificial intelligence during transabdominal preperitoneal inguinal hernia repair

PurposeIn laparoscopic inguinal hernia surgery, proper recognition of loose connective tissue, nerves, vas deferens, and microvessels is important to prevent postoperative complications, such as recurrence, pain, sexual dysfunction, and bleeding. EUREKA (Anaut Inc., Tokyo, Japan) is a system that uses artificial intelligence (AI) for anatomical recognition. This system can intraoperatively confirm the aforementioned anatomical landmarks. In this study, we validated the accuracy of EUREKA in recognizing dissection layers, nerves, vas deferens, and microvessels during transabdominal preperitoneal inguinal hernia repair (TAPP).MethodsWe used TAPP videos to compare EUREKA’s recognition of loose connective tissue, nerves, vas deferens, and microvessels with the original surgical video and examined whether EUREKA accurately identified these structures. Intersection over Union (IoU) and F1/Dice scores were calculated to quantitively evaluate AI predictive images.ResultsThe mean IoU and F1/Dice scores were 0.33 and 0.50 for connective tissue, 0.24 and 0.38 for nerves, 0.50 and 0.66 for the vas deferens, and 0.30 and 0.45 for microvessels, respectively. Compared with the images without EUREKA visualization, dissection layers were very clearly recognized and displayed when appropriate tension was applied.

THE BENEFITS OF USING POLYESTER MESH IMPLANT DURING ANTERIOR INGUINAL HERNIA REPAIR. CASE REPORT

Aims: To find the results of using polyester mesh implant as an optimal alternative to polypropylene for open anterior inguinal hernia repair by Lichtenstein. Case Description: We present a 53-year-old-male patient with uncomplicated right-sided oblique inguinal hernia. Reinforcement of the posterior wall of the inguinal canal was done using polyester mesh implant fixed by dacron sutures. Successful repair was achieved with reduced operative-time and smooth recovery free from complications during post-operative and short-term follow-up intervals. Conclusions: Polyester mesh implant could be considered an optimal alternative to polypropylene for open anterior inguinal hernia repair.

Comparison of trans-umbilical single-port laparoscopic complete extraperitoneal closure and laparoscopic intracorporeal closure for pediatric inguinal hernia: a randomized controlled study

BackgroundThe purpose of this study was to compare the outcomes of Trans-umbilical single-port laparoscopic complete extraperitoneal closure (LCEC) and laparoscopic intracorporeal closure (LIC) for inguinal hernia by analysis of follow-up data over 5 years.MethodsIn this prospective randomized controlled trial, 524 children with inguinal hernia were randomly assigned to undergo LCEC or LIC between August 2016 and December 2017. The primary outcome measures were the success and recurrence rates. The secondary outcome measures were operative time; length of hospital stay; postoperative pain score; and incidence of postoperative complications, including rates of wound infection, stitch abscess, and testicular atrophy.ResultsPrimary analysis of the 227 patients in the LIC group and 215 patients in the LCEC group revealed that in the LCEC group, the success rate of was significantly higher in LCEC group (96.7% vs. 90.3%, P &amp;lt; .05) and the length of hospital stay was significantly shorter (P &amp;lt; .05) than those of the LIC group. Neither the recurrence rate (P &amp;gt; .05) nor the operative time (P &amp;gt; .05) of the groups significantly differed. The pain scores at postoperative 12 and 24 h were significantly lower in the LCEC group than in the LIC group (P &amp;lt; .05). The incidence rates of wound infection (0.93% vs. 5.7%, P &amp;lt; .05) and stitch abscess (1.4% vs. 7.0%, P &amp;lt; .05) were significantly lower in the LCEC group than in the LIC group. No testicular atrophy occurred in either group.ConclusionLCEC is associated with better clinical success and fewer postoperative complications for repair of pediatric inguinal hernia compared with LIC.