Right-sided Inguinal Hernia Research Articles

Neuraxial anesthesia for non-neurological emergency surgery in a patient with acute ischemic stroke: a case report

BackgroundThe recent guidelines recommend delaying elective non-neurological surgery after an index stroke, but there is a lack of consensus regarding emergency surgery in patients with a recent stroke. Impaired cerebral autoregulation and altered baroreceptor function elevate the risk of recurrent stroke in this group. Moreover, the impact of anesthesia type (general vs. regional) for non-cardiovascular, non-neurological surgery in patients with an index stroke remains inconclusive.Case presentationA 67-year-old male with an acute mild ischemic stroke underwent emergency surgery for an obstructed right-sided direct inguinal hernia under combined spinal-epidural anesthesia. Pre-operative assessment showed stable hemodynamics, and perioperative measures were taken to ensure stable blood pressure. Neuraxial anesthesia was employed successfully, and the patient remained hemodynamically stable throughout the surgery and postoperative period. No neurological deficits were observed post-surgery, and follow-up up to 3 months revealed no cognitive impairment or neurological decline.ConclusionsNeuraxial anesthesia can be considered for patients with acute mild strokes requiring urgent non-neurological surgery, provided they are hemodynamically stable and without coagulopathy. However, the choice of anesthesia should be individualized based on factors such as neurological status, stroke severity, coagulation, and existing disabilities. This case highlights the importance of a personalized approach to anesthesia in emergency surgery for stroke patients.

A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia.

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes. This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted. The majority of patients were male (94.31%), with a mean age range of 18-85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively. The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.

V-042 ONSTEP - VIDEO REVISION OF THE TECHNIQUE

Abstract ONSTEP is an open preperitoneal approach for inguinal hernia repair. The technique is simple, fast and consists of twelve standardized steps. The video provides a full step-by-step description of the technique, with some tips and tricks included. The case refers to a 35-year-old man with a right-sided primary inguinal hernia. The procedure took around 15 minutes, was uneventful, and no clinically significant postoperative pain was noted. The patient was able to return to work within 2 weeks. After two years of follow-up, the patient remains pain–free and without recurrence. The ONSTEP technique is an excellent option for inguinal hernia repair, especially for primary unilateral hernias in male patients. The authors believe that this approach should be part of the hernia surgeon´s therapeutic armamentarium.

Vaginal Atresia, Left Unicornuate Unicollis Uterus, Left Pelvic Ectopic Single Kidney with Right Inguinal Hernia Containing Ovary in a 14 y Old Female: A Rare MRKHS Variant

Introduction: Vaginal atresia is a component of Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), which includes variable Mullerian duct abnormalities with normal secondary sexual characteristics. Associated renal anomalies are present in about 30% of cases(1)
 Objective: To present a rare variant of MRKHS in a14-y old female with a right ovary in a right inguinal hernia and renal anomalies managed bysigmoid vaginoplasty.
 Case Description: A 14-year-old girl presented with primary amenorrhea and cyclic abdominal painone year before, pelviabdominal swelling, right inguinal hernia, and well-developed secondary sexual characteristics with a single introital opening. Investigations revealed a left ectopic pelvic single kidney, hematometra with left hematosalpinx and right-sided inguinal hernia containing the right ovary with a left ovarian cyst. The first procedure included diagnostic laparoscopy and cystoscopy with the combined repair of the right-sided inguinal hernia and laparoscopic drilling of the left ovarian chocolate cyst. The patient was diagnosed with unicornuate unicollis uterus, left hematosalpinx with complete vaginal atresia associated with a left ectopic pelvic single kidney. One month later, sigmoid vaginoplasty was done. At the 3-month follow-up, there was a full-thickness neovaginal prolapse which was managed surgically by resection.
 Conclusion: To our knowledge, this is the first description of this variant of MRKH syndrome association, includingvaginal atresia, left unicornuate unicollis uterus with ipsilateral left single pelvic ectopic kidney with right-sided inguinal hernia containing right ovary, in the literature. Renal assessment in cases of vaginal atresia and other mullerian anomalies is mandatory for detecting and managing such anomalies and preserving renal function. Anatomical and functional assessment of the urogenital system is mandatory, and multiple modalities can be integrated to get proper results. Diagnostic laparoscopy and cystoscopy give invaluable information in these cases and can add therapeutic aids.

Scrotal trichilemmal cysts: a case report.

We discuss the case of a 60-year-old male patient who presented to the clinic with a right-sided scrotal swelling, which was identified as a right-sided inguinal hernia on examination, and multiple small swellings on the scrotal skin identified as TCs. The patient had scrotoplasty after hernia surgery to remove the cysts and reconstruct the excised scrotum. Following scrotoplasty, the patient's discomfort was resolved, and cosmetic satisfaction was achieved. Excision is required if TCs become infected or for esthetic reasons. In the event of big cysts, full scrotal wall resection followed by scrotoplasty is necessary. The thigh fasciocutaneous flap is used to cover the denuded testes after scrotoplasty. The procedure's advantages include a good outcome, low morbidity, early discharge, and great esthetic outcomes. We present a literature review about multiple TCs in the scrotum and their surgical management. This case will guide surgeons and future researchers in dealing with similar cases in the future.

Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males.

Inguinal hernia repair is the most commonly performed elective surgery in Indiadraining significant healthcare resources. This observational study was conducted at a tertiary-level institute in northern India to look into the demographics, clinical profile and risk factors of inguinal hernia. This study was conducted as an observational study at the tertiary care centre of northern India, including 110 patients who had come to the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all the participants, demographic details, history and clinical examination were recorded. This was a prospective, single-centre, non-randomized, observational study. In our study, 43 patients (39%) were >50 years of age. One hundred and sevenpatients (97.27%) were males, and three (2.72%) were females. Male: Female ratio was 32:1.The preponderance of males was due to their involvement in more strenuous exercises and lifting weights and the anatomical differences between them. The main risk factor in the present study was lifting heavy weights 55%, followed by altered bowel habits 36.36% and respiratory disease (chronic obstructive airway disease). Smoking and diabetes were also associated as risk factors for the hernia. In this study, the most common side of hernia was on the right side, 63%, on the left, 33% and bilateral in 4% of patients. The indirect hernia was the most common type. Inguinal hernia is a surgical problem found commonly in the male elderly. Right-sided inguinal hernia is common, with the indirect type being more frequent. Heavy weight lifting and strenuous exercises were commonly found risk factors.

An Observational Analysis of Mesh Fixation with Minimum Sutures and Its Postoperative Outcomes

Background The history of hernia repair is the history of the surgery itself. The surgical management of inguinal hernia has continuously evolved for 200 years. Aim This article determines the incidence of recurrence, chronic pain, and complications following open, tension-free Lichtenstein hernioplasty using a minimal stitch approach. Material and Methods This was a single-center, hospital-based, prospective observational study. A total of 197 participants with uncomplicated hernias were enrolled. All participants were operated following open, tension-free, minimal stitch Lichtenstein hernioplasty. The duration of follow-up was 6 months. Results Thirty-one (15.7%) participants were lost to follow-up, and 154 (78.2%) participants completed the follow-up. Making total of 166 cases (of which 142 were unilateral and 12 were bilateral, counted as 24 individually). Overall, right-sided direct inguinal hernia (30%) was the most common type, followed by right-sided indirect hernia (26%). Most participants (85%) were given three sutures to fix the mesh during open tension-free hernioplasty. The incidence of postoperative complications, including wound infection, hematoma, and seroma, was zero among participants in each group. The incidence of chronic pain and recurrence at 3 and 6 months after the surgery was zero among all participants. Conclusion Most patients in this study required three stitches to fix the mesh during hernioplasty. There were zero incidences of chronic pain, recurrence of the hernia, or any postoperative complication among participants. Thus, hernioplasty can be safely and effectively performed with minimal sutures among male patients with either unilateral or bilateral uncomplicated hernia.

Preventing postoperative complications after robot-assisted transabdominal preperetoneal repair: clinical case

Introduction. Inguinal hernia repair is one of the most common elective surgeries today. In our clinic, the majority of inguinal hernia repairs are performed laparoscopically. The most frequent complication after transabdominal preperitoneal inguinal hernia repair is postoperative seroma.Materials and methods. A 35-year-old patient C. with a right-sided inguinal hernia sought medical care in our clinic. He underwent robot-assisted TAPP with fluorescence lymphography using indocyanine green (ICG).Results and discussion. The present paper describes the possible relationship between intraoperative damage of the lymphatic vessels within the spermatic cord induced by robot-assisted transabdominal preperitoneal inguinal hernia repair and postoperative development of inguinal seroma. 5 mg/ml of indocyanine green was injected into the testicle on the side with the hernial bulge to visualize the lymphatic vessels. In this case such procedure is safe and feasible. Due to the tight fusion of the hernia sac with two visualized lymphatic vessels, they were excised during surgery. In the early postoperative period, an ultrasound scan revealed a subclinical seroma in the inguinal region of approximately 10 ml.Conclusion. A case series of ICG fluorescence lymphography during robot-assisted TAPP should be performed further to elucidate the relationship between lymphatic vessel damage and hydrocele.

Лапароскопічна екстраперитонеальна залобкова (транскапсулярна) простатектомія та симультанна передочеревинна герніопластика сітчастим імплантом у хворого іх доброякісною гіперплазією простати та пахвинною грижею

Nowadays, an alternative treatment option for benign prostatic hyperplasia is laparoscopic and robotic methods, in contrast to the traumatic nature of open prostatectomy, a significant percentage of intra- and postoperative bleeding from the prostate fossa with the need for blood transfusions, pronounced pain syndrome in the postoperative wound with the possibility of suppuration, significant postoperative hospital-day and rehabilitation period. Along with the significant prevalence of inguinal hernias in 3-25% of patients, the possibility of onemoment simultaneous hernioplasty during prostatectomy for benign prostatic hyperplasia is an actual issue in both urology and abdominal surgery. A successful case of laparoscopic extra-peritoneal retropubic prostatectomy and pre-peritoneal hernioplasty with a mesh implant in a patient with benign prostatic hyperplasia and a right-sided indirect inguinal hernia (RL3) is presented. The volume of the prostate was 146 cm3. In the first stage, the patient underwent a laparoscopic extra-peritoneal one-moment transcapsular prostatectomy, in the second stage, a right-sided pre-peritoneal inguinal hernioplasty with a polypropylene mesh implant 10x15 cm of size. The duration of the operation was 200 minutes, intraoperative blood loss – 200 g. In the postoperative period, the urinary bladder was irrigated with an antiseptic solution for 1 day, the urethral catheter was removed on the 5th day. The patient was discharged on the 6th day with restored and satisfactory urination. Further studies are needed to establish the advantages of laparoscopic extra-peritoneal pubic prostatectomy and simultaneous pre-peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia.

Indirect inguinal hernia of the urinary bladder

An 83-year-old man was diagnosed with stage IIIA follicular small cleaved cell lymphoma in June 2021. Treatment with rituximab x4 weekly was initiated. Routine CT scanning was obtained in August 2021 to determine response to treatment. A right-sided indirect inguinal hernia was encountered at this time which had not been present upon prior examinations. The hernia sac was found to contain a significant anterior extension of the urinary bladder. An enlarged prostate was also observed measuring 6.2 cm transversely. The patient experienced no lower urinary tract symptoms at this time. Surgical repair of the hernia was deferred because the patient self-reported minimal discomfort and minimal functional restriction due to the hernia.

Optimizing the Working Space for Single-Port Laparoscopic Totally Extraperitoneal Closure of Inguinal Hernia with TPV Protocol in Infants and Young Children.

Purpose: To evaluate the outcomes of single-port laparoscopic internal ring closure of inguinal hernia, optimized according to TPV (tilt, pad, and void) protocol, in infants and young children. Methods: From August 2018 to March 2021, a prospective cohort study was conducted including 400 patients younger than 3 years with either left- or right-side inguinal hernia treated with single-port laparoscopic totally extraperitoneal (TEP) closure of the internal ring using a two-hooked core needle apparatus. Patients whose hospitalization ID ended with an odd number were included in group A (n = 200). They were surgically treated with single-port laparoscopy optimized according to TPV protocol, in which the operating table was placed at a 30° head-down tilt position (tilt), the hip was padded by 4-5 cm (pad), and the bladder was voided (void). The remaining patients in group B (n = 200) were conventionally treated with single-port laparoscopic TEP closure of the internal ring. Success rate of surgery, surgery duration, and postoperative complications of two groups were compared. Results: A significantly higher success rate of surgery was detected in group A than in group B (198/200 versus 182/200, P < .05). Regardless of unilateral or bilateral inguinal hernia, surgery duration was significantly shorter in group A than in group B (unilateral inguinal hernia, 14.38 ± 2.85 minutes versus 21.17 ± 4.47 minutes; bilateral inguinal hernia, 20.73 ± 4.58 minutes versus 28.99 ± 4.12 minutes, both P < .05). In addition, the incidence of postoperative complications was significantly lower in group A (1/200 versus 8/200). Conclusions: TPV protocol to optimize working space for single-port laparoscopic TEP closure of inguinal hernia can increase the success rate, shorten surgery duration, and decrease the incidence of postoperative complications.

Tension-Free Inguinal Hernia Repair in Local Anaesthesia versus Spinal Anaesthesia

Abstract Background: Inguinal hernia is a common presentation in surgical clinics. In the past, the hernia surgeries were done under general and spinal anesthesia. Recently local anesthesia is being increasingly used due to the increased efficacy of local anesthetics and economic reasons. We in the current study tried to evaluate the effectiveness of Lichtenstein repair under local anesthesia and spinal anesthesia and the overall outcomes of both methods. Methods: This cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. Successive cases of uncomplicated inguinal hernia were selected for the study. A total of n=60 cases randomly allotted in two groups The LA group and SA group were taken and studied. Post-operatively VAS scale was used to evaluate pain, other postoperative complications such as testicular swelling and pain, urinary retention, nausea/vomiting, postural hypotension, and wound infections were recorded. Results : The age of the patient varied from 20 to 80 years with the highest prevalence noted in the age group of 41 to 60 years. The Mean age of presentation is 51.3 years. The anatomical location and type of hernia are given in table 1. 60.9% of inguinal hernia in this study was an indirect type, 30.4% was direct, 6.5% was pantaloons type and 2.2% was Ogilvie's hernia. Out of 74 patients, 62.1% had a right-sided inguinal hernia compared to the left side which accounted for 37.8%. Complication records showed N=9(23.7%) of the SA group and n=8(22.2%) LA group developed scrotal edema and in total n=17(23%) developed scrotal edema. N=7(18.4%) patients in the SA group and n=7(19.4%) in the LA group developed seroma and in total patients, n=14(18.9%) developed seroma. Conclusion: Lichtenstein tension-free hernioplasty done under local anesthesia is with less immediate postoperative complications, also the best suitable for patients with medical comorbidities and those who are on antiplatelet therapy where spinal anesthesia is contraindicated.

Acute gangrenous-perforative appendicitis in right-sided inguinal hernia

The author presents acute appendicitis with atypical localization of appendix in hernial sac in a patient with right-sided inguinal hernia. Long-standing disease (3 days), progressive destructive process in appendix (gangrenous-perforative appendicitis) led to spread of infection beyond the hernial sac and development of local inflammatory process in inguinal tissues. Surgical team recognized this pattern as a complication of strangulated right-sided inguinal hernia (hernia sac phlegmon). Despite the diagnostic error, timely surgical intervention and adequate tactical approach contributed to a favorable outcome.

Amyand hernia: a case report and literature review

Background: Amyand hernia is defined as the presence of an appendix within the hernial sac with or without appendicitis. It is an extremely rare condition seen in approximately 1% of all hernias, whereas associated complications like acute appendicitis, or perforated appendicitis, are even rarer. Case presentation:We describe a case of a 50-year-old male patient, who presented to the Department of Surgery with an incarcerated right-side inguinal hernia without any signs of ischemic complications. He was admitted and a hernioplasty was performed. As an incidental finding, an Amyand hernia was encountered that was treated without appendectomy and placement of a prosthetic mesh without any complications. Conclusion: Amyand&amp;apos;s hernia is a rare presentation of inguinal hernias and the preoperative diagnosis of Amyand&amp;apos;s hernia remains a challenge. CT scan and ultrasonography are helpful for the diagnosis but the definite diagnosis should be made by laparoscopy.

S1716 Atypical Appendicitis in the Elderly

Introduction: Amyand’s hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac. Acute appendicitis is much less common in this situation and few reports are found in the literature. We present such a case with the hopes that we increase awareness about this uncommon condition one in which preoperative diagnosis remains difficult. Case Description/Methods: A 97 year old male with dementia, urinary stones and chronic bilateral non-reducible inguinal hernias extending down into his scrotum presented to the emergency department (ED) with right-sided abdominal pain. In the ED, physical exam was notable for soft, non-distended abdomen with right lower quadrant tenderness and two large bilateral inguinal hernias. Labs were without any notable leukocytosis or lactic acidosis. CT abdomen/pelvis findings revealed a large hernia on the right side with what appeared to be the cecum and appendix in the hernia sac with stranding and some pericolonic fluid collection. General Surgery was consulted at this time with concerns for incarcerated right-sided inguinal hernia. Patient underwent open right inguinal hernia repair and appendectomy with intraoperative findings of reducible right direct and indirect inguinal hernia and inflammatory changes of the appendix indicative of likely appendicitis. Patient did well post-operatively and was discharged back to his skilled nursing facility. Discussion: Amyand’s hernia is described as a hernia consisting of an incarcerated appendix associated with or without an acute appendicitis. First described in 1735 by Claudius Aymand in an 11-year-old boy, this condition remains rare with an incidence of about 0.5-1%. Even rarer is the presentation of an acute appendicitis within the inguinal sac with an incidence around 0.1%. It is present three times more likely in the pediatric patient due to a patent processus vaginalis and is more common in males. Because patients may present with nonspecific symptoms, this remains a difficult diagnosis to make preoperatively and hence is mainly found intraoperatively during surgical exploration of a complicated inguinal hernia. With the increased use of CT scans, this diagnosis is more frequently being made preoperatively, allowing for both safer preoperative planning and intraoperative decision-making. While the patient will ultimately require surgical interventions, it is important to keep in mind the role of pre-operative imaging to aid in management and improved intraoperative decision-making.Figure 1.: Patchy Ulceration of the Transverse Colon.

Management of Inguinal Hernia in a Tertiary Center, a two-year Retrospective Study.

Background: Inguinal hernia repair remains the most common surgery performed by general surgeons worldwide. There is a lot of published data on the surgical management of inguinal hernias in our country. This study aims to describe our experiences in the surgical management of inguinal hernias and compare our results with those reported in the literature. Material and Method: A descriptive retrospective study was conducted at the University Hospital of Trauma in Albania. From April 2016 - March 2018 were recorded all the data for patients who presented to our hospital and underwent inguinal hernia repair in our hospital, under the conditions of elective surgery. Statistical data analysis was done using SPSS software version 17.0. Results: In this period had a total of 542 patients with inguinal hernias were enrolled in the study. The median age of patients was 46,12 years (range 14 to 92 years old). Males outnumbered females by a ratio of 18.3:1. This gender difference was statistically significant (p = 0.004). Most patients 130 (23.9%) presented late (more than one year of onset of hernia). At presentation, 208 (38.4%) patients had a reducible hernia, 101(18.6%) had an irreducible hernia. The majority of patients 303(55.9 %) had a right-sided inguinal hernia, and 156(28.7 %) had left-sided inguinal hernia with a right-to-left ratio of 1.94: 1. Eighty-three 83(15.3%) patients had bilateral inguinal hernias. 319 (58.8%) patients had an indirect hernia, Conclusion: Inguinal hernias continue to be a source of morbidity and mortality in our center. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem.

Driving ability after right-sided inguinal hernia surgery.

To investigate driving ability (brake reaction time, BRT) after right-sided hernia repair. It was assumed that postoperatively BRT would be impaired as compared to the preoperative reference and healthy controls. BRT was prospectively collected from 30 patients undergoing hernia repair [Lichtenstein or total extraperitoneal endoscopic procedure (TEP)]. BRT was measured with a driving simulator preoperatively and on postoperative days 2 and 14. After receiving a visual stimulus, the patients had to apply the brake pedal with 160N. The average of ten runs was used as the patient's BRT value. Thirty patients completed all measurements. In the Lichtenstein group, BRT was significantly impaired as compared to the patient's preoperative values (p = 0.021). Two weeks after surgery BRT had returned to the preoperative level (p = 0.859). BRT in the Lichtenstein group was also significantly impaired 2 days postoperatively as compared to the BRT of 60 healthy controls (p = 0.001). In the TEP group, no impaired BRT was detected. Based on our finding of significantly impaired BRT in patients following right-sided Lichtenstein hernia repair, it seems wise to recommend that such patients refrain from driving for 2 weeks after surgery. No such impairment was found in patients following TEP surgery. Consequently, it is deemed safe for them to resume driving 2 days after the procedure.

9 СЛУЧАЕВ ЛЕЧЕНИЯ ДЕТЕЙ С ГРЫЖЕЙ АМИАНДА

9 children aged 4 to 14 years underwent a right-sided inguinal hernia repair, at the same time, a vermiform appendix was found in the hernial sac. All patients were hospitalized with a diagnosis of «Congenital right-sided inguinoscrotal hernia», bilateral hernias were not observed. Objectively, there were all signs of the disease, all hernias were reducible. The presence of the appendix in the hernial sac before the operation was not diagnosed either clinically or by ultrasound. The contents of the hernial sac had a thickened and long vermiform appendix, a greater omentum, and in two cases – a cecum of the type of sliding hernia. The children were operated on under general anesthesia: appendectomy and plastic surgery of posterior wall of inguinal canal were performed. No complications were observed in the postoperative period.

Causes of peritoneal injury during laparoscopic totally extraperitoneal inguinal hernia repair and methods of repair.

Peritoneal injury during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is an intraoperative complication that affects accomplishment. We retrospectively examined the causes of peritoneal injury and methods of TEP repair. This study examined 58 patients with inguinal hernia (43 unilateral, 15 bilateral) who had undergone TEP repair; all procedures were performed by the same surgeon. The incidence of peritoneal injury, clinical characteristics that could have influenced peritoneal injury, and management of the injury were analyzed. Peritoneal injury was noted in 16 inguinal hernias (21.9%, 16 /73). Injury occurred more frequently in right-sided hernias than in left-sided hernias (31.6% vs 11.4%, P= .049). No other factors were related to injury. Peritoneal injury occurred due to anatomical misrecognition in five hernias (31.3%, 5/16) and unintentional dissection in six hernias (37.5%, 6/16). All injuries due to unintentional dissection occurred in right-sided hernias. The procedures used for peritoneal injury repair were endoscopic suturing for 4 hernias, pre-tied loop ligation for 1 hernia, and ligation clips in 11 hernias. Additional techniques were required in three hernias repaired by endoscopic suturing (75% 3/4). After introduction of the ligation clips, endoscopic suturing was discontinued, and no additional techniques were needed. Peritoneal injury more frequently occurred in right-sided inguinal hernia than in left-sided inguinal hernia during TEP repair. The common reasons for peritoneal injury were anatomical misrecognition and unintentional dissection. Repair using ligation clips is the best option for peritoneal injuries that occur during TEP repair.

AMYAND’S HERNIA: A RARE CASE REPORT

Amyand’s hernia is an atypical and rare hernia characterized by the herniation of the vermiform appendix into the inguinal sac. Here,&nbsp;we report the case of a 60-year-old male patient presented with complaints of the right-sided reducible inguinal hernia. On exploration&nbsp;as an incidental finding, we encountered an Amyand’s hernia treated with appendectomy and hernioplasty without any complications.&nbsp;Hence, we should keep in mind to rule out Amyand’s hernia during hernioplasty.