Surgical Repair Of Inguinal Hernia Research Articles

Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group

Background We sought to determine perioperative variables predictive of complications or recurrence for patients undergoing surgical repair of inguinal hernias. Patients and Methods Using data from the Veterans Affairs trial, regression analyses were utilized to identify perioperative factors significantly associated with complications (overall, short-term and long-term), long-term pain, and to develop a risk model for recurrence. Results Recurrent and scrotal hernias were predictors for short term and overall complications, regardless of technique. Older age and higher Mental Component Score of the SF-36 were associated with higher risk of long term complications in the open group while prostatism and increased body mass index were the significant predictors in the laparoscopic group. Long-term pain complaints decreased as patient age increased in both groups. Patient and surgeon factors were predictive of recurrence but varied greatly depending on surgical technique. Conclusions Regardless of technique, scrotal and recurrent hernias were associated with a greater risk of complications and younger patients had more long-term pain. Predictors of recurrence vary based on surgical technique.

Massive inguinoscrotal herniation of the bladder with ureter: incidental demonstration on bone scan

Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy.

Cost analysis applied to postoperative analgesia regimens: a comparison between parecoxib and propacetamol

Postoperative pain management represents a significant part of perioperative costs. Non-opioid analgesics are often used in combination with opiates to improve pain relief and reduce opioid-related side effects. To assess the costs and cost efficacy of intravenous (i.v.) parecoxib versus i.v. propacetamol in postoperative pain. A prospective, randomised, double-blind, clinical evaluation was performed to compare the efficacy of a single bolus injection of 40 mg parecoxib and 2 g propacetamol, administered twice within 12 h following surgical repair of inguinal hernia. Resources for each arm of treatment were collected, and total costs were determined, including costs of drug acquisition, devices and labour for preparation of the two analgesic drugs. Cost-efficacy analysis was performed as the cost to achieve complete satisfaction with analgesia. Incremental cost efficacy was determined as the ratio between the differential costs and the differential patient satisfaction. The analysis was performed from an institutional perspective over a 12 h time frame. A total of 182 patients was evaluated. Pain at rest and morphine consumption were observed to be reduced in the parecoxib group. The percentages of patients totally satisfied with their pain management 12 h after surgery were 87% in the parecoxib-treated group and 70% in the propacetamol-treated group (P < 0.01). The average cost per patient was higher in the parecoxib group, 6.65 euros vs 5.28 euros in the propacetamol group). Cost per patient satisfied was calculated at a mean value of 7.64 euros for parecoxib and 7.54 euros for propacetamol. Incremental cost per additional patient satisfied was 8.02 euros in the parecoxib-treated group when preparation costs were included. Sensitivity analysis (+/-15%), including a bootstrap method applied to costs and efficacy, did not modify these conclusions. Parecoxib exhibits higher cost and greater patient satisfaction than does propacetamol. From a cost-efficacy approach, incremental cost per additional patient satisfied for parecoxib treatment must be analysed in light of overall perioperative pharmaceutical cost.

Tissue Adhesives for Repairing Inguinal Hernia: A Preliminary Study

To investigate the efficacy of tissue adhesives for closing the orifice of the inguinal hernia sac (IHS) as an alternative method for treating inguinal hernia. Five-week-old male Lewis rats (n=4) were used, because Lewis rats have a large patent IHS. The rats were divided into 9 groups (n=6 in each) according to the type of tissue adhesive used: G1, fibrin glue (Beriplast); G1b, Beriplast plus blood; G2, microfibrillar collagen hemostat (Avitene); G2b, Avitene plus blood; G3, fibrinogen-based sealant (TachoComb); G3b, TachoComb plus blood; G4, synthetic absorbable sealant (Advaseal); G5, bilateral single port laparoscopic injection of octylcyanoacrylate (Dermabond); and G6, sham operation (control group). In G1-G4, surgery was performed through a midline lower abdominal incision. In G5, a 5-mm laparoscope was inserted in the epigastrium, a fine catheter was passed through the side port of the laparoscope into the right HIS, and 0.2 mL Dermabond was injected. The left IHS was treated in the same way. All rats were sacrificed 3 months after treatment, and IHS patency was examined macroscopically. All rats in G5 and G6 were mated 50 days after treatment to check fertility. All rats survived until sacrifice. At sacrifice, all IHS were patent in G6. All IHS were also patent in G1-G4, but all IHS were closed at the internal ring in G5. In G5 there were no adhesions between the orifice of the closed sac and the small bowel in 5/6, and only minor adhesions in 1/6. G5 fertility (5/6: 83%) was the same as for the control group (G6). Our results suggest that laparoscopic injection of Db into the IHS is simple, safe, reliable, virtually scarless, and may be a reasonable alternative to standard open surgical inguinal hernia repair.

Persistent Foreign Body Reaction Around Inguinal Mesh Prostheses: A Potential Pitfall of FDG PET

FDG PET has been recognized as an efficient imaging technique for the treatment of oncology patients. However, false-positive results can occur. The purpose of this study is to describe three oncology patients with persistent FDG up-take around inguinal mesh prostheses that occurred up to 10 years after the surgical repair of inguinal hernias and led to false-positive results. Remote mesh prostheses can induce FDG uptake because of persistent foreign body reaction. Consequently, each time an unexpected pelvic focus is noticed on FDG PET, the medical history of patients should be carefully reviewed to avoid false-positive results.

Reparación de la hernia inguinal primaria: Lichtenstein frente a Shouldice. Estudio prospectivo y aleatorizado sobre el dolor y los costes hospitalarios

Hernia is one of the most widely studied processes, and the search for excellence has become the final aim. However, many controversies remain to be resolved. The objective of the present study was to analyze postoperative pain and costs using two techniques of primary inguinal hernia repair. We performed a prospective, randomized study of 54 patients who underwent surgical repair of inguinal hernia through either the Lichtenstein or the Shouldice technique between June 2001 and May 2002. The following variables were analyzed: age, location and type of hernia, evaluation of tolerance to local anesthesia, surgical technique, operating time, pain at days 1, 3 and 5 after surgery, analgesic consumption, days until driving could be resumed, days off work, and occupation. The patient groups were similar, with no significant differences in age, location or type of hernia. For Lichtenstein hernioplasty, operating time was lower (p < 0.01); pain evaluation showed no significant differences on days 1 and 3 after surgery but was higher on day 5 (p = 0.064). No significant differences were found in analgesic consumption, time before driving could be resumed, or days off work. Freelance patients returned to work earlier, independently of the surgical technique performed. The cost of the Lichtenstein technique was 235 euros compared with 180 euros for the Shouldice technique and this difference was statistically significant (p < 0.05). In the hands of expert surgeons, the Shouldice technique is the procedure of choice in the repair of primary hernias. The results are just as satisfactory as those obtained with Lichtenstein hernioplasty and hospital costs are lower.

Controlled-release mepivacaine [APF 112]* demonstrates similar efficacy to bupivacaine for pain relief following surgical inguinal hernia repair,

Controlled-release mepivacaine [APF 112]* demonstrates similar efficacy to bupivacaine for pain relief following surgical inguinal hernia repair,

Radiologic investigation after laparoscopic inguinal hernia repair.

Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive patients that had had laparoscopic herniorraphy in Malmö University hospital between 1992 and 1998 were retrospectively evaluated. A total of 538 groins were included, 3.9% (n=21) of these were postoperatively examined with ultrasound (n=10), herniography (n=7), plain abdominal films (n=2), CT (n=1), or fistulography (n=1). Significant findings were found in five groins, namely, one sinus tract, two hematomas, one small bowel obstruction, and one recurrence of hernia. Four insignificant seromas were found. The characteristics of the findings and pitfalls are described. Symptoms resulting in radiologic examination are rare after laparoscopic herniorraphy. The radiologist must be familiar with the spectrum of such findings.

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived.1 In contrast to...

Inguinal hernias: MRI and ultrasound

This article presents an overview of the key anatomic structures of the groin region as seen on gross anatomy and the appearance of these structures on ultrasound and magnetic resonance imaging (MRI). An overview of the sonographic and MRI techniques used in preoperative diagnosis of inguinal hernias is provided, and their value is discussed. Finally, the role of ultrasound and MRI after surgical inguinal hernia repair is addressed.

Hernia vesical inguinoescrotal gigante. caso clínico y revisión de la literatura

Bladder hernia is an uncommon condition with a frequency between 0,5 and 3%, reaching the 10% between patients older than 50 years. It´s more predominant in males aged between 50 and 70. The diagnosis usually happens in the course of surgical repair of inguinal hernias, because the bladder hernia has no specific clinical findings. Management includes the resection or reduction of the bladder hernia, with de-obstruction of the lower urinary tract, if present, and repairmen of inguinal path. We report a new case and review the literature

Surgical Repair of Inguinal Hernia: Tension Free Technique with Prosthetic Materials (Gore-Tex Mycro Mesh Expanded Polytetrafluoroethylene)

The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Mycro Mesh in patients with inguinal hernias. Over 3 years, 104 patients have undergone the aforementioned procedure for 118 hernias (85 indirect and 33 direct) in our clinic. Ninety-three of the patients were operated for the first time, whereas the remainder of them were operated for hernia recurrence. Fourteen patients had bilateral hernias, and six had incarcerated ones. The median patient's age was 53 years. Eighty-three patients were operated under general and 21 under local or epidural anesthesia. One hundred and two patients were offered a one-day surgery procedure, but three were readmitted with wound infection. Two of these patients were conservatively cured, and the third was submitted to mesh removal. Two patients developed hematoma in the scrotum and were discharged a week later after the absorption of the hematoma. All of the patients except the one who was submitted to mesh removal returned to normal life within a week after the operation. During the follow-up period, none of our patients experienced hernia recurrence. Our results are in accordance with those of the world literature. We perform the tension-free hernia repair by using the expanded polytetrafluoroethylene mesh in our patients because we believe it is a safe procedure without significant postoperative morbidity and with no hernia recurrences.

Laparoscopic Herniorrhaphy

Objective. —To provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias. Participants. —A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 75 physicians with expertise in surgical repair of inguinal hernias. These panelists had been nominated to the DATTA panel by the appropriate specialty societies and medical schools. A total of 55 panelists (73%) responded. Evidence. —Assessment was based on the expert opinion of the panelists, as well as on published literature (available as of February 8,1996). Published studies were identified by a MEDLINE search using the terms laparoscopic surgery, inguinal hernia , and laparoscopic herniorrhaphy and by review of the references cited in these primary sources. Consensus Process. —The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by American Medical Association staff. Conclusions. —The DATTA panelists rated the use of laparoscopic herniorrhaphy as promising for safety and investigational for effectiveness for two indications: the repair of primary inguinal hernias and the repair of bilateral inguinal hernias. The use of laparoscopic herniorrhaphy to repair recurrent inguinal hernias was rated as investigational for both safety and effectiveness by the panel. This technique was rated as promising for safety and effectiveness as a method for decreasing postoperative tenderness and time until return to full activity. ( JAMA . 1996;275:1075-1082)

Laparoscopic herniorrhaphy. Diagnostic and therapeutic technology assessment

To provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias.A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 75 physicians with expertise in surgical repair of inguinal hernias. These panelists had been nominated to the DATTA panel by the appropriate specialty societies and medical schools. A total of 55 panelists (73%) responded.Assessment was based on the expert opinion of the panelists, as well as on published literature (available as of February 8, 1996). Published studies were identified by a MEDLINE search using the terms laparoscopic surgery, inguinal hernia, and laparoscopic herniorrhaphy and by review of the references cited in these primary sources.The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by American Medical Association staff.The DATTA panelists rated the use of laparoscopic herniorrhaphy as promising for safety and investigational for effectiveness for two indications: the repair of primary inguinal hernias and the repair of bilateral inguinal hernias. The use of laparoscopic herniorrhaphy to repair recurrent inguinal hernias was rated as investigational for both safety and effectiveness by the panel. This technique was rated as promising for safety and effectiveness as a method for decreasing postoperative tenderness and time until return to full activity.

Comparative Efficacy of Oral Ibuprofen Arginine and Intramuscular Ketorolac in Patients with Postoperative Pain

The comparative clinical efficacy and tolerability of ibuprofen arginine and ketorolac were determined in a study that used a double-blind double-dummy protocol. 124 patients who underwent surgical repair of inguinal hernia at a single medical centre were randomly assigned to receive either oral ibuprofen arginine 400mg, ketorolac 30mg by intramuscular injection or placebo. Pain intensity was assessed at baseline and at 15, 30, 45, 60, 90, 120, 180, 240, 300 and 360 minutes after medication administration, on a Visual Analogue Scale (VAS) ranging from no pain (0mm) to unbearable pain (100mm).

Prosthetic Inguinal Hernia Repair Using a Laparoscopic Extraperitoneal Approach

The preperitoneal technique offers several advantages over conventional anterior approaches in the surgical repair of inguinal hernias: direct access to the posterior inguinal anatomy, clear visibility of all possible hernial defects, ability to circumvent scar tissue and intra-abdominal adhesions, and ease of effecting difficult repairs. A preperitoneal prosthetic procedure has been successfully used, performed laparoscopically, to repair 163 indirect, 163 direct, and one femoral inguinal defects. In the approach used, a piece of polypropylene mesh, placed extraperitoneally, is used to reinforce or replace the transversalis fascia. In only one of 197 patients (0.5%) was it necessary to convert to an open procedure; this patient had a severely incarcerated hernia. Almost all patients were discharged on the day of surgery, and all returned to normal activities within 7 days. There were few complications, and the recurrence rate in the series of 300 repairs was only 0.3%. One patient required a second procedure because of a retained indirect hernia. Based upon these results and the experience of others using a similar approach, the laparoscopic extraperitoneal prosthetic repair is advocated for patients with recurrent, as well as bilateral and complicated inguinal defects.

Les lésions nerveuses au cours de la cure des hernies de l'aine: bases anatomiques

The anatomical variations of the genital nerves were studied by dissection of the inguinal canal in 25 post mortem specimens. The aim of this work was to provide data allowing to prevent injury to these nerves in the course of surgical repair of inguinal hernia. The course of the genital branches of the iliohypogastric and ilio-inguinal nerves was consistent with that described in classical anatomical texts in only 12/25 dissections. The genital branch of the genitofemoral nerve displayed the features reported in classical anatomical descriptions in 18/25 dissections.

Early surgical correction of inguinal hernias in infancy and childhood.

Introduction Inguinal hernias are as old as man's attempt to meet his medical problems. However, there seems to be much cloudy thinking concerning them when they occur in infancy and childhood. Too often, inquiring parents are given the advice by their doctors that they should not worry about this situation because it may go away, it will recur if corrected too early, or your child is too young to have anything done about it. Recent work has indicated that the early surgical repair of inguinal hernias is the best method of treatment. 5-7 Despite the evidence in favor of early operation and that against the use of temporizing measures, there are still many general surgeons who prefer not to attempt repair of hernias in infants. This paper reports the results of 453 inguinal herniorrhaphies in young subjects. These were done personally out of a large pediatric service in which more

Consideration of the factors influencing the surgical repair of inguinal hernia

Consideration of the factors influencing the surgical repair of inguinal hernia

A TRUSS FOR INGUINAL HERNIA IN INFANTS

Surgical repair of inguinal hernia in children under 2 years of age is rarely indicated except in emergencies. The mother is averse to surgery and the surgeon hesitates to operate because some hernias, especially in very young infants, disappear spontaneously. As long as the child has not been trained the danger of a postoperative infection, while not great with proper precautions, nevertheless exists and adds to the hazard of surgical repair. To prevent incarceration and to aid nature in the spontaneous closure of the peritoneal pouch, a proper truss must be adjusted. The requirements of a truss for infants are specific. It must remain in place and must retain the hernia even when the child is coughing or crying. It must be comfortable, nonirritating, sanitary and simple to apply correctly. The cost should be minimal in a large charity outpatient department where a large number is required. A truss meeting