Inguinal Hernia Research Articles

An insight into the landscape of a rare tumor-persistent Mullerian duct syndrome with testicular seminoma

ABSTRACT Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism in phenotypically males with 46 XY karyotype. The syndrome is caused by insufficient amount of Mullerian-inhibiting substance (MIS) or due to insensitivity of the target organ to MIS. Till date, less than 300 cases of PMDS are described in English literature, and the association of testicular tumor is still rarer. We report a case of seminoma of testis with PMDS in a 22-year male who reported with intermittent pain, fullness, and dragging sensation over right-side lower abdomen for 4 years. The radiological impression was testicular mass arising from undescended testis with persistent Mullerian duct structures. Histopathology and immunohistochemistry confirmed the diagnosis. Association of undescended testis increases the likelihood of developing testicular tumor in PMDS. Clinicians and pathologists should be aware of the rare entity while dealing with the cryptorchidism with inguinal hernia, and necessary management should be done to reduce the complications.

An Update on Open Inguinal Hernia Repair in Adults: Review Article

Open inguinal hernia repairs are a common general surgical procedure, and it can be divided into mesh-based repairs and sutured based repairs. Mesh-based repairs are the most popular open inguinal hernia repair with the Lichtenstein repair being the most common surgical procedure. The sutured based repairs are not as commonly performed with the Shouldice repair being the most popular repair, but the Desarda repair is slowly emerging as a viable sutured based inguinal hernia repair. We have conducted this review article to look at the varies types of mesh based and sutured based repairs for open inguinal hernia repair including their complications and recurrence rate. We also looked at the effect of chronic pain and the role of antibiotic prophylaxis in open inguinal hernia repair.

The effect of surgical inguinal hernia repair on testicular blood supply: A prospective superb microvascular imaging ultrasonography study.

In this study, we aimed to evaluate the differences in vascularity between the testis on the inguinal hernia (IH) side and the contralateral healthy testis by performing preoperative and postoperative (first month) examinations with superb microvascular imaging ultrasonography (SMI USG), and to compare results with power Doppler (PD) USG. In this prospective cohort study, 35 patients diagnosed with IH between April 2023 and July 2023 who were hospitalized in the general surgery ward of a tertiary hospital for IH surgery were evaluated. The postoperative vascular index (VI) values obtained by SMI were found to be significantly lower than preoperative VI values in both operated and non-operated testes (p < 0.001). The VI values obtained with PD in the postoperative period were significantly lower in the operated and nonoperated testes on both sides compared with the VI values obtained in the preoperative period (p < 0.001 and p = 0.029, respectively). There was a significant difference between preoperative and postoperative VI difference values obtained by SMI and PD on the operated side (p = 0.015). In our study examining patients who had undergone IH surgery, testicular vascularity was assessed more precisely with the SMI USG method compared with the PD method.

Effect of ultrasound-guided ilioinguinal-iliohypogastric nerve block on chronic pain in patients undergoing open inguinal hernia surgery under spinal anesthesia: a randomized double-blind study.

Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180-360]) versus (180 min [180-360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

Laparoscopic transabdominal preperitoneal repair for a patient with Laugier’s and inguinal hernia

BackgroundLaugier’s hernia is a very rare atypical femoral hernia and is challenging to diagnose preoperatively. Herein, we report a rare case of inguinal and Laugier’s hernias treated with laparoscopic transabdominal preperitoneal repair.Case presentationA 63-year-old man was admitted to our hospital with right groin swelling for 4 years. Computed tomography revealed an indirect inguinal hernia with protrusion of the small intestine. The preoperative diagnosis was right indirect inguinal hernia; Laugier’s hernia was unknown. The patient underwent laparoscopic transabdominal preperitoneal repair. During the surgery, part of the perivesical adipose tissue penetrated the lacunar ligament. It was located medial to the typical site of a femoral hernia. Thus, Laugier's hernia was diagnosed. Finally, laparoscopic transabdominal preperitoneal repair was performed for Laugier's hernia and inguinal hernia. The postoperative course was good, without recurrence.ConclusionsTo our knowledge, this is the first reported case of inguinal and Laugier’s hernia treated with laparoscopic transabdominal preperitoneal repair. Surgeons should be mindful that inguinal hernias can occur concurrently with other types of hernias, such as femoral hernias, including atypical variants like Laugier's hernia. Additionally, they should actively consider laparoscopic approaches such as transabdominal preperitoneal for femoral hernias. These approaches are beneficial for precise diagnosis, confirming the presence of other hernias, and simultaneously treating all coexisting inguinal hernias.

The use of Virtual Reality Hypnosis (HypnoVR) in inguinal hernia surgeries.

The use of Virtual Reality Hypnosis (HypnoVR) in inguinal hernia surgeries.

Multiple Shunt Catheter Tips Migration into an Inguinal Hernia in an Adult

AbstractAlthough ventriculoperitoneal shunt tip migration into an inguinal hernia is considered common in children, while in adults it is quite rare. In fact, only a handful of cases have been reported in the literature. We report a rare case whereby two catheter tips (one from a lateral ventricle shunt and a second from a 4th ventricular shunt) migrated into an inguinal hernia. This migration caused distal shunt malfunction, and only distal catheter shortening and suturing to the abdominal wall caused the two shunts to function again.

Asuhan Keperawatan Pada Nn. S dengan Post Operasi Hernioraphy : Hernia Inguinalis Lateralis Dextra di Ruang Mawar 2 RSUD dr. Soeselo Kabupaten Tegal

Inguinal hernia is a condition where an organ protrudes into a cavity through a thin or weak part of the wall. The small intestine is usually the organ that enters the cavity, causing the protrusion. In 2018, hernia ranked 8th in Indonesia with a total of 18,145 cases or around 1.05%. The number of hernia cases in Central Java is estimated to be over 500, or approximately 1.01% of cases. If an inguinal hernia is not treated promptly, it will continue to grow and exert significant pressure on the surrounding tissues. A common consequence of untreated hernia is that it will enlarge and interfere with the patient's daily activities. One of the complications of hernia is swelling around the lump. One of the treatments for hernia is surgery. The writer is expected to provide optimal nursing care for patient. S, who has experienced a right lateral inguinal hernia post- operatively following herniorraphy in Mawar 2 ward of dr. Soeselo Regional Hospital, Tegal Regency.

WP1.5 - Outcomes of inguinal hernia repair in adolescents by both paediatric and adult surgeons- a retrospective observational study

Abstract Aims Adolescent inguinal herniae are repaired by both paediatric and adult surgeons, but there is significant variation in operative technique. We aim to report both adult and paediatric practice, and to compare outcomes amongst different repair techniques. Methods Data were collected from records of patients aged 12-18 who underwent inguinal hernia repair in adult or paediatric services within our region between 2000 and 2023. Results 116 inguinal herniae in 106 adolescents were identified. 66% were repaired by paediatric surgeons. 85% were male. Median age was 14.1 years. Median length of follow-up was 15.0 years. 71% herniae were right-sided and 9% bilateral. 98% were indirect. 3% were incarcerated. 72% underwent open repair. Herniotomy with high ligation of the sac was the most common open operation in adult and paediatric practice. 28% herniae were repaired laparoscopically (64% by adult surgeons). Adult surgeons most commonly utilised total extraperitoneal repair, and paediatric surgeons most utilised closure of the deep ring. 4% recurred (all operated on by paediatric surgeons). 4% of patients developed chronic pain (80% from adult services). Only 1 of 5 patients with chronic pain had mesh repair. Logistic regression showed no independent variables predictive for recurrence or chronic pain. Conclusions There is significant variation in practice between adult and paediatric surgeons in adolescents with inguinal herniae. Recurrence was more common after repair by paediatric surgeons whilst post-operative chronic pain was less common. Paediatric and adult surgeons could learn from each other to optimise outcomes. This study also raises the question of who should be doing these procedures.

EP110 - Chyloperitoneum in Follicular lymphoma – presenting as an inguinal hernia

Abstract Introduction Follicular lymphoma is one of the subtypes of slow growing Non-Hodgkin Lymphoma. Rarely, follicular lymphoma can present with chyloperitoneum or chylous ascites which is characterized by a milky-white coloured fluid with raised triglyceride levels. Case Report We present a case of a 60-year-old diabetic male, complaining of a right sided inguinal swelling for 1 year. Examination revealed a reducible right inguinal swelling with a positive cough impulse. The laboratory workup was unremarkable. Ultrasound scan of anterior abdominal wall showed a defect of 2.1 cm in right inguinal region with protrusion of abdominal contents and a positive cough impulse. A diagnosis of right sided reducible direct inguinal hernia was made. Patient was scheduled for Lichtenstein repair. Per-operatively, the hernial sac contained healthy omentum with milky-white ascitic fluid. Omentum was reduced and suture repair was performed. A drain was placed intra-peritoneally. The postoperative course of the patient was uneventful. Ascitic fluid analysis showed high triglyceride levels and no evidence of malignant cells, suggesting chylous ascites. Contrast enhanced CT scan of abdomen and pelvis revealed a large homogenous minimally enhancing soft tissue density retroperitoneal mass in peri aortic and paravertebral location with abdominal lymphadenopathy suggesting retroperitoneal lymphoma. Excisional biopsy of an enlarged inguinal lymph node confirmed follicular lymphoma with positive BCL2 and CD10 markers. Conclusion Follicular lymphoma presents in a variety of ways including chylous ascites in an inguinal hernia and a high index of suspicion is required to diagnose it.

EP537 - Revolutionizing informed consent: A quantum leap in precision for chronic pain awareness in inguinal hernia operations through electronic consent

Abstract Aim The study aimed to assess the extent to which clinicians provide information to patients about the occurrence of chronic pain during consultations, recognizing it's significance as a prevalent postoperative complication following inguinal hernia repair. Methods Data were gathered by two teams at distinct time periods within the same trust. One team utilized the standard paper-based consenting method, while the other employed a recently introduced electronic consenting process. A comparison of these approaches was undertaken to derive the study's results, making it a retrospective and comparative analysis. Results An investigation on this subject conducted initially uncovered that 84% of patients were not informed about the risk of chronic pain and did not provide consent for this common occurrence via standard paper based method. Consequently, the study recommended the implementation of an e-consent facility in the Trust. This facility would feature a template encompassing all pertinent risks associated with inguinal hernia surgery. Following the introduction of e-consent later, we conducted a subsequent analysis on patients who underwent inguinal hernia surgery. The findings indicated a notable improvement, with 98% of patients having given their consent for chronic pain.Manner of consentingPatient who was informed about chronic pain during consentingPatient who wasn't informed about chronic pain during consentingPaper consent16%84%e-Consent982% Conclusion The incorporation of chronic pain as a potential complication in the consenting process for inguinal hernia surgery has seen improvement since the introduction of the e-consent software. However, to achieve full compliance, there is a need for further enhancement and increased utilization of the e-consent software.

WP1.11 - Total Extra Peritoneal (TEP) Inguinal hernia repair is safe and feasible for recurrent inguinal hernia post Total Extra Peritoneal repair "TEP on TEP is possible”

Abstract This abstract share our experience in surgical management of recurrent inguinal hernia post total extra peritoneal (TEP) repair by utilizing the same approach TEP. Methods Two patients with recurrent inguinal hernia post TEP were consulted for laparoscopic VS open approach, and both opted for the laparoscopic approach, understanding the higher risk of conversion. Result The first case of 62y male with recurrent left inguinal hernia after bilateral TEP. The second case of 69y male with recurrent left inguinal hernia post lap TEP repair. Standard three lower midline ports technique, no balloon spacer was used. The first and most important step was developing the plane above the previous mesh. 20 ml of 1 % xylocaine and 1/200000 was instilled in the extra peritoneal space to minimize oozing. Separating the previous mesh from the inferior epigastric artery and posterior wall of rectus muscle, down into bony lard marks and cord structures was performed using suction and sharp dissection with minimal diathermy. All landmarks were exposed in the three zones, before utilizing anatomical mesh. Both patients stayed overnight and operation time was 84 and 90 minute respectively. Three months follow up showed no recurrence or significant pain. Conclusion To our knowledge, this is first study describe the use of TEP on TEP. It suggests that TEP should not be excluded in patients with previous posterior mesh repair, emphasizing the importance of proper consultation. The abstract calls for further cases and studies to assess the efficacy and safety of this approach.

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

FP8.12 - Theatre time utilisation in General Surgery at a district hospital in NHS

Abstract Aim To understand the operation theatre time utilisation in the Department of General Surgery at a busy district NHS hospital. The time spent in each step of surgery and operating list at large and understand the patterns of cancellations and its’ predictors. Method Retrospective study of all elective general surgical patients from 1 Dec 2021 to 15 May 2022. Emergency cases were excluded and statistics were performed on Statsdirect3. Results Total surgeries performed were 182 with 153 true and 41 false cancellations. Mean surgical time was 84.5 minutes (mean 73min) for all general surgical cases. Lap cholecystectomies had a mean time of 92.3mins, upper GI surgeries took 178.6mins (mean) EUA and other procedures was 30.86mins, inguinal hernia 77.2mins, umbilical hernia 68.5mins. Mean anaesthesia time was 33 mins (median 31mins). Theatre time utilised was 56.45%, anaesthesia time utilised was 15.85%, surgery time utilised was 40.60% and non-clinical time was 43.55%. Mean delay in sending for first patient was 31.58mins (median 29min). Delay in calling for first patient is statistically significant (p=0.00015) for cancellation for the last patient in the list. Mean gap in between 2 consecutive cases was 35.74mins (median 22min). Conclusion Delay in sending for the patient will lead to cancellation of the last patient on the list which is proven statistically. We utilised 82.19% of the total surgery days and cancelled 17.81% days. Non clinical time comprised of 43.55%.

A Scoping Review of the Clinical Utility of Laparoscopic Vasectomy.

Vasectomy is a common procedure performed for family planning. Traditionally, this has been via a scrotal approach. In contrast, laparoscopic vasectomy is a documented but rarely described procedure that may minimise anaesthetic risk, surgical risk, and healthcare expenditure in patients undergoing elective laparoscopic procedures for concurrent pathology such as hernia repair. This scoping review evaluates the clinical utility of laparoscopic vasectomy. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Articles were identified with keywords related to laparoscopy and vasectomy. Six peer-reviewed, full-text articles published in English were included in this review. These studies encompass eight individual patient cases of laparoscopic vasectomy performed in the 1990s and early 2000s. All the cases included laparoscopy for concurrent pathology, the most common of which was inguinal hernia. There were no complications associated with laparoscopic vasectomy. For patients requiring laparoscopic surgery for alternate pathologies, synchronous laparoscopic vasectomy improves surgical efficiency by minimising anaesthetic time, operative time, and risk, in addition to lower associated healthcare costs. However, consideration is given to the limitations of this approach, and a note is made of the lack of evidence regarding safety and efficacy given the paucity of cases described in the literature.

EP366 - A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital

Abstract Methods This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair were reviewed including the operative notes, postoperative complications, and any subsequent referral to the surgical department at the Trust to see any recurrence. The data collections included age, sex, type of the mesh, fixing device, primary or recurrent, unilateral or bilateral and conversion to open procedure. Since 2014 all notes were electronic and restored on evolve application. Result All patients records were retrieved from the electronic database system. Out of this cohort, some of patients records were missing. The mesh was not fixed in primary hernia if it was small or medium size, but it was fixed in primary large direct hernia to reduce the risk of blowing in of the mesh inside the defect. Our results showed a recurrence rate with acceptable incidence of post operative pain and wound related complications compliant with the NICE guidance. Conclusion A TEP repair for both primary and recurrent inguinal hernia has a minimal recurrence rate when performed by the specialists in this area giving full attention to the details.

WP1.7 - A systematic review and a meta-analysis of randomised control trials of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair

Abstract Objective The objective of this meta-analysis is to compare the outcomes of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair. Methods Studies reporting the patient outcomes were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Seven studies on 1,333 patients reporting post-operative outcomes were included. In the random effect model analysis, the severe pain at the end of the follow-up period [odds ratio (OR) 0.45, 95%, CI (0.10, 2.08), Z = 1.03, p = 0.30] was similar in both the groups with high heterogeneity (Tau2 = 0.97; Chi2 = 4.45, df = 1 (P = 0.03; I2 = 78 %) among included studies. Hypoesthesia at 6-month follow-up period [odds ratio 1.00, 95%, CI (0.47, 2.15), Z = 0.00, p = 1.00] suggests comparable outcomes in both groups with no heterogeneity among the included studies. The absence of pain reported by patients at the 6-month follow-up period [odds ratio 0.96, 95%, CI (0.72, 1.27), Z = 0.28, P = 0.78] suggests comparable outcomes in both groups with no heterogeneity among the included studies. Conclusion Post-operative outcomes like chronic groin pain, hypoesthesia or no pain reported by patients were similar in both groups. There was a paucity of data, therefore a major multicentre randomised control trial is recommended to strengthen the findings of this meta-analysis.

WP1.9 - An audit of prophylactic antibiotic use in elective inguinal hernia repair

Abstract Aims National guidance states that antibiotic prophylaxis is not indicated in low-risk patients undergoing inguinal hernia repairs and that high-risk patients require a single dose. This audit aimed to compare the use of prophylactic antibiotics by general surgeons in a district general hospital performing elective inguinal hernia repair, to the current national guidance. The rate of post-operative wound infection was also recorded. Method All patients who underwent an elective inguinal hernia repair in the six months between January and June 2023, were identified retrospectively via the hospital database. Data was collected via the electronic patient record system on whether patients were prescribed antibiotics prophylactically at the time of surgery. Data was also collected on patient demographics including sex, age, BMI and rate of post-operative wound infection. Results The patient cohort was 94% male with an average age of 64. 94.79% of repairs were open. 53.33% of patients received antibiotics in line with national guidelines. Overall, 50.00% of patients in this audit had prophylactic antibiotics. The rate of post-operative wound infection was 1.04%, with 0% in patients who received prophylactic antibiotics and 2.08% in those who did not, which is not a statistically significant difference (P = 0.175). Conclusions Current evidence for antibiotic use is weak and therefore auditing local practice is essential in antibiotic stewardship. This audit is limited by the reliance on accurate record keeping, with regards to antibiotic prescribing and documentation of post-operative wound infections. Furthermore, patients may have had post-operative wound infections managed in the community setting.

EP552 - Colonoscope Incarceration in an Inguinal Hernia: A Case Report

Abstract Aim We report a rare case of incarceration of a colonoscope within left inguinal hernia, highlighting the unusual circumstances and challenges faced by colonoscopists. Case presentation An 83-year-old male patient with a known left inguinal hernia underwent an urgent colonoscopy for positive quantitative faecal immunochemical test, anaemia, weight loss and fatigue. The patient had declined any form of analgesia/sedation for colonoscopy. Scope guide was used during the procedure. Initially, a proximal sigmoid loop was negotiated successfully. The colonoscope reached the mid transverse colon but the procedure became uncomfortable for the patient. There was an obvious loop on the scope guide which could not be reduced despite various manoeuvres. An attempt to apply external pressure to allow progression revealed a large left inguinal hernia containing a loop of the colonoscope. Thus, it was decided to discontinue the procedure, however, unexpectedly, during withdrawal, the colonoscope became lodged. Attempts to manually reduce this were very uncomfortable for the patient, therefore, intravenous access was gained to administer sedation &amp; analgesia. Another colleague was summoned to assist with manual reduction while simultaneously withdrawing the colonoscope allowing for reduction of the hernia and removal of the colonoscope. The patient was kept overnight for observations and was discharged home the following day. Subsequently CT colonography confirmed large left inguinal hernia containing sigmoid colon. Conclusion This case delves into the intricate details of the incident, exploring the contributing factors, such as the patient's medical history and the nature of the hernia. We discuss ways to avoid this complication in the future as well as suggest a technique for resolution of the complication.

WP1.2 - Does intraoperative urinary catheterisation decrease postoperative urinary retention after laparoscopic inguinal hernia repair? A systematic review and meta-analysis

Abstract Aims To evaluate comparative outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation. Methods A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies evaluating outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation were included and their risk of bias were assessed using their risk of bias were assessed using ROBINS-I tool. Postoperative urinary retention was analysed as the primary outcome parameter and an odds ratio (OR) was determined using Random-effects modelling. Results We included 6 comparative studies reporting a total of 8,675 patients who underwent laparoscopic inguinal hernia repair with (n=3,318) and without (n=5,357) use of intraoperative urinary catheterisation. There was no significant difference in postoperative urinary retention between the two groups (4.3% versus 3.7%, OR 0.93; 95% CI 0.55-1.58, p=0.80). There was significant heterogeneity among the included studies (I2: 75%, p=0.001). Results of sensitivity analyses were consistent with the results of the main analysis. Conclusions Meta-analysis of best available evidence (level 2a) demonstrated that use of intraoperative urinary catheter has no advantage in prevention of postoperative urinary retention following laparoscopic inguinal hernia repair. Future randomised controlled trials are required to control for confounding factors that increases the risk of urinary retention.