Unilateral Hernia Research Articles

Outcomes and Proportions of Subsequent Contralateral Sports Hernia Repair Following Primary Unilateral Repair.

In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. Case series; Level of evidence, 4. We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis-adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score-Sport (HOS-Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS-Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS-Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS-Sport score at follow-up or the successful return to preinjury sport. Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent.

Current trends and outcomes for unilateral groin hernia repairs in the United States using the Abdominal Core Health Quality Collaborative database: A multicenter propensity score matching analysis of 30-day and 1-year outcomes

BackgroundDifferent unilateral groin hernia repair approaches have been developed in the last 2 decades. The most commonly done approaches are open inguinal hernia repair by the Lichenstein technique, laparoscopic approach by either total extraperitoneal or transabdominal preperitoneal, and robotic transabdominal preperitoneal approach. Hence, this study aimed to compare early and late postoperative outcomes in patients who underwent unilateral robotic transabdominal preperitoneal, laparoscopic transabdominal preperitoneal, and laparoscopic total extraperitoneal, and open groin hernia repair using a United States national hernia database, the Abdominal Core Health Quality Collaborative Database. MethodsProspectively collected data from the Abdominal Core Health Quality Collaborative database was retrospectively reviewed, including all adult patients who underwent elective unilateral groin hernia repair from 2015 to 2022, with a 1:1 propensity score match analysis conducted for balanced groups. The univariate analysis compared the groups across the preoperative, intraoperative, and postoperative timeframes. ResultsThe Abdominal Core Health Quality Collaborative database identified 14,320 patients who underwent elective unilateral groin hernia repair and had documented 30 days of follow-up. Propensity score matching stratified 1,598 patients to each group (total of 6,392). The median age was 64 years (interquartile range 53–74) for open groin hernia repair, whereas 60 (interquartile range 47–69) for laparoscopic transabdominal preperitoneal, 62 (interquartile range 48–70) for laparoscopic total extraperitoneal, and 60 (interquartile range 47–70) for robotic transabdominal preperitoneal were noted. Open groin hernia repair had more American Society of Anesthesiologists score 4 (52, 3%) patients (P < .001). A painful bulge was the most common indication (>85%). Operating room time >2 hours was more significant in the robotic transabdominal preperitoneal group (123, 8%; P < .001). Seroma rate was higher in the laparoscopic transabdominal preperitoneal (134, 8%; P < .001). A 1-year analysis had 1,103 patients. Hematoma, surgical site infection, readmission, reoperation, and hernia recurrence at 30 days or 1 year did not differ, with an overall recurrence rate of 6% (n = 67) at 1 year (P = .33). In patients with body mass index ≥30 kg/m2, the robotic approach had lower rates of surgical site occurrence (n = 12, 4%; P = .002) and seroma (n = 5, 2%; P < .001) compared with the other groups. When evaluating recurrence 1 year after surgery, the robotic transabdominal preperitoneal group had 10% versus 18% open groin hernia repair, 11% laparoscopic transabdominal preperitoneal, and 18% laparoscopic total extraperitoneal, but it was not statistically significant (P = .53). ConclusionThere was no difference in readmission, reoperation, and surgical site infection among the surgical techniques at 30 days. However, laparoscopic transabdominal preperitoneal was associated with more seromas. Hernia recurrence at 1 year was similar across groups; the robotic approach had the lowest recurrence rate among all 3 repairs but did not reach statistical significance. The robotic approach performed better in patients with a body mass index of 30 kg/m2 for surgical site occurrence and seroma than in other surgical techniques.

Comparison Between Mesh Fixation and Non-Fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

Objectives: To compare mesh fixation and non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair in terms of recurrence rate with mesh folding and non-folding. Methodology: A comparative randomized controlled trial was conducted between October 2022 and March 2023 at General Surgery Department, Akbar Niazi Teaching Hospital, Islamabad. Consecutively 100 patients who underwent inguinal hernia surgery. The patient population was divided randomly into two groups. Group-A (Mesh fixation) was administered as a prolene mesh 6 x 11cm and fixed with cooper ligament and pubic symphysis, whereas Group-B (Non-fixation) was administered with the same mesh and placed in the fruchaud myopectineal orifice. The study endpoint in terms of recurrence rate, and mesh folding and non-folding between two groups was measured. The data was analyzed through SPSS v 23. Results: The patients overall mean average age was 36.43±10.81 years. Unilateral hernia in all patients, 60% had right sided, and 40% had left sided. The recurrence rate, and mesh folding was evaluated in both groups during 1 month, 3rd month, and after 6 months completion of follow-up period. No patient developed recurrence in mesh fixation group-A, whereas three patients developed recurrence with mesh folding in non-fixation group-B (p ? 0.05). The chronic pain was lowest and statistically significant difference in non-fixation group-B as compared to mesh fixation group-A (p ? 0.05). Conclusion: Mesh fixation in transabdominal preperitoneal inguinal hernias should be recommended for patients with inguinal hernias less than 4.0 cm in diameter.

To use a simple hernia needle for single-port laparoscopic percutaneous inguinal hernia repair in children: a 5-year experience study.

The aim of this study is to investigate the technique and practical significance of using a simple hernia needle in single-port laparoscopic herniorrhaphy in pediatric patients. The study conducted a retrospective analysis of all pediatric patients who underwent treatment for inguinal hernia using single-port laparoscopic herniorrhaphy with a simple hernia needle at Yellow River Sanmenxia Hospital from June 2018 to May 2023. The medical records of all the children were collected, and clinical characteristics, procedural information, and follow-up data were carefully reviewed. A total of 848 patients underwent inguinal hernia repair, with ages ranging from 7 months to 13 years (2.99 ± 2.49 years), including 756 males and 92 females. A total of 528 cases of unilateral hernia and 310 cases of bilateral hernia were reported, with intra-operative findings revealing contralateral occult hernia in 253 cases. Single-port laparoscopic herniorrhaphy was successfully completed in all patients, with no instances of conversion to open surgery. The mean operation time for unilateral hernia repair was (7.50 ± 4.80) min, while for bilateral hernia repair it was (11.55 ± 7.27) min. Five patients presented with subcutaneous emphysema, while two patients experienced a recurrence of inguinal hernia. No complications, such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, were observed. The duration of the follow-up period ranged from 3 to 24 months. The promotion and utilization of single-port laparoscopy combined with a simple hernia needle in clinical practice are justified. Our initial investigation indicates that this surgical approach is both safe and dependable for the management of pediatric inguinal hernia. The procedure presents numerous benefits, including the utilization of uncomplicated instruments, straightforward operation, a clear curative impact, minimal tissue damage, rapid recovery, and the absence of scarring.

Clinical efficacy of laparoscopic treatment of pediatric inguinal hernia: a meta-analysis.

To evaluate operative outcomes and postoperative complications of laparoscopic treatment for pediatric inguinal hernia using meta-analysis. We conducted a comprehensive search of databases including the Chinese Journal Full-text Database, Wanfang, PubMed, Web of Science, ScienceDirect, VIP Chinese Science, and Technology Journal Database, ProQuest, JSTOR, Wiley, and IEEE Xplore. Relevant randomized controlled trials (RCTs) on laparoscopic surgery for pediatric inguinal hernia were collected, and data were analyzed using Review Manager 5.3. A total of 18 RCTs involving 5,750 children (3,357 in the laparoscopic group and 2,393 in the open surgery group) were included. Compared to the open surgery group, the laparoscopic group had significantly shorter operative times for bilateral hernias [(mean difference (MD) = -11.43, P = 0.04)], and lower incidences of metachronous contralateral inguinal hernia (MCIH) (MD = 0.17, P = 0.02) and testicular ascent (MD = 0.19, P = 0.03). However, there were no significant differences in operative time for unilateral hernia (MD = 0.47, P = 0.87), complication rate (MD = 0.87, P = 0.60), postoperative recurrence (MD = 1.46, P = 0.18), incision infection rate (MD = 2.54, P = 0.34), or testicular atrophy rate (MD = 0.36, P = 0.19). Laparoscopic surgery for pediatric inguinal hernia is effective, especially for bilateral cases, reducing operative time and lowering the risk of MCIH and testicular ascent.

Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP).

Laparoscopic inguinal hernia repair has gained popularity due to its advantages over open procedures. However, technical challenges and anatomical variations can affect surgical outcomes. The umbilicus-symphysis pubis (USP) distance has been identified as a potential factor impacting laparoscopic operations. This study aims to investigate the association between USP distance, technical difficulties, and operative time in the transabdominal preperitoneal (TAPP) surgery. A retrospective analysis was conducted on 122 patients who underwent elective TAPP surgery. USP distance was measured, and surgical data were collected. Statistical analysis was performed to evaluate the relationship between USP distance and operative time. Among the patients, 80 underwent unilateral hernia repair, and 42 underwent bilateral hernia repair. In unilateral repair, USP distance did not significantly affect operative time. However, in bilateral repair, there was a significant association between USP distance and operation time prolongation (P=0.039). TAPP surgery presents challenges due to limited visualization and anatomical variations. Factors like USP distance can impact surgical outcomes. A shorter distance increases complexity, while a longer distance facilitates smoother procedures. Surgeons should consider USP distance during surgical planning to optimize outcomes. The study findings indicate that USP distance is associated with prolonged operative time in TAPP bilateral hernia repair. Surgeons, especially those in the learning phase, can benefit from considering this relationship to optimize surgical outcomes and resource allocation. Further research is needed to validate these findings and explore additional factors influencing operative time in hernia repair surgeries.

Implementing Contralateral Surgical Exploration during Hernia Repair in Children with Unilateral Inguinal Hernia: A Dutch Qualitative Study.

A total of 10-15% of children undergoing unilateral inguinal hernia repair develop a metachronous contralateral inguinal hernia (MCIH) that necessitates second anesthesia and surgery. Contralateral exploration can be performed to prevent MCIH development. This study investigates (1) factors that promote or hinder the adoption and (de-)implementation of contralateral groin exploration in children ≤ 6 months undergoing unilateral hernia repair and (2) strategies to overcome these barriers. A qualitative interview study was conducted using 14 semi-structured interviews and two focus groups involving healthcare professionals, stakeholders involved from a patients' perspective and stakeholders at the organizational/policy level. The results show that the effectiveness of surgical treatment and stakeholders' motivation and attitudes towards the intervention were reported as barriers for implementation, whereas patient and family outcomes and experience and strategies to overcome these barriers were identified as facilitating factors for future implementation. This study is unique in its contributions towards insights into facilitators and barriers for (de-)implementation of contralateral groin exploration in children with a unilateral inguinal hernia. In case the HERNIIA trial shows that contralateral exploration is beneficial for specific patient and family outcomes or a subgroup of children, the results of this study can help in the decision-making process as to whether contralateral exploration should be performed or not.

Long term efficacy of prosthetic inguinal herniorrhaphy concomitant with robot-assisted laparoscopic radical prostatectomy

PurposePatients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP.MethodsData for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded.ResultsA total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007).ConclusionConcomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.

THE EFFECT OF CORSET ON POSTOPERATIVE PAIN FOLLOWING LUMBAR DISC HERNIATIONS

Objective: In this research, we aimed to investigate the effect of lumbar corsets on the postoperative pain of single and multiple-level lumbar disc herniations by the Visual analog scale (VAS) and the health outcomes via the Oswestry Disability Index (ODI).&#x0D; Materials &amp; Methods: Patients (n=101) with a single or double-level unilateral lumbar disc hernia with no history of lumbar surgery were included in this study. All patients decided for operation have been administered non-steroidal NSAIDs and muscle relaxants for 4 – 6 weeks before the operation. All patients were recommended to use a lumbar corset in the postoperative period. A VAS and ODI were utilized to measure the clinical outcomes of corset usage.&#x0D; Results: The first-week and first-month average VAS scores in the corsets group were statistically significantly lower than those who did not use corsets (p

Comparison between minimal stitch hernioplasty and continuous suturing of mesh in inguinal hernia repair: a randomised controlled trial

Background: Inguinal hernia repair is the most commonly done surgery of all general surgical procedures. Hence in an attempt to decrease the pain and increase the patient’s comfort, various techniques have been considered to fix the mesh. The aim of this study was to compare the differences between the two techniques of mesh fixation namely the minimal stitch method and the continuous suturing in terms of various parameters. Methods: This study was conducted selecting 126 patients who attended the general surgery OPD at ESIC MC and PGIMSR and randomly allocating them to the two study groups; the patients were followed up till 6 months post-operatively. The parameters taken into account were: the operative time, the duration of hospital stay, the pain scores at various time intervals (POD 1, 3, 7, 30, 60, 90, 180) and the incidence of complications if any. Results: Among the 126 male patients enrolled in the study, the highest % belonged to the age group 51-60. 90% of them had unilateral hernias. The pain scores were significantly low in the minimal stitch group from the first postoperative day up to 1 month. The operative time and duration of hospital stay was also significantly decreased in the minimal stitch group. Conclusions: Hence, the minimal stitch technique used for inguinal hernia repair in our study proved to be comparable to the conventional suturing, better than the latter in terms of patients’ subjective satisfactory factors such as less operative time and less hospital stay while having no significant difference in terms of occurrence of chronic inguinodynia or any other postoperative complications.

Standardization and learning curve in laparoscopic hernia repair: experience of a high-volume center

PurposeGroin hernias are a common condition that can be treated with various surgical techniques, including open surgery and laparoscopic approaches. Laparoscopic surgery has several advantages but its use is limited due to the complexity of the posterior inguinal region and the need for advanced laparoscopic skills. This paper presents a standardized and systematic approach to trans-abdominal pre-peritoneal (TAPP) groin hernioplasty, which is useful for training young surgeons.MethodsThe paper provides a detailed, step-by-step description of the TAPP based on evidence from literature, anatomical knowledge, and the authors’ experience spanning over 30 years. The sample includes 487 hernia repair procedures, with 319 surgeries performed by experienced surgeons and 168 surgeries performed by young surgeons in training. The authors performed a descriptive analysis of their data to provide an overview of the volume of laparoscopic hernioplasty performed.ResultsThe analysis of the data shows a low complication rate of 0.41% (2/487) and a low recurrence rate of 0.41% (2/487). The median duration of the surgery was 55 min, while the median operation time for surgeons in training was 93 min, specifically 83 min for unilateral hernia and 115 min for bilateral hernia.ConclusionsThe TAPP procedure appears, to date, comparable to the open inguinal approach in terms of recurrence, postoperative pain and speed of postoperative recovery. In this paper, the authors challenge the belief that TAPP is not suitable for surgeons in training. They advocate for a training pathway that involves gradually building surgical skills and expertise. This approach requires approximately 100 procedures to achieve proficiency.

Laparoscopic TAPP Inguinal Hernia Repair: Mesh Fixation &amp; Peritoneal Closure by Sutural Technique

Background: The laparoscopic transabdominal preperitoneal (TAPP) inguinal repair is an evolving technique associated with well-known advantages of a minimally invasive approach. This prospective study was conducted to evaluate the feasibility, safety and effectiveness of laparoscopic TAPP using sutural mesh fixation &amp; peritoneal closure. Intracorporeal sutural technique needs steep learning curve. Methods: Between May 2018 to December 2019, a total of 41 inguinal hernias underwent TAPP repair in 37 adults under general anesthesia. All the patients scheduled for elective inguinal hernia repair were offered the choice of the laparoscopic TAPP repair under general anesthesia. A detailed explanation of the procedure was given to all patients and informed consent was obtained. We used 2/0 vicryl for mesh fixation &amp; peritoneal closure which took only 6.80 US Dollar in comparison to Protack from Covidien which is 167.80 US Dollar. Intraoperative &amp; postoperative variables were recorded in pre structured proforma. Results: The 41 hernia includes 34(82.92%) direct, 07(17.08%) indirect. Unilateral hernia were 33(89.19%), &amp; bilateral were 4(10.81%). Mean operating time for unilateral cases was 122 minutes &amp; for bilateral 210 minutes. Mean operating time in the cases using 3D-4K image system was 70 minutes. Mean duration of hospital stay was 2.9 days. There was no conversion in this study. Postoperative complications included scrotal seroma 2(5.40%), hematoma 1(2.70%), port site infection 2(5.40%) &amp; mesh infection 1(2.70%). Assessment of intensity of postoperative pain was evaluated according to VAS. 05 patients complained of mild pain: pain on the visual analog score (VAS) = 1-3 during one month follow-up. No patient reported with chronic pain &amp; recurrence during the followup period. Conclusion: TAPP inguinal hernia repair with sutural mesh fixation &amp; peritoneal closure is a feasible &amp; safe technique with minimum postoperative morbidity and maximum patient’s satisfaction. J Bangladesh Coll Phys Surg 2023; 41: 187-192

Laparoscopic treatment of complicated obturator hernia: A case series of 6 patients

Abstract Obturator hernia (OH) is a rare type of abdominal hernia. Preoperative diagnosis of OH is often challenging because of nonspecific signs and symptoms, leading to late diagnosis and increased mortality. Laparoscopic repair has been suggested as one of the alternative options for complicated inguinal hernias. We describe a case series of 6 consecutive patients diagnosed with complicated OH and treated by laparoscopic repair. All patients were females, aged 81 to 90 years. Most of them were underweight (body mass index, &lt;18.5 kg/m2). All cases presented with acute small bowel obstruction. All cases were unilateral OH. Concomitant femoral hernia existed in 3 cases (50%). Bowel resection was required in 2 cases because of bowel ischemia and perforation. Four of 6 cases were repaired using synthetic mesh, and the 2 remaining patients were treated with peritoneal closure and medial umbilical fold flap reinforcement. There were no postoperative deaths. Laparoscopic repair seems to be a safe and effective option for the treatment of complicated OH.

Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience.

Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repairperformed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.

Needlescopic sutureless repair of congenital inguinal hernia: A randomized controlled study

Congenital inguinal hernia [CIH] can be treated laparoscopically using various methods documented in the literature. Many authors have recommended dividing the sac and stitching peritoneal defects. Other studies claimed that peritoneal disconnection alone is sufficient. In this study, the feasibility, operative time, recurrence rate, and other postoperative complications of needlescopic disconnection of the CIH sac with or without peritoneal defect suturing were compared. A prospective controlled randomized trial was conducted between January 2020 and December 2022. Two hundred and thirty patients who met the study requirements were included. Patients were assigned at random to either Group A or Group B. A group of 116 patients (Group A) had needlescopic separation of the neck of the sac and peritoneal defect closure. The remaining 114 patients (Group B) underwent needlescopic separation without peritoneal defect closure (Sutureless group). A total of 260 hernial defects in 230 patients were repaired using needlescopic disconnection with or without suturing of the defect. There were 89 females (38.7%) and 141 males (61.3%), with a mean age of 5.14 ± 2.79 years. In Group A, the mean operation time was 27.98 ± 2.89 for a unilateral hernia and 37.29 ± 4.68 for a bilateral one, whereas, in Group B, the mean operation time was 20.37 ± 2.37 and 23.38 ± 2.22 for a unilateral and bilateral hernia, respectively. In terms of the operating time, whether unilateral or bilateral, there was a significant difference between the groups. There was no significant difference between groups A and B in the mean Internal Ring Diameter [IRD], which was 1.21 ± 0.18 cm in group A and 1.19 ± 0.11 cm in group B. Throughout the follow-up period, there was no postoperative hydrocele formation, recurrence, iatrogenic ascending of the testes, or testicular atrophy. All patients had nearly invisible scars with no keloid development at 3 months follow-up. Needlescopically separating the hernia sac without stitching the peritoneal defect is feasible, safe, and less invasive. It provides outstanding cosmetic results with a short operative time and no recurrence.

Comparison of Laparoscopic Percutaneous Extraperitoneal Internal Ring Closure by Two-Hook Hernia Needle and Open Repair for Pediatric Inguinal Hernia.

Purpose: In children, pediatric inguinal hernia (PIH) is a prevalent condition. PIH is currently more frequently managed by laparoscopic closure of the hernia sac. We improved this minimally invasive technique; that is, laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure. Safety and effectiveness were evaluated by comparing the differences between laparoscopic repair (LR) and open repair (OR) in terms of operation time, surgical complications, contralateral metachronous hernia incidence, and recurrence rate. Methods: A retrospective clinical data analysis was performed on pediatric patients who had hernia surgery utilizing the LR or OR method between June 2019 and June 2021. Medical records of all of the children were gathered, and clinical traits, information about the procedure, and follow-up were all analyzed. Results: A total of 370 patients' inguinal hernias were repaired. For 136 patients undergoing OR and 234 patients undergoing LR, all procedures were completed satisfactorily. There were 98 cases of bilateral hernias and 272 cases of unilateral hernias (180 on the right side and 92 on the left). In the LR group, 58 patients who had been initially diagnosed with unilateral hernias developed contralateral occult hernias intraoperatively. Inguinal hernia operations took an average of 13.82 (LR) and 32.07 (OR) minutes for unilateral cases, and 21.00 (LR) and 54.85 (OR) minutes for bilateral cases. For LR and OR, the average follow-up time was 22.41 months and 23.10 months, respectively. The perioperative complications included peritoneal rupture in 3 patients, scrotal edema or hematoma in 5, hydrocele in 3, and groin pain in 6. In the LR group, 1 patient experienced the postoperative recurrence, whereas 8 individuals in the OR group did. Conclusions: Our initial research showed that laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure inguinal hernia repair is a safe and effective procedure. The LR method has the benefits of concealing the incision, a quicker procedure, having a lower risk of complications, and finding contralateral patent processus vaginalis. Therefore, promoting and using this surgical technique in clinical practice are merited. Clinical Trial Registration number: Medical Association of Xiangtan (2022-xtyx-28).

Implementing an outpatient surgical management in moderated-high risk patients with groin hernia repair.

There is a growing trend to expand Ambulatory Surgery (AS) criteria in abdominal wall surgery. No Admission (NOADS) circuit. The present study aimed to assess the impact of classification criteria on postoperative results and hospital stays in a NOADS versus a conventional admission circuit to throw some light on surgical circuit inclusion. A retrospective analysis of a prospective;y maintained database was performed comparing groin hernia's interventions in a NOADS vs Admission circuit in our center in 2018-2021. A multiple regression predictive model followed by a retrospective retest were dessigned to assess the impact of each criterion on hospital stay. In total, 743 patients were included, 399 in the Admission circuit (ADC) and 344 in NOADS circuit (NOADS). There were no statistical differences in complication or readmission rates (p = 0.343 and p = 0.563), nevertheless, a shorter hospital stay was observed in NOADS (p = 0.000). A hierarchical multiple regression predictive model proposed two opposite scenarios. The best scenario, not likely to need admission, was a female patient operated via the laparoscopic approach of a unilateral primary hernia (Estimated Postoperative Stay: 0.049days). The worst scenario, likely to need admission, was a male patient operated via the open approach of a bilateral and recurrent hernia (Estimated Postoperative Stay: 1.505 Days). Groin hernia patients could safely benefit from a No Admission (NOADS) circuit. Our model could be useful for surgical circuit decision-making, especially for best/worst scenarios.

Low incidence of recurrence and chronic pain after groin hernia repair in adolescents: a systematic review and meta-analysis

PurposeThe best operative management of groin hernia in adolescents is uncertain. The aim of this systematic review was to assess recurrence and chronic pain after mesh versus non-mesh repair for groin hernia in adolescents.MethodsA systematic search was done in PubMed, EMBASE, and Cochrane CENTRAL in May 2022 for studies reporting postoperative chronic pain (≥6 months) or recurrence after groin hernia repair in adolescents aged 10–17 years. We included randomized controlled trials and observational studies on primary unilateral or bilateral groin hernia repair. Risk of bias was assessed with the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Meta-analysis of the incidence of recurrence was conducted. This review is reported according to PRISMA guideline.ResultsA total of 21 studies including 3,816 adolescents with groin hernias were included comprising two randomized controlled trials, six prospective, and 13 retrospective cohort studies. For non-mesh repairs, the weighted mean incidence proportion of recurrence was 1.6% (95% CI 0.6–2.5) after 2,167 open repairs and 1.9% (95% CI 1.1–2.8) after 1,033 laparoscopic repairs. For mesh repairs, it was 0.6% (95% CI 0.0–1.4) after 406 open repairs while there were no recurrences after 347 laparoscopic repairs (95% CI 0.0–0.6). Across all surgical techniques, the rate of chronic pain after 1,153 repairs ranged from 0 to 11%. Follow-up time varied and was reported in various ways.ConclusionThe incidences of recurrence after groin hernia repair in adolescents were low for both open and laparoscopic mesh and non-mesh repairs. Rates of postoperative chronic pain were low.Trial registrationPROSPERO: CRD42022130554.

Return to Work in Patients With Unilateral Inguinal Hernia Surgery: A Comparative Study Between Laparoscopic Transabdominal Preperitoneal Approach and Lichtenstein Tension-Free Mesh Repair.

Objective The objective of this prospective cohort study was to compare the time to return to work between patients who underwent laparoscopic transabdominal preperitoneal (TAPP) hernia repair and those who underwent Lichtenstein tension-free hernia repair with mesh for unilateral inguinal hernia. Methodology Patients were registered for unilateral inguinal hernia review at Aga Khan University Hospital, Karachi, Pakistan, from May 2016 to April 2017 and followed till April 2020. All patients aged 16-65 planned for unilateral transabdominal preperitoneal hernia repair or Lichtenstein tension-free hernia mesh repair were included. Patients with bilateral inguinal hernia repair, limited activity, or above retirement age were excluded. A non-probability consecutive sampling technique was implemented, and patients were divided into two cohort groups: Group A underwent laparoscopic transabdominal preperitoneal hernia repair, while Group B underwent Lichtenstein tension-free mesh repair. Patients were followed up at one week to inquire about the resumption of activities and then at one and three years for recurrence. Results Sixty-four patients met the inclusion criteria; three patients opted out of research, and 61 patients agreed to participate; one patient was excluded due to the conversion of the procedure. The remaining 30 in Group A and 30 in Group B were followed for the study period. The mean time to return to work in Group A was 5.33 ± 4.46 days; in Group B, it was 6.83 ± 4.58 days, with a p-value of 0.657.One recurrence was observed at three years in Group A. Conclusion Although the time to return to work at our hospital was slightly shorter in laparoscopic hernia repair than in the open technique, the results were not statistically significant. In addition, there was no significant difference in hernia recurrence at the one-year follow-up between laparoscopic transabdominal preperitoneal hernia repair and Lichtenstein tension-free hernia mesh repair for unilateral inguinal hernia.

P-069 TOTAL EXTRAPERITONEAL (TEP) APPROACH FOR THE TREATMENT OF SPIGELIAN HERNIAS: SINGLE-CENTRE EXPERIENCE

Abstract Aim Spigelian hernias are rare. Surgical treatment is often recommended. Different minimally invasive techniques are available by means of intraperitoneal or extraperitoneal mesh placement, either by IPOM, transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) approach. TEP approach is seldom reported in the literature. We present a short series of TEP repair of Spigelian hernias. Materials and Methods Between February and October 2022, TEP repair was performed in two patients with unilateral Spigelian hernia, one case of bilateral hernia, and one combined unilateral Spigelian and inguinal hernia, ensuing the following technique. Preperitoneal access was achieved placing a contralateral 11mm trocar, a few centimetres above the umbilicus, posterior to the rectus muscle toward Retzius space. A 5mm trocar was placed suprapubic and another 11mm trocar at the flank. Working space is developed by blunt dissection. Spigelian hernia sac is dissected and reduced. At this point other inguinal or femoral hernias are explored, performing simultaneous repair if necessary. Sufficient preperitoneal space is ensured to allow correct overlap of a polypropylene self-gripping mesh, prior to closing the defect with barbed-polydioxanone suture. Results Median age was 72 years. Three cases were right hernias and two left, all diagnosed by imaging test due to symptoms. Latest discharge was 24 hours after surgery. No complications or recurrences were encountered at a median follow-up of 4 months. Conclusions Comparative studies between minimally invasive approaches of Spigelian hernias are scarce. In the presented experience, TEP approach proved to be an efficient and reproducible technique with favourable results.