Unilateral Indirect Inguinal Hernia Research Articles

Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males.

Inguinal hernia repair, particularly using TAPP, is common in males, and acclaimed for minimal invasiveness but often complicated by seromas, significantly affecting recovery and health care costs. This retrospective study analyzed data from 266 male patients with unilateral indirect inguinal hernia who underwent transabdominal preperitoneal (TAPP) repair. We divided the patients into a training set (n = 188) and a validation set (n = 78). We employed logistic regression to identify independent risk factors for post-TAPP seroma and developed a nomogram to predict the occurrence of seromas. The model's accuracy was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, and decision curve analysis (DCA). Postoperatively, 20.3% of patients developed a seroma. Multivariate logistic regression analysis highlighted several independent risk factors for seroma formation: the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac (P < 0.05). The ROC curves for the training and validation sets demonstrated areas under the curve of 0.893 (95% CI: 0.845-0.942) and 0.864 (95% CI: 0.765-0.963), respectively, indicating good model fits (P > 0.05). DCA confirmed significant clinical applicability of the model. The findings suggest that the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac are significant independent risk factors for seroma formation after TAPP repair. Clinical consideration of these factors and proactive preventive measures are essential. Although many of these factors are non-modifiable, understanding them is crucial for preoperative risk assessment and patient management.

Construction and validation of a predictive model for the risk of contralateral patent processus vaginalis in children with unilateral inguinal hernia or hydrocele.

To develop a nomogram model for predicting contralateral patent processus vaginalis in children with unilateral inguinal hernia or hydrocele. A retrospective analysis was conducted on 259 children with unilateral inguinal hernia or hydrocele who underwent laparoscopic surgery at the Southern Hospital of Southern Medical University from January 2021 to December 2023. The patients were randomly divided into a training set (n = 207) and a validation set (n = 52) in an 8:2 ratio to analyze the characteristics of CPPV. Multivariate logistic regression analysis was used to screen for independent risk factors for CPPV, and a nomogram prediction model was constructed. The predictive ability, calibration, and clinical net benefit of the model were evaluated by plotting receiver operating characteristic (ROC) curves, calibration curves (HL), and clinical decision curves (DCA). Among children under 1year old, the laparoscopic exploration revealed a CPPV incidence rate of 55.17%. The incidence rates for children aged 2-10years ranged from 29.03 to 39.13%, and the incidence rate for children aged 11-14years was 21.21%. Multivariate logistic regression analysis showed that age (OR = 0.9, 95%CI 0.82-0.99, P = 0.035) and female gender (OR = 2.42, 95%CI 1.21-4.83, P = 0.013) were independent risk factors for CPPV, and the incidence of CPPV decreased with age. The area under the ROC curve (AUC) for the training set of the constructed model was 0.632, and the AUC for the validation set was 0.708. The Hosmer-Lemeshow goodness-of-fit test indicated good model fit (training set P = 0.085, validation set P = 0.221), and the DCA curve suggested good clinical benefit.The nomogram model developed in this study demonstrates good clinical value. Children with unilateral inguinal hernia or hydrocele who are younger in age and female gender should undergo careful intraoperative exploration for the presence of CPPV. What is Known: •The probability of developing inguinal hernia in children with CPPV is 11%-25%, and redo surgery can increase surgical risks and financial burden. •The risk factors of unilateral inguinal hernia combined with CPPV are controversial. What is New: • Age and female gender are independent risk factors for CPPV. •A nomogram prediction model was constructed to provide a theoretical basis as well as an assessment tool for preoperative evaluation of whether children with unilateral indirect inguinal hernia are susceptible to CPPV.

Higher rate of chronic pain in young men after open mesh vs nonmesh repair of elective primary unilateral indirect inguinal hernia: A nationwide questionnaire study

PurposeYoung age is a risk factor for chronic pain after inguinal hernia repair, but the role of the mesh in young patients is uncertain. The aim of this study was to assess chronic pain after open mesh versus non-mesh repair of indirect inguinal hernia in young men. Materials and methodsValidated questionnaires were sent to men aged 18–29 years at the time of an elective primary unilateral open repair of an indirect inguinal hernia between 1998 and 2015. Patients were identified in the Danish Hernia Database. Non-mesh repairs were matched 1:3 with mesh repairs (Lichtenstein) on age and follow-up time. The primary outcome was the proportion of patients with chronic pain evaluated with the Activity assessment scale. Secondary outcomes included other pain measures and sexual impairment. ResultsIn total, 661 patients were included in this study (77% mesh and 23% non-mesh) with a median follow-up of 14.8 years (range 2.3–20.0) in the mesh group and 15.9 years (range 3.6–20.0) in the non-mesh group. For the primary outcome, 12% of patients in the mesh group compared with 6% in the non-mesh group had chronic pain (p=0.03). Patients in the mesh group had higher odds of chronic pain in adjusted analysis (OR=2.30 [95% confidence interval=1.11–4.77]). More patients in the mesh group had pain during sexual activity (p=0.01), but there were no differences for most of the remaining secondary outcomes. ConclusionYoung men had a higher rate of chronic pain after open mesh compared with non-mesh repair for indirect inguinal hernia, but results should be interpreted with caution.

Analysis of Contralateral Patent Processus Vaginalis in Laparoscopic High Ligation of the Vaginal Process and Clinical Long-term Effect of Individualized Treatment

Background: We aimed to analyze contralateral patent processus vaginalis (CPPV) in the laparoscopic high ligation of the vaginal process, treat eligible children surgically, and evaluate the clinical long-term outcomes. Methods: A total of 300 children with unilateral inguinal hernia or unilateral hydrocele treated in our hospital were selected for laparoscopic high ligation of the vaginal process, during which CPPV was analyzed. The 300 children were randomly divided into two groups of 150. In the study group (n = 58), 11 children met the requirements of high ligation and were treated with simultaneous surgery. The 53 children in the control group received simultaneous treatment. The prevalence of CPPV was compared between children with unilateral indirect inguinal hernia and unilateral hydrocele, left and right patent processus vaginalis (PPV), and different ages. After surgery, both groups were followed up for one year. The recurrence rate of contralateral indirect inguinal hernia or hydrocele was compared. Significant differences were assessed between the two groups receiving different treatments. Results: The prevalence of CPPV was 23% in children with unilateral indirect inguinal hernia and 49% in children with unilateral hydrocele. The prevalence of CPPV in children with unilateral hydrocele was significantly higher than that in children with inguinal hernia (P = 0.00). The prevalence of CPPV was 42% in children with left PPV and 33% in children with right PPV, without a statistically significant difference (P = 0.19). The prevalence of CPPV was 63% in children aged 1 - 2 years, which was significantly higher than that in other age groups (χ2 = 7.46, P = 0.01). The prevalence of CPPV was 14% in children aged &gt; 6 years, which was significantly lower than that in other age groups (χ2 = 4.43, P = 0.04). A postoperative one-year follow-up showed that the recurrence rate was 9% in the study group and 1% in the control group, without a statistically significant difference (P = 0.25). Conclusions: The prevalence of CPPV decreases with age. Hydrocele combined with CPPV is more common. For younger children with hydrocele, it is very important to explore the contralateral side during surgery. Moreover, the transformation of CPPV to indirect inguinal hernia or hydrocele occurs rarely, and only eligible children can receive simultaneous treatment during surgery.

Comparison of Preoperative and Postoperative Testicular Elasticity and Vascularity in Pediatric Patients With Inguinal Hernia.

Testicular complications after inguinal hernia (IH) operations can be overlooked because they are difficult to diagnose, but usually have a long-term effect. This study evaluates the effects of IH on preoperative and postoperative testicular elasticity and vascularity in children with unilateral hernias, examined using the superb microvascular imaging (SMI) and shear wave elastography (SWE) modalities. Forty-four male children with unilateral indirect IHs were included. Quantitative SMI and SWE examinations of the testicles were performed on the herniated and intact sides, both preoperatively and at 1, 3, and 6 months postoperatively. The SMI and SWE values of the testicles were compared between the herniated and intact sides, as well as with the opposite testicle. Preoperative vascular index (VI) values were lower on the herniated side than on the intact side. Furthermore, preoperative kPa and m/s values were higher on the herniated side than on the intact side. In follow-up examinations performed at 6 months postoperatively, there was no equalization of kPa or m/s values, although VI values were equalized on both sides. Testicular vascularization secondary to mechanical compression in testicles on the herniated side increased significantly in the postoperative period, and reached a level similar to that of the contralateral side. Mean SWE values decreased in testicles on the herniated side, but were not equal with those of contralateral testicles. Preoperative and postoperative evaluation of testicles using SMI and SWE is important for detecting possible advanced testicular complications in children with IH.

Impact of mesh fixation vs non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair on chronic groin pain and quality of life: a prospective randomized study

Aim A randomized controlled study comparing the impact of fixation vs non-fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic groin pain and quality of life of patients. Patients and methods This study includes 100 patients presented with primary unilateral indirect inguinal hernia treated at Benha University Hospital from June 2016 to August 2018. Patients were randomized to TAPP inguinal hernia repair with fixation of mesh (group A, n=50) and without fixation of mesh (group B, n=50). Parameters assessed included operative duration, time to early ambulation, postoperative pain, and postoperative complications and quality of life. Assessment of pain was done using the visual analog scale at 1 day, 3 months, and 6 months after surgery. Evaluation of quality of life was done using the 36-item short-form health survey 3 months postoperatively. Results The mean operative duration and time to early ambulation in group B (without mesh fixation) were reduced significantly in comparison to group A (with mesh fixation). The visual analog scale score at 1 day, 3 months, and 6 months after surgery for group B was significantly lower than in group A. The physical function (PF), bodily pain (BP), role physical (RP), and general health (GH) in group B were significantly higher than group A while there is no statistically significant difference in vitality (VT), role emotional (RE), social function (SF), and mental health (MH) between group A and group B. Conclusion Mesh fixation and non-fixation in laparoscopic TAPP approach for the repair of inguinal hernia are comparable regarding operative duration, postoperative complications, and time to ambulation while pain scores and quality of life were significantly better in the non-fixation group.

Evaluation of oxidative stress response in endoscopic and Lichtenstein hernia repair: A randomized control study

BACKGROUND: The extent of inflammatory and oxidative stress response varies with different surgical procedures. The aim of the study was to compare the same between total extraperitoneal repair and Lichtenstein repair for inguinal hernia. MATERIALS AND METHODS: Men, aged 18–60 years with an ASA score of 1, presenting with primary unilateral indirect inguinal hernia were randomized to total extraperitoneal repair (TEP) and Lichtenstein repair. Blood samples were collected an evening before surgery and postoperatively at 2, 24, and 48 h to compare the levels of highly sensitive C-reactive protein (hs-CRP), malondialdehyde (MDA), and neutrophil: lymphocyte ratio between the two modes of repair. RESULTS: Both modalities of repair cause a significant inflammatory response in the body (P CONCLUSION: Endoscopic repair is associated with a significantly lesser oxidative response than Lichtenstein repair based on this study (P

Laparoscopic purse-string suture sac closure is appropriate procedure for children with unilateral indirect inguinal hernia: comparative study versus laparoscopic sac excision and closure procedure

Objective Evaluation of immediate and 6-month postoperative (PO) outcomes of laparoscopic repair of unilateral indirect inguinal hernia (IIH) and comparison of outcomes of purse-string versus stitch closure of the deep inguinal ring (DIR). Patients and methods The study included 84 children who had unilateral IIH, and they were randomly divided into two groups: group I included patients who underwent sac disconnection and stitch closure, and group II included patients who underwent purse-string suture closure of DIR without manipulation or sac dissection. PO pain sensation was evaluated using the observational pain-discomfort scale. Time till first oral intake, length of PO hospital stay, and immediate and 6-month PO outcomes were determined. Results One patient in group I was converted to open procedure and another patient in group II required sac disconnection. Patients of group II had significantly shorter operative time, lower collective observational pain-discomfort scale pain score, and shorter time till first oral intake and duration of PO hospital stay compared with patients of group I. A total of three (3.6%) patients developed port site wound infection. At the end of follow-up, in group I, one patient developed hydrocele and three patients developed recurrent hernia, for a 6-month PO complication rate of 9.8%. In group II, one (2.4%) patient developed recurrent hernia. Conclusion Application of laparoscopic purse-string suture closure of the DIR shortens operative time, time till first oral intake, and home return of children with unilateral IIH with low 6-month recurrence rate than disconnection and stitch closure of the DIR (2.4 vs. 7.3%).

The Characteristics of the Contralateral Inguinal Internal Ring and Hernia Sac by Transinguinal Laparoscopy in Boys with Unilateral Indirect Inguinal Hernia: Analysis of Risk Factors and Associated Features with Metachronous Development

Purpose: We evaluated the contralateral patent processus vaginalis (CPPV) by transinguinal laparoscopy in boys with unilateral inguinal hernia, to determine its incidence and the association with various clinical parameters. We also investigated the factors responsible for the development of a metachronous inguinal hernia. Materials and Methods: One hundred sixty seven boys with unilateral inguinal hernia were analyzed. The morphology of the ring was classified into four patterns (type 1, 2a, 2b, and 3). We analyzed the morphology of the internal ring and the variables related to a CPPV by age, laterality and the size of the ipsilateral and/or bilateral hernia sac. Results: The incidence of a CPPV was 33.9%. The positive predictive value was 94.9% (56/59). There was no statistical difference in the incidence of a CPPV by laterality. The incidence of a CPPV was significantly higher in the group with a larger size (≥1cm) compared to the smaller abnormalities (<1cm). The incidence of the type 3 pattern was higher than the type 2b pattern in the group with larger abnormalities. With increasing age, type 1 and 2a patterns increased in frequency, but type 2b decreased and the type 3 pattern was stable. The size of the contralateral hernia sac was significantly larger with the type 3 pattern than the type 2b. Conclusions: The results of our study showed that the size of the hernia sac and patient age were related to the presence of a CPPV. A type 3 pattern was associated with a more primitive morphology, a wider hernia sac and no change in the incidence with advancing age. Therefore, the findings of this study suggest that a metachronous inguinal hernia develops more commonly in patients with a type 3 pattern internal ring. (Korean J Urol 2007;48:735-740) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Incidence of contralateral patent processus vaginalis in children with inguinal hernia

Purpose: The aim of this study was to investigate the incidence of contralateral patent processus vaginalis (PPV) in children with inguinal hernia using direct laparoscopic inspection. Methods: This study evaluates the incidence and size of contralateral PPVs in 143 children (96 boys, 47 girls) with clinically unilateral indirect inguinal hernia who underwent laparoscopic hernia repair. During repair, the contralateral internal inguinal ring was evaluated for PPV. Results: Boys with hernias on the right side had wide-open contralateral PPVs in 26% of cases compared with 11% in girls. Boys with hernias on the left side had wide-open contralateral PPVs in 30% of cases compared with 38% in girls. In all 4 groups, there were small contralateral openings in 15% to 20% of cases. Conclusion: Contralateral PPV seems to occur less commonly than previously assumed. J Pediatr Surg 36:1561-1563. Copyright © 2001 by W.B. Saunders Company.

Diagnostic pneumoperitoneum accurately predicts the presence of patent processus vaginalis

Ninety-four infants with unilateral indirect inguinal hernia underwent repair and diagnostic pneumoperitoneum (DPP). Contralateral groin exploration was performed in all patients including those with a negative DPP result. Thirty-seven (39%) of the 94 patients had a positive DPP result, and 36 of 37 (97%) had a patent processus vaginalis (PPV) on the side contralateral to the clinical hernia. Fifty-seven (61%) of the 94 patients had a negative DPP result, and 54 (95%) of these had no PPV. Female patients had a 1:1 correlation between DPP and PPV. DPP can predict the presence of PPV in the contralateral groin of patients with unilateral hernia with precision and minimizes the need for diagnostic groin exploration.

Hydrocoele associated with unilateral inguinal hernia in a young Basset Hound

ABSTRACTA 14‐month‐old Basset Hound developed hydrocoele of the left half of the scrotum associated with unilateral indirect inguinal hernia. The hernia was repaired without orchidectomy being performed.